{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T01:52:34Z","timestamp":1791337954361,"version":"4.3.1"},"reference-count":35,"publisher":"The Endocrine Society","issue":"11","license":[{"start":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T00:00:00Z","timestamp":1684368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UK Research and Innovation Fellowship","award":["MR\/S003932\/1"],"award-info":[{"award-number":["MR\/S003932\/1"]}]},{"DOI":"10.13039\/501100000884","name":"British Thyroid Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000884","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Optimal thyroid status in pregnancy is essential in reducing the risk of adverse outcomes. The management of hyperthyroidism in women of reproductive age poses unique challenges and it is unclear how preconception treatment strategies impact on thyroid status in subsequent pregnancy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We aimed to determine trends in the management of hyperthyroidism before and during pregnancy and to assess the impact of different preconception treatment strategies on maternal thyroid status.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We utilized the Clinical Practice Research Datalink database to evaluate all females aged 15-45 years with a clinical diagnosis of hyperthyroidism and a subsequent pregnancy (January 2000 to December 2017). We compared thyroid status in pregnancy according to preconception treatment, namely, (1) antithyroid drugs up to or beyond pregnancy onset, (2) definitive treatment with thyroidectomy or radioiodine before pregnancy, and (3) no treatment at pregnancy onset.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Our study cohort comprised 4712 pregnancies. Thyrotropin (TSH) was measured in only 53.1% of pregnancies, of which 28.1% showed suboptimal thyroid status (TSH &amp;gt;4.0 mU\/L or TSH &amp;lt;0.1 mU\/L plus FT4 &amp;gt;reference range). Pregnancies with prior definitive treatment were more likely to have suboptimal thyroid status compared with pregnancies starting during antithyroid drug treatment (odds ratio 4.72, 95% CI 3.50-6.36). A steady decline in the use of definitive treatment before pregnancy was observed from 2000 to 2017. One-third (32.6%) of first trimester carbimazole-exposed pregnancies were switched to propylthiouracil while 6.0% of propylthiouracil-exposed pregnancies switched to carbimazole.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The management of women with hyperthyroidism who become pregnant is suboptimal, particularly in those with preconception definitive treatment, and needs urgent improvement. Better thyroid monitoring and prenatal counseling are needed to optimize thyroid status, reduce teratogenic drug exposure, and ultimately reduce the risk of adverse pregnancy outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgad276","type":"journal-article","created":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T16:16:39Z","timestamp":1684426599000},"page":"2886-2897","source":"Crossref","is-referenced-by-count":5,"title":["Preconception Management of Hyperthyroidism and Thyroid Status in Subsequent Pregnancy: A Population-Based Cohort Study"],"prefix":"10.1210","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9406-1928","authenticated-orcid":false,"given":"Caroline","family":"Minassian","sequence":"first","affiliation":[{"name":"Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine , London WC1E 7HT , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lowri A","family":"Allen","sequence":"additional","affiliation":[{"name":"Diabetes Research Group, Cardiff University School of Medicine , Cardiff CF14 4XN , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Onyebuchi","family":"Okosieme","sequence":"additional","affiliation":[{"name":"Thyroid Research Group, Systems Immunity Research Institute Medicine, Cardiff University School of Medicine , Cardiff CF14 4XN , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bijay","family":"Vaidya","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Royal Devon & Exeter Hospital, University of Exeter Medical School , Exeter EX2 5DW , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3436-422X","authenticated-orcid":false,"given":"Peter","family":"Taylor","sequence":"additional","affiliation":[{"name":"Thyroid Research Group, Systems Immunity Research Institute Medicine, Cardiff University School of Medicine , Cardiff CF14 4XN , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2023,5,18]]},"reference":[{"issue":"10","key":"2023101816082057700_dgad276-B1","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1038\/nrendo.2017.93","article-title":"Thyroid disease in pregnancy: new insights in diagnosis and clinical management","volume":"13","author":"Korevaar","year":"2017","journal-title":"Nat Rev Endocrinol"},{"issue":"5","key":"2023101816082057700_dgad276-B2","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1038\/nrendo.2018.18","article-title":"Global epidemiology of hyperthyroidism and hypothyroidism","volume":"14","author":"Taylor","year":"2018","journal-title":"Nat