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T*
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[(R3)2217.2(5)]TJ
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43.7356 0 TD
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43.7356 1.1128 TD
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[(Q)-2102.2(4)0(2)-2104.6(What)-236.3(is)-238.8(the)-231.4(impact)-242(of)-237.2(mild)-235.3(to)-237.2(moderate)-237.8(iodine)-237.4(deciency)-237(on)-233.8(the)-237.7(mother,)-241.7(fetus,)-240.4(and)-233.5(child?)-5070.4(1097)]TJ
T*
[(Q)-2102.2(4)0(3)-2104.6(What)-331.2(is)-340(the)-332.5(iodine)-338.6(status)-333.2(of)-338.4(pregnant)-335.6(and)-334.7(breastfeeding)-337.1(women)-334(in)-335.7(the)-332.5(United)-340.5(States?)-5683.7(1097)]TJ
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5.9878 -1.1128 TD
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43.7356 1.1128 TD
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5.9878 -1.1065 TD
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43.7356 1.1065 TD
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5.9878 -1.1128 TD
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43.7356 1.1128 TD
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[(decrease)-300.7(in)-297.8(serum)-298(TSH)-298.6(is)-302(observed)-297.3(during)-300.9(the)-300.9(rst)-296.3(trimester)]TJ
T*
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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T*
[(pr)23.2(e)12.8(g)0(n)23.8(a)13.1(nc)22.6(y)-472.3(o)0(u)21.2(t)12.2(c)13.4(o)0(m)25(e)12.8(s;)-459.5(t)12.2(h)0(e)22(r)0(e)24.7(f)12.2(or)21.8(e)12.8(,)-470.8(a)-467.4(T)0(S)23.8(H)-474.2(va)25(l)15.4(u)0(e)-462.8(t)12.2(h)15.6(a)0(t)-461.6(i)15.4(s)-475.5(w)0(i)26.5(t)12.2(hi)24.7(n)]TJ
0 -1.2266 TD
[(de)22.4(t)12.2(e)12.7(ct)19.2(i)15.4(o)0(n)-259.1(i)15.4(s)-266.9(u)0(n)20.5(l)15.4(ik)23.7(e)12.8(l)0(y)-260.9(t)12.2(o)-268.3(b)14.6(e)-265.5(c)0(l)22.5(i)0(n)24.7(i)0(c)22.5(a)13.1(ll)24.6(y)-270(s)0(i)26.8(g)14.6(ni)18.4()16(c)13.4(a)13.1(n)0(t)-256.8(\()12.2(25)19.9(\))12.2(.)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 58.9606 243.7228 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 69.4488 241.2283 Tm
[(RECOMMENDATION)-284.2(1)]TJ
/F6 1 Tf
.0569 -1.2203 TD
[(Trimester-specic)-337.7(reference)-345.6(ranges)-338(for)-339.1(TSH,)-333.2(as)-335.9(dened)-341(in)]TJ
0 -1.2267 TD
[(populations)-230(with)-230.3(optimal)-230(iodine)-231.1(intake,)-229.1(should)-230.3(be)-225.6(applied.)]TJ
/F4 1 Tf
0 -1.2203 TD
[(Level)-278.8(B-USPSTF)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 58.9606 185.896 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 69.4488 183.4582 Tm
[(RECOMMENDATION)-284.2(2)]TJ
/F6 1 Tf
.0569 -1.2266 TD
