2025 clinical practice guideline hyperthyroidism hypothyroidism pregnancy treatment ATA thyroid disease pregnancy guideline

hyperthyroidism AND pregnancy

hypothyroidism AND pregnancy

https://www.thyroid.org/hyperthyroidism-in-pregnancy

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site:thyroid.org 2026 ATA Guidelines thyroid disease preconception pregnancy postpartum full text hyperthyroidism hypothyroidism

diagram thyroid gland endocrine feedback TSH T4 T3

Graves disease pregnancy fetal monitoring ultrasound goiter

thyroid disease AND pregnancy

PMID: 42219800

mkdir -p "/tmp/workspace/thyroid-guidelines-ppt/src" "/tmp/workspace/thyroid-guidelines-ppt/output" "/tmp/workspace/thyroid-guidelines-ppt/assets" && python -c "import pptx; print('python-pptx ready')"

python "/tmp/skills/shared/scripts/fetch_images.py" "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_6f82970f9f7319e651f853444406dd2b35b7feffc3334ebb3c549f9b030a044f.jpg" > "/tmp/workspace/thyroid-guidelines-ppt/assets/fetched.json" && python - <<'PY' import json,base64 p='/tmp/workspace/thyroid-guidelines-ppt/assets/fetched.json' x=json.load(open(p))[0] assert x['base64'],x open('/tmp/workspace/thyroid-guidelines-ppt/assets/hpt_axis.jpg','wb').write(base64.b64decode(x['base64'].split(',',1)[1])) print('saved') PY

