ATA Guidelines Tools

4 Assessment Screening for Thyroid Dysfunction Before or During Pregnancy Î All pregnant women should be verbally screened at the initial prenatal visit for any history of thyroid dysfunction, and prior or current use of either thyroid hormone (LT4) or anti-thyroid medications (methimazole [MMI], carbimazole [CM], or propylthiouracil [PTU]). (S-H) Î Universal screening to detect low free thyroxine concentrations in pregnant women is NOT recommended. (W-M) Î All patients seeking pregnancy, or newly pregnant, should undergo clinical evaluation. If any of the following risk factors are identified, testing for serum TSH is recommended. (S-M) 1. A history of hypothyroidism/hyperthyroidism or current symptoms/signs of thyroid dysfunction 2. Known thyroid antibody positivity or presence of a goiter 3. History of head or neck radiation or prior thyroid surgery 4. Age >30 years 5. Type 1 diabetes or other autoimmune disorders 6. History of pregnancy loss, preterm delivery, or infertility 7. Multiple prior pregnancies (≥2) 8. Family history of autoimmune thyroid disease or thyroid dysfunction 9. Morbid obesity (BMI ≥40 kg/m 2 ) 10. Use of amiodarone or lithium, or recent administration of iodinated radiologic contrast 11. Residing in an area of known moderate to severe iodine insufficiency Î There is insufficient evidence to recommend for or against universal screening for abnormal TSH concentrations in early pregnancy. (I) Î There is insufficient evidence to recommend for or against universal screening for abnormal TSH concentrations preconception, with the exception of women planning assisted reproduction or those known to have positive TPOAb. (I) Thyroid Function Testing and Pregnancy Î When possible, population-based trimester-specific reference ranges for serum thyroid-stimulating hormone (TSH) should be defined through assessment of local population data representative of a healthcare provider's practice. Reference range determinations should only include pregnant women with no known thyroid disease, optimal iodine intake, and negative autoantibodies to thyroid peroxidase (TPOAb) status. (S-M)

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