[(If)-647.5(trimester-specic)-651.3(reference)-655.4(ranges)-647.8(for)-648.9(TSH)-646.4(are)-651.4(not)]TJ
0 -1.2203 TD
[(available)-305(in)-304.1(the)-307.3(laboratory,)-306.3(the)-307.3(following)-310.6(reference)-307.6(ranges)]TJ
T*
[(are)-373.2(recommended:)-376.6(rst)-378.5(trimester,)-380.5(0.12.5)-370.1(mIU/L;)-376.7(second)]TJ
0 -1.2266 TD
[(trimester,)-361.5(0.23.0)-351.2(mIU/L;)-357.8(third)-365.2(trimester,)-355.2(0.33.0)-357.5(mIU/L.)]TJ
/F4 1 Tf
0 -1.2203 TD
[(Level)-278.8(I-USPSTF)]TJ
/F10 1 Tf
-1.1381 -2.447 TD
[(Question)-293.7(3:)-291.1(What)-298.2(is)-286.2(the)-296.7(optimal)-290.7(method)-295.6(to)-292.3(assess)-285.7(FT)]TJ
6.7246 0 0 5.9768 286.5826 105.222 Tm
(4)Tj
8.9663 0 0 8.9663 59.7543 95.7543 Tm
[(during)-336.6(pregnancy?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(The)-271.8(normal)-273(ranges)-268.5(for)-269.5(FT)]TJ
6.7246 0 0 5.9768 169.9653 77.8393 Tm
(4)Tj
8.9663 0 0 8.9663 175.748 79.3134 Tm
[(index)-271.2(are)-272(calculated)-268.6(by)-274.4(TT)]TJ
6.7246 0 0 5.9768 279.8361 77.8393 Tm
(4)Tj
/F9 1 Tf
8.9663 0 0 8.9663 283.181 79.3134 Tm
()Tj
/F6 1 Tf
.7714 0 TD
(T)Tj
6.7246 0 0 5.9768 295.5401 77.8393 Tm
(3)Tj
8.9663 0 0 8.9663 59.7543 68.3716 Tm
[(uptake)-342.1(or)-338.6(a)-340.9(ratio)-335.8(of)-338.4(TT)]TJ
6.7246 0 0 5.9768 151.7102 66.8976 Tm
(4)Tj
8.9663 0 0 8.9663 158.0598 68.3716 Tm
[(and)-341(TBG,)-336.5(but)-341.4(trimester-specic)-347.8(ref-)]TJ
-10.9639 -1.2203 TD
[(erence)-306.6(intervals)-303.9(for)-307.4(FT)]TJ
6.7246 0 0 5.9768 148.5921 55.8992 Tm
(4)Tj
8.9663 0 0 8.9663 154.6582 57.4299 Tm
[(index)-302.8(have)-300.7(not)-303.8(been)-304.8(established)-304.8(in)-304.1(a)]TJ
17.4196 58.664 TD
[(reference)-472(population.)-465.6(Only)-469.6(0.03%)-464.7(of)-464.8(serum)-468.7(TT)]TJ
6.7246 0 0 5.9768 502.9227 581.9526 Tm
(4)Tj
8.9663 0 0 8.9663 510.4628 583.4266 Tm
[(content)-471.3(is)]TJ
-22.263 -1.2203 TD
[(unbound)-253.6(to)-249.8(serum)-253.7(proteins)-253.7(and)-252.5(is)-251.4(the)-250.4(FT)]TJ
6.7246 0 0 5.9768 471.0046 571.0109 Tm
(4)Tj
8.9663 0 0 8.9663 476.6172 572.4849 Tm
[(available)-254.5(for)-250.5(tissue)]TJ
-18.4882 -1.2203 TD
[(uptake.)-313.4(Sera)-308.4(TT)]TJ
6.7246 0 0 5.9768 373.4361 560.0125 Tm
(4)Tj
8.9663 0 0 8.9663 379.6156 561.5432 Tm
[(concentrations)-317.3(are)-309.9(in)-310.4(the)-313.6(nanomolar)-316.6(range,)]TJ
-7.6697 -1.2266 TD
[(but)-233.9(FT)]TJ
6.7246 0 0 5.9768 336.4156 549.0707 Tm
(4)Tj
8.9663 0 0 8.9663 341.8582 550.5447 Tm
[(concentrations)-241.5(are)-234.1(in)-228.2(the)-231.4(picomolar)-238.7(range.)-232.1(Measuring)]TJ
-3.4586 -1.2203 TD
(FT)Tj
6.7246 0 0 5.9768 321.222 538.129 Tm
(4)Tj
8.9663 0 0 8.9663 327.855 539.603 Tm
[(in)-373.6(the)-370.5(presence)-372.5(of)-370(high)-375.1(concentrations)-374.3(of)-370(bound)-369(T)]TJ
6.7246 0 0 5.9768 529.9085 538.129 Tm
