Management of Hyperthyroidism in Pregnancy: Comparison of Recommendations of American Thyroid Association and Endocrine Society

Table 1

Comparison of recommendations of American Thyroid Association and Endocrine Society on the management of hyperthyroidism before pregnancy and on the diagnosis of hyperthyroidism and pregnancy.

Topic	Recommendations
	American Thyroid Association (2011)	Endocrine Society (2012)
Management before pregnancy	Same (R and T)	For overt hyperthyroidism due to Graves’ disease or thyroid nodules, antithyroid drug (ATD) therapy should be either initiated (before pregnancy if possible, and for those with new diagnoses) or adjusted (for those with a prior history) to maintain the maternal thyroid hormone levels for free T4 at or just above the upper limit of the nonpregnant reference range, or to maintain total T4 at 1.5 times the upper limit of the normal reference range or the free T4 index in the upper limit of the normal reference range.
Thyroid function; tests	In the presence of a suppressed serum TSH in the first trimester (TSH < 0.1 mIU/L), a history and physical examination are indicated. FT4 measurements should be obtained in all patients. Measurement of TT3 and TRAb may be helpful in establishing a diagnosis of hyperthyroidism.	Same (R)
Ultrasonography	There is not enough evidence to recommend for or against the use of thyroid ultrasound in differentiating the cause of hyperthyroidism in pregnancy.	None
Scanning and; uptake	Radioactive iodine (RAI) scanning or radioiodine uptake determination should not be performed in pregnancy.	None
Differentiation of; Graves disease; and gestational thyrotoxicosis	Same (T)	Differentiation of Graves’ from gestational thyrotoxicosis is supported by the presence of clinical evidence of autoimmunity, typical goiter, and presence of TSH receptor antibodies (TRAb). TPO-Ab may be present in either case.