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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Thyroid Disorders in Pregnancy
Sponsored by The Indian Health Service Clinical Support Center
12. American College of Obstetricians and Gynecologists (A.C.O.G.) Resources
What is the latest A.C.O.G. statement on this?
Non-ACOG members
- If you are NOT an ACOG member, Thyroid Disease in Pregnancy ACOG Practice Bulletin NUMBER 37, AUGUST 2002
- American College of Obstetricians and Gynecologists. Thyroid disease in pregnancy.
ACOG Practice Bulletin No. 37. Obstet Gynecol 2002;100:387–396
What are the evidence based recommendations?
Summary of Recommendations**
The following recommendation is based on good and consistent scientific evidence (Level A):
- Levels of TSH or FT4/FTI should be monitored to manage thyroid disease in pregnancy.
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- Either PTU or methimazole can be used to treat pregnant women with hyperthyroidism
- Thyroid function tests are not indicated in asymptomatic pregnant women with slightly enlarged thyroid glands
The following recommendations are based primarily on consensus and expert opinion (Level C):
- There is no need to measure TFTs routinely in women with hyperemesis
- There are insufficient data to warrant routine screening of asymptomatic pregnant women for hypothyroidism
- Indicated testing of thyroid function may be performed in women with a personal history of thyroid disease or symptoms of thyroid disease
- The presence of maternal thyroid disease is important information for the pediatrician to have at the time of delivery
- Thyroid nodules should be investigated to rule out malignancy.
A.C.O.G. member resources
- If you ARE an A.C.O.G. member, read this on-line; Thyroid Disease in Pregnancy,
ACOG Practice Bulletin NUMBER 37, AUGUST 2002
** ACOG Evidence grading system
- The MEDLINE database, the Cochrane Library, and ACOG's own internal resources and documents were used to conduct a literature search to locate relevant articles published between January 1985 and October 2000. The search was restricted to articles published in the English language. Priority was given to articles reporting results of original research, although review articles and commentaries also were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document. Guidelines published by organizations or institutions such as the National Institutes of Health and the American College of Obstetricians and Gynecologists were reviewed, and additional studies were located by reviewing bibliographies of identified articles. When reliable research was not available, expert opinions from obstetrician–gynecologists were used.
- Studies were reviewed and evaluated for quality according to the method outlined by the U.S. Preventive Services Task Force:
I Evidence obtained from at least one properly designed randomized controlled trial.
II-1 Evidence obtained from well-designed controlled trials without randomization.
II-2 Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
II-3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Based on the highest level of evidence found in the data, recommendations are provided and graded according to the following categories:
Level A—Recommendations are based on good and consistent scientific evidence
Level B—Recommendations are based on limited or inconsistent scientific evidence
Level C—Recommendations are based primarily on consensus and expert opinion
