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Background First-trimester care of maternal thyroid dysfunction has previously been shown to be poor. This study evaluates early management of thyroid dysfunction in pregnancy in Australia. Methods Patients reviewed by the Obstetric Medicine team for thyroid dysfunction from 1 January 2012 to 30 June 2013 were included. Data were collected on gestation at referral from the patient’s general practitioner to the antenatal clinic, information provided in the referral letter, thyroid function tests and thyroid medications. Results Eighty-five women were included in the study. At the time of general practitioner referral to antenatal services, 19% of women with preexisting thyroid disease had no thyroid function tested. Forty-three percent had an abnormal thyroid-stimulating hormone defined as being outside the laboratory-specific pregnancy reference range if available, or outside the level of 0.1–2.5 mIu/L in the first trimester, 0.2–3.0 mIu/L in the second trimester and 0.3–3.0 mIu/L in the third trimester. Only 21% of women increased their thyroxine dose prior to their first antenatal clinic review. Conclusion This study highlights that a significant proportion of women with known thyroid disease either have untested thyroid function in the first trimester or a thyroid-stimulating hormone outside of levels recommended by guidelines. [ABSTRACT FROM AUTHOR]

Background In humans, measurement of serum thyroid-stimulating hormone ( TSH) concentration is commonly used as a first-line discriminatory test of thyroid function. Recent reports indicate that canine TSH ( cTSH) assays can be used to measure feline TSH and results can help diagnose or exclude hyperthyroidism. Objectives To investigate the usefulness of cTSH measurements as a diagnostic test for cats with hyperthyroidism. Animals Nine hundred and seventeen cats with untreated hyperthyroidism, 32 euthyroid cats suspected of having hyperthyroidism, and 131 clinically normal cats. Methods Prospective study. Cats referred to the Animal Endocrine Clinic for suspected hyperthyroidism were evaluated with serum T4, T3, free T4 ( fT4), and TSH concentrations. Thyroid scintigraphy was used as the gold standard to confirm or exclude hyperthyroidism. Results Median serum TSH concentration in the hyperthyroid cats (<0.03 ng/ mL) was significantly ( P < .001) lower than concentrations in clinically normal cats (0.05 ng/ mL) or euthyroid cats with suspected thyroid disease (0.06 ng/ mL). Only 18 (2.0%) hyperthyroid cats had measurable TSH concentrations (≥0.03 ng/ mL), whereas 114 (69.9%) of the 163 euthyroid cats had detectable concentrations. Combining serum TSH with T4 or fT4 concentrations lowered the test sensitivity of TSH from 98.0 to 97.0%, but markedly increased overall test specificity (from 69.9 to 98.8%). Conclusions and Clinical Importance Serum TSH concentrations are suppressed in 98% of hyperthyroid cats, but concentrations are measurable in a few cats with mild-to-moderate hyperthyroidism. Measurement of serum TSH represents a highly sensitive but poorly specific test for diagnosis of hyperthyroidism and is best measured in combination with T4 and fT4. [ABSTRACT FROM AUTHOR]

Objective: To review the optimal use of sensitive assays for thyroid-stimulating hormone (TSH) by clinicians.Methods: The available literature pertinent to the clinical application of sensitive TSH testing was identified through a systematic MEDLINE search and reviewed. Selection of materials for inclusion was based on clinical validity of the data and relevance to the study question.Synopsis: Sensitive TSH assays have contributed greatly to our basic knowledge of thyroid physiology and are a powerful clinical tool in the diagnosis and treatment of thyroid disease. The clinical applicability of these assays, as is our understanding of their appropriate use, is rapidly expanding. Based upon the best evidence and current understanding of thyroid physiology, strategies are presented for appropriate use of sensitive TSH assays in healthy outpatients, in patients who are likely to have a disturbed hypothalmic-pituitary-thyroid axis, and in patients on levothyroxane therapy.Conclusions: Although many clinical questions regarding the use of sensitive TSH assays remain to be studied, it has emerged as a powerful tool for the diagnosis and management of thyroid disease. Optimal use of sensitive TSH assays requires an understanding of TSH physiology and measurement, coupled with appropriate application and interpretation in specific clinical settings. [ABSTRACT FROM AUTHOR]

This JAMA Guidelines Synopsis summarizes the 2017 American Thyroid Association guidelines on diagnosis and management of thyroid disease during pregnancy and the postpartum period. [ABSTRACT FROM AUTHOR]