2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children
Open accessAbstract
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.
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Both ETA and ATA guidelines on management of hypothyroidism during pregnancy have been published.
“Both ETA and ATA guidelines on this topic have been published (85, 86).”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [85]
Pregnancy is physiologically associated with a higher requirement of T4 production from the thyroid due to increased production of thyroid hormone distribution proteins (mainly TBG) in the liver, delivery of T4 to the feto-placental unit, and increased degradation of T4 by placental D3.
“Pregnancy is physiologically associated with a higher requirement of T4 production from the thyroid due to a variety of factors, including increased production of thyroid hormone distribution proteins (mainly TBG) in the liver, delivery of T4 to the growing feto-placental unit and increased degradation of T4 by placental D3.”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [85]
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- Authors
- Lazarus, J., Brown, R. S., Daumerie, C., Hubalewska-Dydejczyk, A., Negro, R., & Vaidya, B.
- Affiliations
- University Hospital of Wales (GB)
- Boston Children's Hospital (US)
- Cliniques Universitaires Saint-Luc (BE)
- 5Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
- Ospedale Vito Fazzi (IT)
- University of Exeter (GB)
- Venue
- European Thyroid Journal
- Publisher
- Bioscientifica
- Published
- 2014-06-01
- Volume
- 3
- Issue
- 2
- Pages
- 76-94
- ISSN
- 2235-0640 (ISSN-L)
- 2235-0802
- PMC
- PMC4109520
- OpenAlex
- W2140494520
- Cited by
- 742
- References
- 13
- Citations by year
- 2026: 26 · 2025: 52 · 2024: 51 · 2023: 81 · 2022: 71 · 2021: 61 · 2020: 76 · 2019: 72 · 2018: 71 · 2017: 65 · 2016: 60 · 2015: 44 · 2014: 11 · 2013: 1
- FWCI
- 48.29
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- European Thyroid Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Homo Politicus (Academy of Humanities and Economics in Lodz) (submittedVersion, cc-by-nc-nd)
- Jagiellonian University Repository (Jagiellonian University) (submittedVersion, cc-by-nc-nd)
- Digital Access to Libraries (submittedVersion, other-oa)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Royal Devon and Exeter Research Repository (Royal Devon and Exeter) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- subclinical hypothyroidism, pregnancy, children, levothyroxine therapy, thyroid-stimulating hormone, autoimmune thyroiditis, iodine deficiency, obstetric outcomes, neurodevelopmental outcomes, antenatal thyroid screening, thyroid function
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