Hyperthyroidism and pregnancy. An Italian Thyroid Association (AIT) and Italian Association of Clinical Endocrinologists (AME) joint statement for clinical practice.

Background: An optimal management of maternal hyperthyroidism is important for positive pregnancy outcome, and to this end, the Endocrine Society published their guidelines in 2007. This survey aimed to investigate to what extent the clinical practice relating to the management of hyperthyroidism during pregnancy in Europe is uniform and consistent with the guidelines. Materials and Methods: We emailed an online questionnaire survey based on clinical case scenarios to 605 members of the European Thyroid Association. We analysed 190 responses from 28 European countries. Results: For a woman with newly diagnosed Graves’ disease (GD) and wishing pregnancy, 78% of the responders would initiate antithyroid drugs (ATDs), while 22% would recommend definitive treatment with radioiodine or surgery. In case of a relapsed GD before pregnancy, 80% preferred definitive treatment. For a woman with newly diagnosed GD during pregnancy, 53% would treat with propylthiouracil, 12% with methimazole, and 34% with propylthiouracil initially and switch to methimazole after the first trimester. Responders used several combinations of tests to monitor the dose of ATDs, and the thyroid test results they targeted were inconsistent. For a lactating woman with GD, 68% would give ATDs without stopping lactation. Conclusions: Variation in the clinical practices surrounding the management of hyperthyroid pregnant women in Europe still exists.