Management of Thyroid Disorders during Pregnancy: A Survey of Physicians from the Middle East and North Africa

Objectives We explored the clinical practice of screening and managing hyperthyroidism and hypothyroidism during pregnancy in the Middle East and North Africa. Methods We used an online questionnaire based on clinical case scenarios to a regional physician database and invited those managing pregnant women with thyroid disease to respond. Results We analyzed 136 eligible responses. For a woman with newly diagnosed Graves' disease (GD) and wishing to conceive, 77.5% of the respondents would initiate antithyroid drugs (ATDs), while 20.3% would recommend definitive treatment with radioiodine or surgery. In the case of a relapsed GD before pregnancy, 84.3% preferred definitive treatment. For a woman with newly diagnosed GD during pregnancy, 39.4% will start propylthiouracil (PTU), 8.5% with methimazole/carbimazole, while 50.0% will start with PTU and then switch to methimazole after the first trimester. Respondents used several combinations of tests to monitor the dose of ATDs, and the thyroid test results they targeted were inconsistent, though nearly half of the respondents targeted achieving low serum thyroid-stimulating hormone (TSH) with free thyroxine (or total T4) in the upper end of the normal range. For a lactating woman with GD, 80.3% would give ATDs without stopping lactation. For the management of gestational thyrotoxicosis, 45.1% chose to follow-up, and 40.8% treated patients with PTU. Although the timing of TSH receptor antibody measurement in pregnant hyperthyroid patients was variable, 53% of respondents would check it at least once during pregnancy. The starting dose of L-thyroxine for a woman diagnosed with overt hypothyroidism in pregnancy, preconception management of euthyroid women with known thyroid autoimmunity, and approach related to ovarian hyperstimulation in women with thyroid peroxidase antibodies were widely variable. For women with known hypothyroidism, 34.6% of respondents would increase the L-thyroxine dose by 30 to 50% as soon as pregnancy is confirmed. Concerning screening, 42.7% of respondents perform universal evaluation and 70% recommend TSH < 2.5 mUI/L in the first trimester and TSH < 3 mUI/L in the second and third trimester as target results in known hypothyroid women. Conclusion Physicians' clinical practices regarding thyroid disorders in pregnant women vary. This highlights the need for focused training and quality assurance to achieve more consistent care.