cat > "/tmp/workspace/thyroid-guidelines-ppt/src/create_deck.py" <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.dml.color import RGBColor from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.text import MSO_AUTO_SIZE from pathlib import Path OUT=Path('/tmp/workspace/thyroid-guidelines-ppt/output/Thyroid_Treatment_Guidelines_2026.pptx') IMG='/tmp/workspace/thyroid-guidelines-ppt/assets/hpt_axis.jpg' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # Palette NAVY=RGBColor(12,38,64); TEAL=RGBColor(0,128,137); MINT=RGBColor(81,181,166); CORAL=RGBColor(218,94,83) INK=RGBColor(30,48,61); MUTED=RGBColor(91,109,119); BG=RGBColor(246,249,249); WHITE=RGBColor(255,255,255); PALE=RGBColor(226,241,239); PALE2=RGBColor(234,241,246); GOLD=RGBColor(236,186,72) def rect(slide,x,y,w,h,fill,line=None,r=MSO_SHAPE.ROUNDED_RECTANGLE): s=slide.shapes.add_shape(r, Inches(x), Inches(y), Inches(w), Inches(h)); s.fill.solid(); s.fill.fore_color.rgb=fill s.line.color.rgb=(line or fill); return s def text(slide,txt,x,y,w,h,size=18,color=INK,bold=False,align=PP_ALIGN.LEFT,font='Aptos',val=None): tb=slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)); tf=tb.text_frame; tf.clear(); tf.word_wrap=True tf.margin_left=tf.margin_right=Inches(.05); tf.margin_top=tf.margin_bottom=Inches(.03) p=tf.paragraphs[0]; p.alignment=align; r=p.add_run(); r.text=txt; r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color if val: tf.vertical_anchor=val return tb def title(slide,kicker,heading,sub=''): text(slide,kicker.upper(),.62,.35,11.8,.28,10,TEAL,True) text(slide,heading,.62,.70,12,.65,27,NAVY,True) if sub:text(slide,sub,.64,1.39,11.7,.42,12,MUTED) rect(slide,.62,1.90,1.0,.06,TEAL,r=MSO_SHAPE.RECTANGLE) def foot(slide,n): text(slide,'Clinical education summary | Verify local protocols and individualize care',.62,7.12,9.8,.18,8,MUTED) text(slide,f'{n:02d}',12.15,7.04,.55,.24,10,TEAL,True,align=PP_ALIGN.RIGHT) def bulletbox(slide,items,x,y,w,h,fill=WHITE,accent=TEAL,fs=15): rect(slide,x,y,w,h,fill,fill) rect(slide,x,y,.08,h,accent,r=MSO_SHAPE.RECTANGLE) tf=slide.shapes.add_textbox(Inches(x+.24), Inches(y+.15), Inches(w-.38), Inches(h-.25)).text_frame; tf.clear(); tf.word_wrap=True tf.margin_left=tf.margin_right=0; tf.margin_top=0 for i,it in enumerate(items): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=it; p.level=0; p.font.name='Aptos'; p.font.size=Pt(fs); p.font.color.rgb=INK; p.space_after=Pt(9); p.bullet=True return tf def card(slide,head,body,x,y,w,h,accent=TEAL): rect(slide,x,y,w,h,WHITE,WHITE) rect(slide,x,y,w,.10,accent,r=MSO_SHAPE.RECTANGLE) text(slide,head,x+.22,y+.25,w-.4,.34,16,NAVY,True) text(slide,body,x+.22,y+.72,w-.42,h-.8,12,INK) def arrow(slide,x1,y1,x2,y2,color=TEAL): c=slide.shapes.add_connector(MSO_CONNECTOR.STRAIGHT, Inches(x1), Inches(y1), Inches(x2), Inches(y2)); c.line.color.rgb=color; c.line.width=Pt(2); c.line.end_arrowhead=True # base bg def add_bg(slide,dark=False): rect(slide,0,0,13.333,7.5,NAVY if dark else BG,r=MSO_SHAPE.RECTANGLE) # 1 s=prs.slides.add_slide(blank); add_bg(s,True) # decorative circles for x,y,sz,c in [(10.9,.6,2.7,TEAL),(11.9,4.8,1.8,MINT),(.2,5.8,1.6,RGBColor(18,69,95))]: rect(s,x,y,sz,sz,c,c,MSO_SHAPE.OVAL) text(s,'THYROID CARE',.75,.78,5.8,.32,13,MINT,True) text(s,'Treatment of\nhyperthyroidism &\nhypothyroidism',.72,1.30,7.1,2.05,32,WHITE,True) text(s,'Current adult care with pregnancy, preconception and postpartum updates',.75,3.62,6.4,.48,16,RGBColor(210,228,232)) rect(s,.75,4.5,4.65,.64,TEAL,TEAL); text(s,'Guideline-focused slide summary | Sept 2026',.96,4.69,4.25,.22,11,WHITE,True) text(s,'Key source: ATA 2026 pregnancy guideline (PMID 42219800)',.76,6.82,7,.20,9,RGBColor(180,207,214)) # 2 s=prs.slides.add_slide(blank); add_bg(s); title(s,'Approach','Start