(4)Tj
8.9663 0 0 8.9663 536.5983 539.603 Tm
(has)Tj
-25.1778 -1.2203 TD
[(proved)-438.4(challenging)-445.6(especially)-439.9(in)-436.9(abnormal)-441.4(binding-protein)]TJ
0 -1.2266 TD
[(states)-281.2(such)-283.5(as)-279(pregnancy.)]TJ
1.1128 -1.2203 TD
[(Equilibrium)-317.8(dialysis)-317.3(and)-322(ultraltration)-320.1(are)-322.6(used)-321.7(for)-320.1(phys-)]TJ
-1.1128 -1.2203 TD
[(ical)-182.9(separation)-195.8(of)-186.6(serum)-184.2(FT)]TJ
6.7246 0 0 5.9768 414.7086 494.2487 Tm
(4)Tj
8.9663 0 0 8.9663 419.7542 495.7794 Tm
[(from)-184.9(bound)-192(T)]TJ
6.7246 0 0 5.9768 473.2156 494.2487 Tm
(4)Tj
8.9663 0 0 8.9663 478.2613 495.7794 Tm
[(prior)-186.1(to)-186.6(analysis)-193.6(of)]TJ
-18.6716 -1.2266 TD
[(the)-345.2(dialysate)-344(or)-338.6(ultraltrate.)-351.2(Assays)-338.1(based)-343.3(on)-347.6(classical)-339.6(equi-)]TJ
0 -1.2203 TD
[(librium)-880.9(dialysis)-886.4(or)-882.4(ultraltration)-889.2(are)-885.3(laborious,)-882.7(time-)]TJ
T*
[(consuming,)-279.2(expensive,)-287(and)-284.1(not)-278.5(widely)-281.6(available.)]TJ
1.1128 -1.2203 TD
-.0209 Tc
(FT)Tj
6.7246 0 0 5.9768 330.8597 450.4251 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 336.7558 451.9558 Tm
-.018 Tc
[(immunoassay)-300.6(a)-4.9(pproaches)-303.8(are)-302.4(l)3.8(iable)-302.4(t).5(o)-299(e)-5.2(rror)-296.9(b)-3.5(y)-294.3(d)-2(isrupt-)]TJ
-2.8896 -1.2266 TD
-.0164 Tc
[(i)5.4(n)-.8(g)-387.5(t)-4.2(h)5.5(e)-395.7(o)6.1(r)1.9(ig)4.5(inal)-393(eq)4.5(uili)5.4(bri)5.4(u)1.2(m,)-386(which)-392.8(i)5.4(s)-390.8(d)-.4(ependent)-389.9(on)-386.5(dil)5.4(u)1.2(ti)5.4(on,)]TJ
0 -1.2203 TD
-.0181 Tc
[(temperat)-5.9(ure,)-305.5(buff)-5.9(er)-303.3(composition,)-305.5(afnity,)-305.5(and)-299.3(c)-4.7(onc)-4.7(e)1(ntration)-299.7(of)]TJ
T*
-.0171 Tc
[(the)-333.1(T)]TJ
6.7246 0 0 5.9768 330.8597 417.5432 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 337.096 419.0739 Tm
-.018 Tc
[(antibody)-338.6(reagent)-334.6(a)-4.9(nd)-337.1(T)]TJ
6.7246 0 0 5.9768 428.0881 417.5432 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 431.3195 419.0739 Tm
-.0176 Tc
[(-binding)-338.2(capac)-4.2(i)4.2(t)-5.4(y)-331.8(of)-340.5(the)-333.6(s)-17.6(e)12.8(r).7(um)]TJ
-13.4362 -1.2266 TD
-.0184 Tc
[(sample)-227(\(26\))-6.2(.)-223.6(H).6(igh)-224.1(T)-2.4(BG)-225.8(concentra)-5.3(t).1(ions)-222.1(in)-224.1(serum)-224.6(s)-.7(amples)-222(te)-5.6(nd)-223.7(t)-6.2(o)]TJ
0 -1.2203 TD
-.0166 Tc
[(result)-187.8(in)-184.4(hig)4.3(h)-1(er)-188(FT)]TJ
6.7246 0 0 5.9768 378.8787 395.6597 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 383.8109 397.1338 Tm
-.0166 Tc
[(values,)-190.2(w).7(hereas)-188.6(l)5.2(o)-.4(w)-188.9(a)2.9(lb)4.3(umi)5.2(n)-190.7(in)-184.4(serum)-184.9(lik)4.3(ely)]TJ
-8.1376 -1.2203 TD
-.0172 Tc
[(will)-419.1(yield)-412.2(l)-1.8(ower)-416.2(FT)]TJ
