Title

Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Authoring Organization

Publication Month/Year

March 1, 2017

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adult

Health Care Settings

Ambulatory

Intended Users

Physician assistant, physician, nurse practitioner, nurse midwife, nurse

Scope

Counseling, Assessment and screening, Diagnosis, Prevention, Management

Keywords

pregnancy, Thyroid Disease

Methodology

Number of Source Documents
621
Literature Search Start Date
January 1, 1990
Literature Search End Date
May 29, 2016
Description of External Review Process
The guidelines were then provided to the ATA membership for review and comments over a 2-week period.
Description of Public Comment Process
ATA sent to membership. There is no information that they promoted to patient groups or the public.
Specialties Involved
Endocrinology, Family Medicine, Obstetrics And Gynecology, Thyroidology, Endocrinology
Description of Systematic Review
The literature review for each section included an analysis of all primary studies in the area published since 1990 and SELECTIVE review of the primary literature published prior to 1990 that was seminal in the field. Electronic databases were used. Standard data collection form was used.
List of Questions
111 Key Questions. 97 Recommendations.
Description of Study Criteria
Studies were selected according to the following criteria: N ≥ 500, exclusion of thyroid peroxidase antibody (TPOAb)-positive women and availability of data from the manuscript or via personal communication. Iodine status was estimated based on references from article, WHO iodine status reports or from the Vitamin and Mineral Nutrition Information System (VMNIS).
Description of Search Strategy
No formal workplan was developed, reviewed, and approved. The guideline mentions "standard data collection form" and "electronic databases" (at least we know: no meeting abstracts). Also: “The literature review for each section included an analysis of all primary studies in the area published since 1990 and selective review of the primary literature published prior to 1990 that was seminal in the field.” Opinion: "selective review" is not a search strategy (it's cherry picking). There is also no end date listed.
Description of Study Selection
Prior to initiating the reviews, all task force members were provided written and verbal group advice on conducting electronic literature searches, critical appraisal of articles, and rationale for formulating strength of recommendations. Standard data collection forms were used by all reviewers. For each question, a primary reviewer performed a literature search, appraised relevant literature, and generated recommendations, accompanying text, and a relevant bibliography. This information was then reviewed by both chairs, revised as needed, and presented for review by the entire panel. Feedback and suggestions for revisions from the Chairs and panel members were obtained via e-mail, regularly scheduled teleconferences, and face-to-face meetings. Once the manuscript was drafted, all suggestions for revisions were regularly reviewed by the entire panel in the form of a tracked changes draft manuscript and teleconferences. The draft document continued to be revised until no suggestions for further revisions were requested by any panel members. Thus, general consensus on acceptability of recommendations and manuscript text was achieved, with the fundamental understanding that not all recommendations may be feasible in all practice settings and adaptation of the guideline recommendations to individual care may be needed.
Description of Evidence Analysis Methods
The draft document continued to be revised until no suggestions for further revisions were requested by any panel members. Thus, general consensus on acceptability of recommendations and manuscript text was achieved, with the fundamental understanding that not all recommendations may be feasible in all practice settings and adaptation of the guideline recommendations to individual care may be needed.
Description of Evidence Grading
ATA referred to clinical methodology of The American College of Physicians. "In accordance with current ATA policies, the American College of Physicians Grading System was adopted for use in these guidelines (Tables 1 and 2)."
Description of Recommendation Grading
In accordance with current ATA policies, the American College of Physicians Grading System was adopted for use in these guidelines (Tables 1 and 2)
Description of Funding Source
ATA provides funding for Guideline Development.
Company/Author Disclosures
Competing interests of all task force members were reviewed at inception of the group, yearly, and upon completion of the guidelines and are included with this document.These guidelines were funded by the ATA without support from any commercial sources.
Percentage of Authors Reporting COI
100