with cause, severity and clinical context','Treatment follows the diagnosis, not TSH alone.'); foot(s,2) # flow steps=[('1','Confirm','TSH + FT4; consider FT3'),('2','Classify','Overt vs subclinical\nPrimary vs central'),('3','Identify cause','TRAb, uptake/imaging if appropriate\nMedication & thyroiditis review'),('4','Select therapy','Symptoms, age, cardiac/bone risk\nPregnancy plans and preference')] for i,(num,h,b) in enumerate(steps): x=.72+i*3.13; rect(s,x,2.42,2.65,2.35,WHITE,WHITE); rect(s,x+.18,2.66,.48,.48,TEAL,TEAL,MSO_SHAPE.OVAL); text(s,num,x+.18,2.76,.48,.16,12,WHITE,True,align=PP_ALIGN.CENTER) text(s,h,x+.22,3.35,2.1,.3,16,NAVY,True); text(s,b,x+.22,3.82,2.15,.63,12,INK) if i<3: arrow(s,x+2.67,3.6,x+3.05,3.6) text(s,'Urgent referral/admission: thyroid storm, severe decompensation, myxedema coma, atrial fibrillation with instability, or pregnancy with uncontrolled overt disease.',.78,5.55,11.7,.48,14,CORAL,True) #3 s=prs.slides.add_slide(blank); add_bg(s); title(s,'Hyperthyroidism','Adult treatment: Graves disease and toxic nodular disease'); foot(s,3) card(s,'Immediate control','Beta-blocker for troublesome adrenergic symptoms when appropriate. Use shortest practical course and assess contraindications.',.72,2.22,3.85,2.05,TEAL) card(s,'Antithyroid drug','Methimazole is usual first-line outside pregnancy. Educate: fever/sore throat -> stop drug and urgent CBC; jaundice/dark urine -> urgent liver review.',4.75,2.22,3.85,2.05,CORAL) card(s,'Definitive therapy','Radioiodine (RAI) or thyroidectomy for relapse, intolerance, large goiter/nodules, patient preference, or selected high-risk disease.',8.78,2.22,3.85,2.05,MINT) bulletbox(s,['Check FT4/FT3 and TSH during titration. TSH can remain suppressed early and should not drive early dose escalation.','Avoid routine block-and-replace therapy in pregnancy.','Thyroiditis: antithyroid drugs do not treat hormone leakage; use symptomatic care.'],.72,4.75,11.92,1.55,PALE,TEAL,14) #4 s=prs.slides.add_slide(blank); add_bg(s); title(s,'Hyperthyroidism','Choosing long-term therapy'); foot(s,4) for x,h,body,ac in [(0.72,'Antithyroid drugs','Best for initial control and a remission trial in Graves. Balance relapse risk and adverse effects.',TEAL),(4.48,'Radioiodine','Highly effective definitive option. Contraindicated in pregnancy and during breastfeeding. Causes or worsens hypothyroidism long term.',CORAL),(8.24,'Surgery','Preferred if compressive goiter, suspicious nodule/cancer, rapid control needed, or RAI/ATD unsuitable. Use experienced surgeon.',MINT)]: card(s,h,body,x,2.35,3.52,2.48,ac) text(s,'Preconception: discuss a durable plan before conception. Achieve stable euthyroidism; RAI requires delaying pregnancy until thyroid status is stable on replacement.',.76,5.47,11.5,.47,14,NAVY,True) #5 s=prs.slides.add_slide(blank); add_bg(s); title(s,'Hypothyroidism','Adult treatment: levothyroxine is standard of care'); foot(s,5) # image rect(s,.72,2.22,4.15,3.83,WHITE,WHITE); s.shapes.add_picture(IMG,Inches(.88),Inches(2.38),width=Inches(3.83),height=Inches(3.42)) bulletbox(s,['Overt primary hypothyroidism: treat with levothyroxine (LT4).','Take consistently fasting, or at bedtime at least 3 hours after the last meal. Separate iron, calcium and similar interacting products by at least 4 hours.','Recheck TSH about 6-8 weeks after initiation or dose change, then periodically once stable.','Central hypothyroidism: dose and monitor by FT4, not TSH; assess other pituitary axes.'],5.25,2.22,7.36,3.83,WHITE,TEAL,15) #6 s=prs.slides.add_slide(blank); add_bg(s); title(s,'Hypothyroidism','Subclinical disease: selective, shared decision-making'); foot(s,6) text(s,'Subclinical hypothyroidism = elevated TSH with normal FT4. Confirm persistence and