Rev Endocrinol"},{"issue":"3","key":"2023101816082057700_dgad276-B3","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1038\/s41574-021-00604-z","article-title":"Assessment and treatment of thyroid disorders in pregnancy and the postpartum period","volume":"18","author":"Lee","year":"2022","journal-title":"Nat Rev Endocrinol"},{"issue":"3","key":"2023101816082057700_dgad276-B4","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/S2213-8587(13)70086-X","article-title":"Hyperthyroidism in pregnancy","volume":"1","author":"Cooper","year":"2013","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"3","key":"2023101816082057700_dgad276-B5","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1210\/jc.2014-3588","article-title":"Hyperthyroidism incidence fluctuates widely in and around pregnancy and is at variance with some other autoimmune diseases: a Danish population-based study","volume":"100","author":"Andersen","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2023101816082057700_dgad276-B6","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/S2213-8587(20)30061-9","article-title":"Association of maternal thyroid function with birthweight: a systematic review and individual-participant data meta-analysis","volume":"8","author":"Derakhshan","year":"2020","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"4","key":"2023101816082057700_dgad276-B7","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/S2213-8587(22)00007-9","article-title":"Association between maternal thyroid function and risk of gestational hypertension and pre-eclampsia: a systematic review and individual-participant data meta-analysis","volume":"10","author":"Toloza","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"1","key":"2023101816082057700_dgad276-B8","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/bmb\/ldac018","article-title":"Late offspring effects of antenatal thyroid screening","volume":"143","author":"Panagiotou","year":"2022","journal-title":"Br Med Bull"},{"issue":"3","key":"2023101816082057700_dgad276-B9","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1159\/000342920","article-title":"Side effects of anti-thyroid drugs and their impact on the choice of treatment for thyrotoxicosis in pregnancy","volume":"1","author":"Taylor","year":"2012","journal-title":"Eur Thyroid J"},{"issue":"11","key":"2023101816082057700_dgad276-B10","doi-asserted-by":"crossref","first-page":"E337","DOI":"10.1210\/jc.2010-0652","article-title":"Treatment of hyperthyroidism in pregnancy and birth defects","volume":"95","author":"Clementi","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2023101816082057700_dgad276-B11","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1210\/jc.2009-0850","article-title":"Putting propylthiouracil in perspective","volume":"94","author":"Cooper","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"2023101816082057700_dgad276-B12","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1530\/EJE-17-0314","article-title":"Birth defects after use of antithyroid drugs in early pregnancy: a Swedish nationwide study","volume":"177","author":"Andersen","year":"2017","journal-title":"Eur J Endocrinol"},{"issue":"10","key":"2023101816082057700_dgad276-B13","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1089\/thy.2014.0150","article-title":"Severity of birth defects after propylthiouracil exposure in early pregnancy","volume":"24","author":"Andersen","year":"2014","journal-title":"Thyroid"},{"issue":"11","key":"2023101816082057700_dgad276-B14","doi-asserted-by":"crossref","first-page":"4373","DOI":"10.1210\/jc.2013-2831","article-title":"Birth defects after early pregnancy use of antithyroid drugs: a Danish nationwide study","volume":"98","author":"Andersen","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2023101816082057700_dgad276-B15","doi-asserted-by":"crossref","first-page":"405","DOI":"10.7326\/M17-1398","article-title":"Antithyroid drugs and congenital malformations a nationwide Korean cohort study","volume":"168","author":"Seo","year":"2018","journal-title":"Ann Intern Med"},{"issue":"3","key":"2023101816082057700_dgad276-B16","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1089\/thy.2016.0457","article-title":"2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum","volume":"27","author":"Alexander","year":"2017","journal-title":"Thyroid"},{"issue":"6","key":"2023101816082057700_dgad276-B17","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1111\/cen.14646","article-title":"Antithyroid drug therapy in pregnancy and risk of congenital anomalies: systematic review and meta-analysis","volume":"96","author":"Agrawal","year":"2022","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"10","key":"2023101816082057700_dgad276-B18","doi-asserted-by":"crossref","first-page":"3890","DOI":"10.1111\/bcp.14805","article-title":"Antithyroid drug use during pregnancy and the risk of birth defects in offspring: systematic review and meta-analysis of observational studies with methodological considerations","volume":"87","author":"Morales","year":"2021","journal-title":"Br J Clin