The Need for Dynamic Clinical Guidelines: A Systematic Review of New Research Published After Release of the 2017 ATA Guidelines on Thyroid Disease During Pregnancy and the Postpartum.

{"article_title":"The Need for Dynamic Clinical Guidelines: A Systematic Review of New Research Published After Release of the 2017 ATA Guidelines on Thyroid Disease During Pregnancy and the Postpartum.","author":"\"Dong, Allan C , Stephenson, Mary D , Stagnaro-Green, Alex Stewart\"","journal_title":"Frontiers in endocrinology","issn":"1664-2392 ; Print","isbn":"","publication_date":"20200407","volume":"11","issue":"","first_page":"193","page_count":"","accession_number":"32318026","doi":"10.3389\/fendo.2020.00193","publisher":"Frontiers Research Foundation]","doctype":"Historical Article; Research Support","subjects":"Gynecology and Obstetrics ","interest_area":["Obstetrics & Gynecology"," Endocrinology"],"abstract":"<b>Background:<\/b> The American Thyroid Association Guidelines on Thyroid Disease During Pregnancy and the Postpartum (ATA Guidelines) were published in 2017, with an update not expected for another 5 years. Since release of the 2017 ATA Guidelines, greater than 500 articles have been published in the field. Furthermore, there are presently 14 prospective, interventional trials in progress registered at Clinicaltrials.gov Static guidelines updated every 5-7 years fail to provide timely evidence-based guidance to practicing clinicians. Consequently, guideline development should move toward the creation of dynamic documents. The present article reviews the literature published since the 2017 ATA Guidelines, both to benefit clinicians in practice and to make the case for Dynamic ATA Guidelines. <b>Methods:<\/b> Using the search terms \"thyroid\" and \"pregnancy,\" a systematic review of literature published in Pubmed from 3\/1\/2017 to 12\/31\/2018 was conducted. The titles and\/or abstracts of all articles were reviewed. All articles were classified by subject headings used in the 2017 ATA Guidelines. English-text articles classified under \"hypothyroidism\" or \"thyroid autoimmunity\" were examined in full-text. Using the questions and recommendations put forth by the previous ATA Guidelines, relevant articles were selected for discussion in this review. <b>Results:<\/b> At the time of the search, 659 unique articles on \"thyroid and pregnancy\" were identified, including 66 original studies on hypothyroidism and 26 on thyroid autoimmunity. Of these, 26 studies on hypothyroidism and 18 studies on thyroid autoimmunity were selected for inclusion in this review based on specific questions in the 2017 ATA Guidelines. Based on these 44 articles, we propose two specific changes to the 2017 ATA Guidelines. <b>Conclusion:<\/b> Based on new research, we recommend the 2017 ATA Guidelines be updated to recommend against treating thyroid antibody-negative women diagnosed with subclinical hypothyroidism in the second trimester or later; to reflect new, moderate-quality evidence supporting the treatment of thyroid peroxidase antibody-negative women with elevated thyroid stimulating hormone levels in the first trimester or earlier; and to recommend against treatment of euthyroid, thyroid peroxidase antibody-positive women undergoing assisted reproductive technology. Transitioning to a Dynamic ATA Guidelines would allow for these and future recommendations to be implemented in real time.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=32318026&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Dong AC, Stephenson MD, Stagnaro-Green AS","Journal_Info":"Publisher: Frontiers Research Foundation] Country of Publication: Switzerland NLM ID: 101555782 Publication Model: eCollection Cited Medium: Print ISSN: 1664-2392 (Print) Linking ISSN: 16642392 NLM ISO Abbreviation: Front Endocrinol (Lausanne) Subsets: MEDLINE","Publication_Type":"Historical Article; Research Support, Non-U.S. Gov&#39;t; Systematic Review; Journal Article","Published_Date":"2020-04-07","Source":"Frontiers in endocrinology [Front Endocrinol (Lausanne)] 2020 Apr 07; Vol. 11, pp. 193. Date of Electronic Publication: 2020 Apr 07 (Print Publication: 2020).","Languages":"English","MeSH_Terms":"Needs Assessment* , Practice Guidelines as Topic*\/standards, Pregnancy Complications\/*therapy , Puerperal Disorders\/*therapy , Thyroid Diseases\/*therapy, Female ; History, 21st Century ; Humans ; Postpartum Period\/physiology ; Practice Patterns, Physicians'\/standards ; Practice Patterns, Physicians'\/statistics & numerical data ; Pregnancy ; Pregnancy Complications\/epidemiology ; Publications\/history ; Publications\/statistics & numerical data ; Puerperal Disorders\/epidemiology ; Societies, Medical\/standards ; Thyroid Diseases\/epidemiology ; United States\/epidemiology","Subjects":"Female, History, 21st Century, Humans, Postpartum Period physiology, Practice Patterns, Physicians' standards, Practice Patterns, Physicians' statistics & numerical data, Pregnancy, Pregnancy Complications epidemiology, Publications history, Publications statistics & numerical data, Puerperal Disorders epidemiology, Societies, Medical standards, Thyroid Diseases epidemiology, United States epidemiology, Needs Assessment, Practice Guidelines as Topic standards, Pregnancy Complications therapy, Puerperal Disorders therapy, Thyroid Diseases therapy","Title_Abbreviations":"Frontiers in endocrinology","Volume":"11"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"32318026","RelevancyScore":"837","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"837.181396484375"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=32318026&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=32318026&authtype=shib&custid=ns346513&group=main&profile=eds"}