assess cause before committing to life-long therapy.',.74,2.14,11.7,.45,15,NAVY,True) card(s,'Usually treat','TSH ≥10 mIU/L, or persistent elevation with symptoms, positive thyroid autoimmunity, goiter, or cardiovascular risk after clinical review.',.72,2.95,3.8,2.32,TEAL) card(s,'Often observe','Mild TSH elevation without compelling factors: repeat testing, assess symptoms and antibodies, and avoid treating transient abnormalities.',4.76,2.95,3.8,2.32,GOLD) card(s,'Do not use routinely','LT4 + liothyronine or desiccated thyroid is not routine replacement, and is not appropriate in pregnancy.',8.80,2.95,3.8,2.32,CORAL) text(s,'Targets and thresholds differ by age, comorbidity, assay and pregnancy-specific reference ranges.',.76,5.82,11.6,.3,12,MUTED) #7 s=prs.slides.add_slide(blank); add_bg(s); title(s,'Pregnancy','Principles that change management'); foot(s,7) for x,n,h,b,ac in [(0.72,'01','Use pregnancy ranges','Interpret TSH and FT4 using assay- and trimester-specific reference ranges where available.',TEAL),(3.75,'02','Treat overt disease','Both uncontrolled overt hyper- and hypothyroidism carry maternal and fetal risk.',CORAL),(6.78,'03','Avoid RAI','RAI scanning and treatment are contraindicated during pregnancy.',GOLD),(9.81,'04','Plan together','Endocrinology + obstetrics/fetal medicine for complex Graves disease or unstable thyroid status.',MINT)]: rect(s,x,2.55,2.63,2.48,WHITE,WHITE); text(s,n,x+.22,2.81,.5,.24,13,ac,True); text(s,h,x+.22,3.33,2.12,.36,15,NAVY,True); text(s,b,x+.22,3.86,2.1,.78,11,INK) text(s,'The 2026 ATA guideline updates the 2017 recommendations across preconception, pregnancy, postpartum and lactation.',.75,5.82,11.7,.3,13,MUTED) #8 s=prs.slides.add_slide(blank); add_bg(s); title(s,'Pregnancy','Hypothyroidism: practical management'); foot(s,8) # timeline for x,head,body,ac in [(0.72,'Preconception','Aim for euthyroidism. For treated hypothyroidism, commonly target TSH 0.5-2.5 mIU/L before conception.',TEAL),(4.48,'Pregnancy confirmed','For established full replacement, increase LT4 about 25%-30% promptly (often 2 extra tablets/week), then test in ~4 weeks.',CORAL),(8.24,'During & after','Check TSH about every 4 weeks through mid-gestation, then at least once per trimester. Return near pre-pregnancy dose postpartum; check TSH 4-8 weeks later.',MINT)]: card(s,head,body,x,2.4,3.52,2.72,ac) text(s,'Use LT4 monotherapy. Do not use desiccated thyroid or T3-only/T3-containing therapy in pregnancy, because fetal brain development depends on maternal T4 supply.',.78,5.76,11.5,.52,14,NAVY,True) #9 s=prs.slides.add_slide(blank); add_bg(s); title(s,'Pregnancy','Subclinical hypothyroidism: what changed in 2026'); foot(s,9) card(s,'Confirm mild abnormalities','For newly found mild overt or subclinical hypothyroidism, repeat thyroid function testing when clinically safe to confirm persistence. Mild elevations can normalize.',.72,2.35,3.8,2.68,TEAL) card(s,'Do not use TPOAb alone','TPO antibody status alone no longer determines LT4 treatment for subclinical hypothyroidism. Timing and persistence guide individualized decisions.',4.76,2.35,3.8,2.68,CORAL) card(s,'Euthyroid + antibodies','Do not offer LT4 solely for euthyroid TPOAb-positive infertility, fertility treatment, or recurrent miscarriage. Monitor thyroid function preconception.',8.80,2.35,3.8,2.68,MINT) text(s,'Overt hypothyroidism remains an indication for prompt LT4 treatment. This slide describes the nuanced approach to mild/subclinical abnormalities.',.77,5.65,11.4,.4,13,MUTED) #10 s=prs.slides.add_slide(blank); add_bg(s); title(s,'Pregnancy','Hyperthyroidism and Graves disease'); foot(s,10) # columns card(s,'Diagnose the driver','Distinguish Graves disease from hCG-mediated transient thyrotoxicosis and