Pharmacol"},{"issue":"1","key":"2023101816082057700_dgad276-B19","doi-asserted-by":"crossref","first-page":"R13","DOI":"10.1530\/EJE-14-0135","article-title":"Therapy of endocrine disease: antithyroid drug use in early pregnancy and birth defects: time windows of relative safety and high risk?","volume":"171","author":"Laurberg","year":"2014","journal-title":"Eur J Endocrinol"},{"issue":"8","key":"2023101816082057700_dgad276-B20","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1089\/thy.2022.0088","article-title":"Outcomes of early-pregnancy antithyroid drug withdrawal in Graves\u2019 disease: a preliminary prospective follow-up study","volume":"32","author":"Hou","year":"2022","journal-title":"Thyroid"},{"issue":"10","key":"2023101816082057700_dgad276-B21","doi-asserted-by":"crossref","first-page":"3895","DOI":"10.1210\/jc.2014-1954","article-title":"TSH Levels and risk of miscarriage in women on long-term levothyroxine: a community-based study","volume":"99","author":"Taylor","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"2023101816082057700_dgad276-B22","author":"CPRD","year":"2022"},{"issue":"3","key":"2023101816082057700_dgad276-B23","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1093\/ije\/dyv098","article-title":"Data resource profile: Clinical Practice Research Datalink (CPRD)","volume":"44","author":"Herrett","year":"2015","journal-title":"Int J Epidemiol"},{"issue":"7","key":"2023101816082057700_dgad276-B24","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1002\/pds.4811","article-title":"Methods to generate and validate a pregnancy register in the UK clinical practice research datalink primary care database","volume":"28","author":"Minassian","year":"2019","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2023101816082057700_dgad276-B25","author":"CPRD","year":"2022"},{"key":"2023101816082057700_dgad276-B26","doi-asserted-by":"publisher","author":"Minassian","year":"2023","DOI":"10.17037\/DATA.00003365"},{"issue":"2","key":"2023101816082057700_dgad276-B27","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-055773","article-title":"Investigating the optimal handling of uncertain pregnancy episodes in the CPRD GOLD pregnancy register: a methodological study using UK primary care data","volume":"12","author":"Campbell","year":"2022","journal-title":"BMJ Open"},{"key":"2023101816082057700_dgad276-B28","author":"NHS Digital","year":"2022"},{"issue":"10047","key":"2023101816082057700_dgad276-B29","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/S0140-6736(16)00278-6","article-title":"Hyperthyroidism","volume":"388","author":"De Leo","year":"2016","journal-title":"Lancet"},{"issue":"25","key":"2023101816082057700_dgad276-B30","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples","volume":"28","author":"Austin","year":"2009","journal-title":"Stat Med"},{"issue":"8","key":"2023101816082057700_dgad276-B31","doi-asserted-by":"crossref","first-page":"2543","DOI":"10.1210\/jc.2011-2803","article-title":"Management of thyroid dysfunction during pregnancy and postpartum: an endocrine society clinical practice guideline","volume":"97","author":"De Groot","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"2023101816082057700_dgad276-B32","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1159\/000365101","article-title":"Spontaneous abortion, stillbirth and hyperthyroidism: a Danish population-based study","volume":"3","author":"Andersen","year":"2014","journal-title":"Eur Thyroid J"},{"issue":"5","key":"2023101816082057700_dgad276-B33","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1111\/cen.14853","article-title":"Maternal hypothyroidism and adverse outcomes of pregnancy","volume":"98","author":"Kn\u00f8sgaard","year":"2022","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"7","key":"2023101816082057700_dgad276-B34","doi-asserted-by":"crossref","first-page":"3234","DOI":"10.1210\/jc.2010-0013","article-title":"Thyroid hormone early adjustment in pregnancy (the THERAPY) trial","volume":"95","author":"Yassa","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"issue":"11","key":"2023101816082057700_dgad276-B35","first-page":"3633","article-title":"Effects of propylthiouracil and methimazole on fetal thyroid status in mothers with Graves\u2019 hyperthyroidism","volume":"82","author":"Momotani","year":"1997","journal-title":"J Clin Endocrinol Metab"}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgad276\/50512888\/dgad276.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/108\/11\/2886\/52218483\/dgad276.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/108\/11\/2886\/52218483\/dgad276.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T16:21:12Z","timestamp":1697646072000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/108\/11\/2886\/7170083"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,18]]},"references-count":35,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,5,18]]},"published-print":{"date-parts":[[2023,10,18]]}},"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgad276","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,11]]},"published":{"date-parts":[[2023,5,18]]}}}