2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum
2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum
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DOI：
10.1089/thy.2016.0457
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发表时间：
2017-03-01
期刊：
影响因子：
6.6
通讯作者：
Sullivan, Scott
中科院分区：
文献类型：
--
作者：
Alexander, Erik K.;Pearce, Elizabeth N.;Sullivan, Scott
背景：妊娠期甲状腺疾病是常见的临床问题。自美国甲状腺协会（ATA）于2011年首次发布这些疾病的管理指南以来，该领域取得了重大的临床和科学进展。这些指南的目的是向临床医生、患者、研究人员和卫生政策制定者通报与怀孕、孕前和产后妇女甲状腺疾病诊断和管理有关的已发表证据。方法：这些指南中涉及的具体临床问题是基于先前版本的指南、利益相关者的意见和工作组成员的意见。工作队小组成员接受了知识综合方法方面的教育，包括电子数据库检索、审查和选择有关引文，以及对选定的研究进行批判性评价。已发表的英文文章符合入选条件。使用美国医师学会指南分级系统对证据和建议的强度进行严格评估。指南工作组完全独立于ATA进行编辑。指南工作组成员的竞争利益定期更新、管理，并与ATA和工作组成员进行沟通。结果:经修订的妊娠期甲状腺疾病管理指南包括以下方面的建议：解释妊娠期甲状腺功能检查、碘营养、甲状腺自身抗体和妊娠并发症、不孕妇女的甲状腺问题、妊娠期甲状腺功能减退、妊娠期甲状腺中毒、孕妇的甲状腺结节和癌症、胎儿和新生儿问题、甲状腺疾病和哺乳、妊娠期甲状腺功能障碍筛查。以及未来的研究方向。结论：我们已经制定了基于证据的建议，为孕妇和产后妇女甲状腺疾病管理的临床决策提供信息。虽然所有的护理都必须个性化，但在我们看来，这些建议为这些疾病患者提供了最佳的护理范例。
Background: Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period.Methods: The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members.Results: The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research.Conclusions: We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.