TOPIC: Knowledge concerning thyroid diseases and pregnancy
Title: Thyroid disease and pregnancy: degrees of knowledge.
Authors: Rinaldi MD & Stagnaro-Green AS.
Reference: Thyroid 17: 747-753, 2007
The literature on the impact of thyroid abnormalities on pregnancy and the postpartum has expanded rapidly over the last two decades. Objective of present study was to determine the level of knowledge of endocrinologists, obstetrician/gynecologists, internists, and family physicians in regard to thyroid disease and pregnancy.
A 16-item questionnaire on issues related to thyroid disease and pregnancy was developed by the authors. Endocrinologists (N=116), obstetrician/gynecologists (N=81), internists (N=109), and family physicians (N=99) were asked to complete the questionnaire. Physician self-report of confidence regarding degree of knowledge was obtained through completion of a seven-point scale (the -Likert- scale).
Main Outcome: The percentage of questions answered correctly by all physicians was 63%. Endocrinologists had the highest correct response rate (77%), followed by obstetrician/gynecologists. Hierarchical regression analysis revealed that medical specialty, years of training, confidence level, and whether or not the physician treated pregnant women were significantly related to the overall knowledge score.
The present survey demonstrates a suboptimal level of knowledge regarding thyroid disease and pregnancy among physicians in four specialties. A comprehensive physician education program is needed.
Thanks to a large series of clinical studies conducted over the last two decades in all continents, our knowledge of the intricate interrelations between pregnancy and thyroid diseases has expanded rapidly. Globally, we understand much better today why (and how) thyroid disorders may influence the outcome of pregnancy and, alternatively, why (and how) pregnancy by itself may influence the course of thyroid diseases. One of the challenges is to translate new information derived from research into clinical practice and this goal can only be achieved through education of the various medical care providers involved with pregnant women and also directly of the public.
Present study consisted in a survey organized through a 16-item questionnaire developed by the authors to assess level of knowledge of clinicians on thyroid disease during pregnancy and the postpartum. Questions asked corresponded mostly to a multiple-choice type questionnaire addressing the following topics: hypothyroidism & Graves- disease during pregnancy, thyroid autoimmunity & pregnancy, postpartum thyroiditis, and risk of IQ impairment in the progeny of mothers with thyroid disorders. Questionnaires were distributed by the investigators to consenting participants in the New Jersey/New York metropolitan area, and a total of 412 physicians completed the questionnaire. Among them, the percentage of physicians who declared that they treated pregnant women was 94% (endocrinologists), 90% (obstetrician/gynecologists), 58% (internists), and 68% (family physicians).
The main findings of this survey were considered by the authors to indicate a -disturbingly- low level of knowledge in physicians across all disciplines. Knowledge gaps were mainly related to areas of relatively recent scientific new acquisitions, but also to facts that have been known for decades. Endocrinologists scored highest, with a 77% rate of correct responses to the questionnaire and an average 5.1 confidence level on the Likert scale (ranging from 1 [not confident] to a maximum of 7 [extremely confident]). In the questionnaire, two questions dealt specifically with the management of Graves- disease in pregnancy (natural course of the disease and therapeutic goal of treatment with antithyroid drugs). Correct response rates to these questions were (in decreasing order) 71% for the endocrinologists, less than 50% for the obstetrician/gynecologists and internists, and finally less than 40% for the family physicians. The authors considered that the overall low scores may be attributed to a lack of adequate education on thyroid disease during pregnancy, lack of exposure to women during pregnancy, or the inability to translate research information into clinical practice.
In 2005, an international ad hoc committee was established under the auspices of the American Endocrine Society to review the best evidence for thyroid disorders associated with pregnancy and develop evidence-based guidelines for clinical practice. Members of the ten-person task force (chairman: Leslie De Groot) included representatives of the Endocrine Society, the American, European, Latino-American and Asian-Oceanic regional Thyroid Associations, the American Association of Clinical Endocrinologists, and the American College of Obstetrics & Gynecology. All these medical and scientific associations (except for ACOG) eventually endorsed the 35 recommendations made by this committee. They have been published in the JCEM (August 2007) and the full text is available online on the website of the Endocrine Society. One can only hope that efforts such as those undertaken by such expert committees will help improve the overall knowledge in this important clinical field. Summary and commentary prepared by Daniel Glinoer (related to Chapter 14 of TDM)