Diagnosing and managing thyroid disorders during pregnancy: a survey of obstetrician-gynecologists.

OBJECTIVE To document the knowledge and clinical practice of obstetrician-gynecologists regarding their diagnosis and management of thyroid disorders during pregnancy. STUDY DESIGN We surveyed 1,392 practicing obstetrician-gynecologists about their knowledge and clinical practice of treating thyroid disorders during pregnancy; 569 of the surveys were returned. Of those, 441 respondents treated pregnant women and completed the entire survey. RESULTS A majority of respondents had treated patients for hypothyroidism (88.7%) and hyperthyroidism (60.5%) within the previous year. In general, respondents appeared to be well versed in the symptoms of hypothyroidism and hyperthyroidism. Most respondents correctly predicted the likely results for thyroid-stimulating hormone, free thyroxine and total thyroxine for pregnant euthyroid, hyperthyroid and hypothyroid women, but about 50% appeared uncertain of the meaning of free thyroxine index. A majority (53.1%) of respondents considered their training during residency concerning thyroid disorders during pregnancy to be adequate, but few (7.5%) considered it to be comprehensive, and the remainder considered it barely adequate at best. Self-assessment of training and confidence regarding diagnosing and managing thyroid disorders during pregnancy were in concordance (r = .462 and r = .464, respectively; P < .001 in both cases). CONCLUSION Thyroid disorders are commonly treated by obstetrician-gynecologists, and in general their practices for diagnosis and management conform to accepted practices. A sizable minority of responding obstetrician-gynecologists indicated that they considered their training to be inadequate and their confidence in diagnosing and managing thyroid disorders to be low.