6.7246 0 0 5.9768 386.9857 384.6613 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 393.959 386.192 Tm
-.0183 Tc
[(values.)-419.6(I)-1.4(n)-420(o)4.2(rder)-423.7(to)-419.4(de)-5.5(crease)-422.9(nonspec)-4.9(i)3.5(c)]TJ
-9.2694 -1.2266 TD
-.0181 Tc
[(binding)-275.4(a)-5(nd)-280.3(neut)-5.9(ralize)-283.6(the)-277.2(e)-5.4(ffec)-4.7(t)-277.8(of)-277.8(noneste)-5.4(r).2(ied)-280.3(fa)-5(tty)-281.7(acids)-278.6(o)-1.9(n)]TJ
0 -1.2203 TD
[(serum)-268.7(F)-3.6(T)]TJ
6.7246 0 0 5.9768 347.0172 362.7779 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 350.2487 364.2519 Tm
.2503 Tc
[(,s)268(o)266.5(m)271.7(ea)269.8(s)268(s)268(a)263.4(y)271.2(s)-3.9(a)269.8(d)272.6(d)-5.6(a)269.8(l)272.1(b)264.9(u)267.9(m)271.7(i)265.7(n)265.9(;h)265.9(o)272.8(w)267.6(e)263.1(v)268.5(e)269.4(r)268.6(,a)269.8(l)265.7(b)264.9(u)267.9(m)271.7(i)265.7(n).3(b)271.2(i)265.7(n)265.9(d)272.6(s)]TJ
-4.3944 -1.2203 TD
0 Tc
(T)Tj
6.7246 0 0 5.9768 316.0629 351.7794 Tm
(4)Tj
8.9663 0 0 8.9663 321.0519 353.3101 Tm
-.0178 Tc
[(and)-197.8(w)-.5(hen)-198.2(i)4(t)-201.6(i)4(s)-196.2(a)-4.7(dded)-197.8(in)-198.2(sufcient)-201.6(a)1.7(mounts,)-197.8(i)-2.4(t)-195.3(m)-2.7(ay)-192.9(disrupt)-195.3(the)]TJ
-1.1381 -1.2266 TD
-.0166 Tc
[(equi)5.2(li)5.2(brium)4.8(.)-392.6(Nevertheless,)-386.2(th)5.3(e)-395.9(c)3.1(urrently)-387.7(used)-386.3(FT)]TJ
6.7246 0 0 5.9768 499.8613 340.8377 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 506.6077 342.3117 Tm
-.02 Tc
[(im)-4.9(mun)-4.4(o)-3.8(as-)]TJ
-21.833 -1.2203 TD
-.018 Tc
[(says)-297.5(perform)-293.8(r).3(easonably)-294.3(w)-.7(ell)-293.4(u)-.4(nd)]TJ
14.5237 0 TD
-.0182 Tc
[(e)-5.5(r)-290.8(most)-296.9(circumstances,)-293(a)-5.1(ccu-)]TJ
-14.5237 -1.2203 TD
-.0198 Tc
[(rate)-7.1(ly)-353(re)-7(port)-7.6(ing)-353(l)-4.4(ow)-356.5(FT)]TJ
6.7246 0 0 5.9768 401.5558 318.9542 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 407.9054 320.4283 Tm
-.016 Tc
[(levels)-352.4(i)5.8(n)-348.2(th)5.9(yroi)5.8(d)-354.1(h)]TJ
7.9289 0 TD
-.0169 Tc
[(ormo)5.6(ne)-351.9(deciency)]TJ
-18.7538 -1.2203 TD
-.0163 Tc
[(and)-278.5(h)5.6(igh)-278.9(F)4.6(T)]TJ
6.7246 0 0 5.9768 357.5621 307.9558 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 363.2881 309.4865 Tm
-.0197 Tc
[(lev)-19.7(e)11.3(ls)-286.6(in)-282.3(t)-7.5(h)2.2(y)-5.1(r)-1.4(o)-3.5(i)2.1(d)-281.9(h)-4.1(o)-3.5(r)-1.4(m)-4.6(o)2.8(n)-4.1(e)-285.2(excess)-286.6(\(27\))-7.5(.)]TJ
-4.7359 -1.2266 TD
-.0221 Tc
[(The)-439.3(s)1.9(er)-3.8(um)-443.3(of)-439.9(pr)-3.8(egnant)-439.9(wo)-5.9(men)-442.8(i)]TJ
14.4668 0 TD
-.0219 Tc
[(s)-440.5(c)-2.2(haracterized)-442.2(by)-437.3(high)-6.3(er)]TJ
-15.5797 -1.2203 TD
-.0201 Tc
[(concentr)4.5(ations)-179.5(of)-185(TBG)-183.2(and)-181.2(n)1.8(ones)3.9(ter)4.5(i)-4.7(ed)-181.2(f)4.7(atty)-176.3(acids)-185.8(a)-.6(nd)-181.2(by)-182.6(lowe)5.3(r)]TJ
T*
