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    2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children

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    URI
    http://hdl.handle.net/11287/593820
    Author
    Lazarus, J.
    Brown, R. S.
    Daumerie, C.
    Hubalewska-Dydejczyk, A.
    Negro, R.
    Vaidya, Bijay
    Date
    2014-06-01
    Journal
    European thyroid journal
    Type
    Journal Article
    Publisher
    Karger
    DOI
    10.1159/000362597
    Metadata
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    Abstract
    This guideline has been produced as the official statement of the European Thyroid Association guideline committee. Subclinical hypothyroidism (SCH) in pregnancy is defined as a thyroid-stimulating hormone (TSH) level above the pregnancy-related reference range with a normal serum thyroxine concentration. Isolated hypothyroxinaemia (defined as a thyroxine level below the 2.5th centile of the pregnancy-related reference range with a normal TSH level) is also recognized in pregnancy. In the majority of SCH the cause is autoimmune thyroiditis but may also be due to iodine deficiency. The cause of isolated hypothyroxinaemia is usually not apparent, but iodine deficiency may be a factor. SCH and isolated hypothyroxinaemia are both associated with adverse obstetric outcomes. Levothyroxine therapy may ameliorate some of these with SCH but not in isolated hypothyroxinaemia. SCH and isolated hypothyroxinaemia are both associated with neuro-intellectual impairment of the child, but there is no evidence that maternal levothyroxine therapy improves this outcome. Targeted antenatal screening for thyroid function will miss a substantial percentage of women with thyroid dysfunction. In children SCH (serum TSH concentration >5.5-10 mU/l) normalizes in >70% and persists in the majority of the remaining patients over the subsequent 5 years, but rarely worsens. There is a lack of studies examining the impact of SCH on the neuropsychological development of children under the age of 3 years. In older children, the evidence for an association between SCH and impaired neuropsychological development is inconsistent. Good quality studies examining the effect of treatment of SCH in children are lacking.
    Citation
    Eur Thyroid J. 2014 Jun;3(2):76-94.
    Publisher URL
    http://www.karger.com/?DOI=10.1159/000362597
    Note
    This article is available via Open Access. Please click on the 'Additional Link' above to access the full-text.
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    • 2014 RD&E publications
    • Diabetes and endocrinology

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