Pregnancy, subclinical hypothyroidism and thyroid antibodies

[diogenes]

This preview paper which will soon become completely in print shows that new evidence is making the US authorities on the treatment of pregnancy rethink their guidance sooner than they normally do. I present this not just because it may be important for thyroid treatment in pregnancy, but that this rethink might force the authorities to rethink in other situations such as Hashimoto's and hypothyroidism/treatment. Progress is coming fast to encourage this rethink. I don't tink this will apply to the UK, because the new NICE guidelines produced by hidebound, restricted-analytic and partial evidence from out-of-date physicians (who of highest calibre would go into thyroid, when genetics is the whizz field nowadays) will be stubbornly defenced.

SYSTEMATIC REVIEW ARTICLE

Front. Endocrinol. | doi: 10.3389/fendo.2020.00193

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 Provisionally accepted The final, formatted version of the article will be published soon. Notify me

Allan C. Dong1, Mary D. Stephenson and Alex S. Stagnaro-Green

[helvella Administrator Thyroid UK]

Looks like it is now available:

frontiersin.org/articles/10...

Conclusions

How to best create a process for the generation and continual updating of dynamic guidelines should be a high-priority topic for organizations such as the ATA. Based on the quality of the evidence, recommendations should be reviewed and updated. A dynamic guideline committee would need to convene frequently. Perhaps membership of the committee would be rotational, with one-fifth of the committee changing within any given year. This would provide both consistency over time, along with the inclusion of new members with developing expertise. In conclusion, through the introduction of a dynamic guideline process, the ATA would be able to provide optimal information to practicing clinicians on a real time basis.

It has sometimes been claimed that research takes seventeen years to reach practice. We are now at least thirteen years from some of the earlier papers which considered the taking of levothyroxine at bed-time rather than in the morning.

We are still surrounded by documentation which insists that it be taken in the morning (if by nothing other than assuming it).

If something as relatively uncontroversial and simple, and with very low impact on costs, simply doesn't get through, what chance other ideas which might be more complicated, and more costly?

(I am unaware of any formal research which identifies that levothyroxine should be taken in the morning. Assumption alley, I think.)