thyroiditis. TRAb helps diagnose Graves and assess fetal/neonatal risk.',.72,2.25,3.75,2.6,TEAL) card(s,'Treat overt Graves','Use the lowest antithyroid-drug dose that maintains maternal FT4 high-normal to mildly elevated. PTU is preferred through week 16; then consider methimazole to reduce PTU hepatotoxicity.',4.79,2.25,3.75,2.6,CORAL) card(s,'Protect the fetus','No block-and-replace. Check TRAb in women with current or prior Graves disease, including after ablation/surgery, and arrange fetal surveillance if risk is elevated.',8.86,2.25,3.75,2.6,MINT) text(s,'Mild disease may be observed closely. Surgery is reserved for selected cases and, if needed, is generally safest in the second trimester. RAI is contraindicated.',.77,5.45,11.4,.43,14,NAVY,True) #11 s=prs.slides.add_slide(blank); add_bg(s); title(s,'Postpartum & lactation','Close the loop after delivery'); foot(s,11) card(s,'LT4 after delivery','Reduce to near the pre-pregnancy dose immediately after delivery, then check TSH 4-8 weeks later and adjust.',.72,2.35,3.73,2.42,TEAL) card(s,'Postpartum thyroiditis','Typically transient thyrotoxic and/or hypothyroid phases in the first year. Antithyroid drugs are not useful for the thyrotoxic phase. Reassess for permanent hypothyroidism.',4.80,2.35,3.73,2.42,GOLD) card(s,'Breastfeeding','ATA patient guidance considers methimazole up to 20 mg/day or PTU up to 450 mg/day compatible with breastfeeding. Coordinate medication decisions with clinicians.',8.88,2.35,3.73,2.42,MINT) text(s,'In Graves disease, neonatal risk is driven by maternal TRAb, even if the mother has previously had thyroidectomy or RAI.',.78,5.51,11.3,.34,13,CORAL,True) #12 sources s=prs.slides.add_slide(blank); add_bg(s,True) text(s,'KEY TAKEAWAYS',.75,.65,5,.28,12,MINT,True) text(s,'Treat the patient,\nnot a single TSH value.',.72,1.05,8.0,1.13,30,WHITE,True) for i,t in enumerate(['Confirm etiology before treatment.','LT4 is standard replacement; titrate with timely laboratory follow-up.','Pregnancy needs disease-specific drug choices, tighter follow-up and fetal-risk assessment in Graves disease.']): rect(s,.77,2.72+i*.78,.38,.38,TEAL,TEAL,MSO_SHAPE.OVAL); text(s,str(i+1),.77,2.82+i*.78,.38,.13,10,WHITE,True,align=PP_ALIGN.CENTER); text(s,t,1.35,2.77+i*.78,10.4,.30,15,WHITE) text(s,'Selected sources',.75,5.35,3,.25,13,MINT,True) sources=['Korevaar TIM, et al. American Thyroid Association 2026 Guidelines for Thyroid Disease in Preconception, Pregnancy, and Postpartum. Thyroid. 2026;36:481-544. PMID 42219800.','Harrison’s Principles of Internal Medicine, 22nd ed. Thyroid disease in pregnancy, p. 428.','Creasy & Resnik’s Maternal-Fetal Medicine, 9th ed. Treatment of hypothyroidism in pregnancy, pp. 1504-1505.','American Thyroid Association patient resource: Hyperthyroidism in Pregnancy. Accessed Sept 2026.'] for i,ss in enumerate(sources): text(s,ss,.77,5.75+i*.31,11.8,.25,9,RGBColor(210,228,232)) prs.save(OUT) print(OUT) PY python "/tmp/workspace/thyroid-guidelines-ppt/src/create_deck.py"

python - <<'PY' from pptx import Presentation p='/tmp/workspace/thyroid-guidelines-ppt/output/Thyroid_Treatment_Guidelines_2026.pptx' prs=Presentation(p) print('slides',len(prs.slides)) for i,s in enumerate(prs.slides,1): words=[] for sh in s.shapes: if hasattr(sh,'text') and sh.text.strip(): words.append(sh.text.replace('\n',' | ')) print(i, ' :: '.join(words)[:230]) PY python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/thyroid-guidelines-ppt/output/Thyroid_Treatment_Guidelines_2026.pptx') print('exists=',p.exists(),'bytes=',p.stat().st_size) PY

2025 2026 guideline hyperthyroidism hypothyroidism pregnancy thyroid disease clinical practice guideline

thyroid disease AND pregnancy

hyperthyroidism AND guideline

hypothyroidism AND guideline