Endocrine Abstracts

Increase of patients submitted to assisted reproduction techniques (ART) and to the high prevalence of thyroid disorders in the fertile age, this survey aimed to evaluate the current management of these women by the Italian thyroidologists. A short questionnaire was sent to all members of the AIT. The questions concerned the out-patients management of women of childbearing age with thyroid diseases. According to our results, there is a clinic dedicated to the management of patients with thyroid diseases planning conception or during pregnancy in about 50% of the centers, but 97.4% of the endocrinologists investigate the possible desire for pregnancy during the visit and more than 70% of them follow patients during ART. The iodine supplementation when planning a pregnancy is suggested by 70% of the endocrinologists and precise indications about the need of TSH and FT4 measurement are given by more than 95% of participants. Concerning the L-T4 therapy, a “blind increase” of 30% in case of pregnancy positive test is suggested in slightly less than 60%, 15% of whom only if pregnancy is achieved by ART. A thyroid screening in women planning conception is recommended by almost all the participants (94%); similarly, TSH screening if largely recommended in women with PCO (90%). According to the recent ETA guidelines, 87.3% of endocrinologists starts L-T4 treatment in case of TSH >2.5 mU/l in case of positive thyroid autoimmunity; moreover, therapy is suggested also in the absence of autoimmunity in women with previous miscarriage by about 60% of participants. L-T4 therapy is often already started by gynecologist, as referred in our survey by 83.8% of endocrinologists. After ovarian stimulation, TSH levels are measured by 68% of participants, 72% of whom in all patients, while 17% and 11%, respectively, only in case of positive autoantibodies or in hypothyroid women already on L-T4 replacement therapy. As far as the timing of the TSH check, the majority of endocrinologists (75%) suggests to perform it at the time of HCG measurement, while almost everyone else at the oocytes pick-up (25%). Although only 50% of the centers have a thyroid clinic program dedicated to pregnancy, almost all the Italian thyroidologists are involved in the management of infertile/pregnant women. This survey identified a discordant application of ETA guidelines dedicated to the infertile women submitted to ART.