The thyrotoxic phase of PPT must be differentiated from recurrent or Graves’ disease. ?RECOMMENDATION 64 During the thyrotoxic phase of PPT, symptomatic women may be treated with beta blockers. of 2.5 mIU/L. Ten percent to 20% of all pregnant women in the 1st trimester of pregnancy are thyroid peroxidase (TPO) or thyroglobulin (Tg) antibody positive and euthyroid. Sixteen percent of the women who are euthyroid and positive for TPO or Tg antibody in the 1st trimester will develop a TSH that exceeds 4.0 mIU/L by the third trimester, and 33%C50% of women who are positive for TPO or Tg antibody in the 1st trimester will develop postpartum thyroiditis. In essence, pregnancy is definitely a stress test for the thyroid, resulting in hypothyroidism in ladies with limited thyroidal reserve or iodine deficiency, and postpartum thyroiditis in ladies with underlying Hashimoto’s disease who have been euthyroid prior to conception. Knowledge concerning the interaction between the thyroid and pregnancy/the postpartum period is definitely advancing at a rapid pace. Only recently has a TSH of 2.5 mIU/L been approved as the top limit of normal for TSH in the first trimester. This has important implications in regards to interpretation of the literature as well as a crucial impact for the clinical diagnosis of hypothyroidism. Although it is usually well accepted that overt hypothyroidism and overt hyperthyroidism have a deleterious impact on pregnancy, studies are now focusing on the potential impact of subclinical hypothyroidism and subclinical hyperthyroidism on maternal and fetal health, the association between miscarriage and preterm delivery in euthyroid women positive for TPO and/or Tg antibody, and the prevalence and long-term impact of postpartum thyroiditis. Recently completed prospective randomized studies have begun to produce critically needed data around the impact of treating thyroid disease around the mother, fetus, and the future intellect of the unborn child. It is in this context that this American Thyroid Association (ATA) charged a task pressure with developing clinical guidelines on the diagnosis and treatment of thyroid disease during pregnancy and the postpartum. The task pressure consisted of international experts in the field of thyroid disease and pregnancy, and included associates from your ATA, Asia and Oceania Thyroid Association, Latin American Thyroid Society, American College of Obstetricians and Gynecologists, and the Midwives Alliance of North America. Inclusion of thyroidologists, obstetricians, and midwives on the task pressure was essential to ensuring common acceptance and adoption of the developed guidelines. The clinical guidelines task pressure commenced its activities in late 2009. The guidelines are divided into the following nine areas: 1) thyroid function assessments, 2) hypothyroidism, 3) thyrotoxicosis, 4) iodine, 5) thyroid antibodies and miscarriage/preterm delivery, 6) thyroid nodules DKFZp686G052 and malignancy, 7) postpartum thyroiditis, 8) recommendations on screening for thyroid disease during pregnancy, and 9) areas for future research. Each section consists of a series of questions germane to the clinician, Olcegepant followed by a conversation of the questions and concluding with recommendations. Literature review for each section included an analysis of all Olcegepant main papers in the area published since 1990 and selective review of the primary literature published prior to 1990 that was seminal in the field. In the past 15 years there have been a number of recommendations and guideline statements relating to aspects of thyroid and pregnancy (1,2). In deriving the present guidelines the task pressure conducted a new and comprehensive analysis of the primary literature as the basis for all of the recommendations. The strength of each recommendation was graded according to the United States Preventive Services Task Pressure (USPSTF) Guidelines layed out below (3). Level A. The USPSTF strongly recommends that clinicians provide (the support) to eligible Olcegepant patients. fertilization; IVIG, intravenous immunoglobin; LT4, levothyroxine; MMI, methimazole; OH, overt hypothyroidism; PPT, postpartum thyroiditis; PTU, propylthiouracil; Q, Question; R, Recommendation; RAI, radioactive iodine; SCH, subclinical hypothyroidism; TAb+, positive for thyroid peroxidase antibody and/or thyroglobulin antibody; Tg, thyroglobulin; TPOAb+, positive for thyroid Olcegepant peroxidase antibody; Olcegepant TRAb, TSH receptor antibodies; TSH, thyrotropin. The final document was approved by the ATA Table of Directors and officially endorsed.