-.021 Tc
[(concentration)-5.4(s)-262.6(o)-4.8(f)-268.1(albumin)-264.7(r)-2.7(elati)-5.6(v)3.6(e)-267.5(t)-2.5(o)-264(t)-2.5(he)-267.5(serum)-265.2(o)1.5(f)-268.1(n)-5.4(onpregnant)]TJ
0 -1.2266 TD
-.0219 Tc
[(wo)-5.7(men)-6.3(.)-233.5(Many)-235(cur)-3.6(r)2.7(ent)-237.3(F)-1(T)]TJ
6.7246 0 0 5.9768 406.9983 264.1322 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 412.3275 265.6063 Tm
-.0202 Tc
[(immu)3.7(noas)3.8(sa)5.6(ys)-236.5(fail)-232.4(to)-231.6(accou)3.7(n)-4.6(t)-229.3(f)-1.7(or)-235.9(the)]TJ
-11.318 -1.2203 TD
-.0199 Tc
[(ef)4.9(fect)-538.9(of)-538.9(dilution)-535.4(\(26,28)5.9(\).)-535(Be)5.5(cau)4(s)-2.2(e)-538.3(F)1(T)]TJ
6.7246 0 0 5.9768 458.5322 253.1905 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 466.5258 254.6645 Tm
-.0198 Tc
[(refe)5.6(rence)-538.2(i)2(nter)4.8(vals)-539.6(in)]TJ
-17.3627 -1.2203 TD
-.0204 Tc
[(pregnancy)-442.1(v)-2.2(a)5.4(r)-2.1(ied)-440.7(w)-3.1(idely)-442.1(b).5(etween)-441.1(methods,)-440.6(int)4.4(e)-1.3(rpreta)5.4(tion)-447.4(of)]TJ
0 -1.2266 TD
-.0209 Tc
(FT)Tj
6.7246 0 0 5.9768 320.8251 231.2503 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 325.7574 232.7244 Tm
-.0228 Tc
[(va)-3.3(lu)-5.2(e)-3.7(s)-194.8(re)-3.7(qu)-5.2(ire)-3.7(s)-201.2(met)-4.3(h)-.9(o)-6.6(d)-.5(-)-4.3(s)1.2(p)-5.2(e)2.6(ci)-6.8(c)]TJ
13.3097 0 TD
-.0191 Tc
[(ra)6.7(nge)6.3(s)-197.5(\()5.7(11,12,2)6.7(9).4(\).)-192.7(More)6.3(ov)5.5(er,)]TJ
-14.9727 -1.2203 TD
-.0222 Tc
[(such)-278.5(ran)-6.6(g)-1.3(es)-282.7(are)-281.3(a)-2.7(lso)-284.2(i)-.4(nuenced)-284.4(by)-279.5(th)-6.6(e)-275(i)-6.8(odine)-281.3(s)-4.5(tatus)-282.8(o).3(f)-281.9(t)-3.7(he)-281.3(po)-6(p-)]TJ
T*
-.0211 Tc
[(ulation)-365.9(s)-3.4(tudied.)-365.5(W)-1.2(hereas)-363.8(it)-363(is)-363.8(cu)]TJ
13.9989 0 TD
-.0209 Tc
[(stomary)-366.8(f)-2.4(or)-363(manufacturers)-363.7(t)-2.4(o)]TJ
-13.9989 -1.2203 TD
-.0199 Tc
[(suggest)-184.8(that)-178.4(la)5.9(bor)4.7(a)-.4(torie)5.5(s)-185.6(establish)-181.4(t)-1.4(heir)-185(own)-187.7(r)4.7(efer)4.7(ence)-184.2(ra)5.9(nge)-177.9(f)-1.4(or)-178.7(a)]TJ
0 -1.2266 TD
-.0208 Tc
[(test,)-226(t)-2.3(hi)-5.4(s)-230.8(i)1(s)-230.8(i)-5.4(mpractical)-233(in)-232.8(clinical)]TJ
13.6132 0 TD
-.0211 Tc
[(practice.)-232.7(I)2.1(t)-236.5(i).7(s)-231.1(e)-2(special)-5.7(l).7(y)-227.9(d)-5.1(ifcult)]TJ
-13.6132 -1.2203 TD
-.0221 Tc
[(to)-271.5(recr)-3.8(uit)-269.2(s)1.9(u)-4.5(b)-1.2(ject)-3.6(s)-270(w)1.6(it)-3.6(h)-265.8(s)-4.4(pecic)]TJ
13.158 0 TD
-.0217 Tc
[(condi)-6.3(t)3.1(io)-5.5(ns)-263.3(such)-271.7(as)-269.6(pregnancy)-266.4(i).1(n)]TJ
-13.158 -1.2203 TD
-.021 Tc
[(order)-255.6(t)3.8(o)-257.7(i).8(nd)-5(ependently)-253(establis)]TJ
13.0252 0 TD
[(h)-258.4(m).3(etho)-4.9(d-)-255.5(and)-251.7(t)-2.6(rimester-specic)]TJ
-13.0252 -1.2266 TD
[(ranges.)-175.8(I)-4.2(t)-179.6(f)-2.6(ollo)-4.9(ws)-180.5(that)-179.6(i)-5.7(t)-179.6(is)-180.5(custom)]TJ
