How is pregnancy-related hypothyroidism treated in China?

While prenatal hypothyroidism is about as common in China as it is in the U.S., cultural and demographic differences mean that the two nations deal with the condition in divergent ways, although that is beginning to change.

A guest editorial printed in a recent issue of the journal Thyroid addressed the diagnosis and treatment of pregnancy-related thyroid diseases, including hypothyroidism, in China. The authors, a pair of endocrinologists at the Institute of Endocrinology of China Medical University in Shenyang, estimated that six in every 1,000 of the nation's pregnant women are diagnosed with overt hypothyroidism.

In the U.S., the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) states that between one and three in every 1,000 expectant mothers are diagnosed with the disease.



Subclinical hypothyroidism is also similarly prevalent in the U.S. and China. In the former, it occurs in 2 to 3 percent of pregnancies, the NIDDK estimates, while in the latter it is diagnosed in around 5 percent of all pregnancies, according to the new study.



Overall, the Chinese diagnostic criteria for prenatal thyroid disease are much like those used by American doctors. However, the authors noted that the attention and concern with which Chinese expectant mothers are screened for hypothyroidism and other glandular conditions is much greater.

The pair explained this by pointing to the "one child per family" policy, which was instituted in 1978. This population-control regulation affects about 40 percent of couples, a spokesman for the National Population and Family Planning Commission recently told China National.

Because Chinese law restricts some families to having just one - or in some cases, two - children, mothers in developed areas are screened carefully for thyroid disease, the editorial stated.

The authors added that the 2011 Standards of Healthcare During Pregnancy in China Act mandates that mothers-to-be receive five checkups prior to giving birth, for diseases ranging from thyroid conditions and anemia to hepatitis B and HIV.

Likewise, the law requires that all newborns be tested for congenital hypothyroidism.

The editorial also made mention of the Subclinical Hypothyroid and Iodine De?ciency in Early Pregnancy and Women Planning for Pregnancy: Screening and Intervention (SHEP) study.

This screening protocol will test both pregnant women and (uniquely) those merely planning a pregnancy for thyroid conditions. The authors expressed the hope that the findings will be of use to scientists worldwide.

"After the SHEP study is ?nished, the results will be reported to Ministry of Health as evidence-based medical data," they conclude. "We are looking forward to cooperating with the international academic community to establish reasonable and feasible routines for screening and treating thyroid disease during pregnancy."

Regardless of the country in which it is diagnosed, prenatal hypothyroidism is usually treated in the same way. The NIDDK states that women with the condition are prescribed a synthetic version of thyroxine, one of several hormones produced by the thyroid gland.

Such hormone replacement is considered safe for both mother and child, provided thyroid function is tested every 6 to 8 weeks, the agency adds.
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