13.6765 0 TD
-.0205 Tc
[(ar)4.1(y)-183(f)-2(or)-179.3(laborat)4.3(o)-4.3(r)4.1(i)-5.1(e)4.9(s)-179.9(to)-181.3(adopt)-179(t)-2(he)]TJ
-13.6765 -1.2203 TD
-.0211 Tc
[(ranges)-300.6(provi)-5.7(d)1.2(ed)-302.3(b)6.1(y)-303.7(the)-305.5(m).3(an)-5.5(ufacturer)-306.3(o)1.4(f)-299.8(t)-2.6(he)-305.5(test.)-302.2(T)1.2(ypically,)-302.2(t)-2.6(he)]TJ
T*
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T*
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T*
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T*
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(*)Tj
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T*
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T*
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(4)Tj
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[(concentration)-429.8(is)-428.5(necessary)-427(to)-420.6(classify)-424.4(the)-427.4(pa-)]TJ
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[(tients)-440.9(status)-434.4(as)-430.8(either)-437.8(subclinical)-433.7(\(SCH\))-435.9(or)-433.4(overt)-434.5(hypothy-)]TJ
T*
[(roidism)-284.3(\(OH\).)-278.8(This)-283.1(is)-283.1(dependent)-279.9(upon)-287.1(whether)-281.3(FT)]TJ
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(4)Tj
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[(is)-283.1(within)]TJ
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[(or)-338.6(below)-341(the)-338.9(trimester-specic)-347.8(FT)]TJ
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(4)Tj
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[(reference)-339.2(range.)-339.6(The)-341.4(dis-)]TJ
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[(tinction)-212.8(of)-211.9(OH)-205.4(from)-210.2(SCH)-213.6(is)-207.2(important)-212.1(because)-208(published)-211.5(data)]TJ
T*
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[(parently)-449.6(healthy,)-441.2(nonpregnant)-452.6(women)-441.5(of)-445.8(childbearing)-445.9(age)]TJ
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T*
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T*
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T*
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[(sufcient)-290.9(country.)-287.2(It)-287.1(would)-284.2(be)-282.5(anticipated)-285.8(that)-288.4(such)-283.6(percent-)]TJ
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[(ages)-321.3(would)-322.1(be)-320.5(higher)-325.1(in)-323.1(areas)-317.1(of)-325.7(iodine)-319.6(insufciency.)-329.3(When)]TJ
T*
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[(pothyroidism)-562.3(is)-554.9(autoimmune)-557.5(thyroid)-555.7(disease)-558.6(\(also)-557.7(called)]TJ
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[(Hashimotos)-419.2(thyroiditis\).)-416.2(Thyroid)-412.8(auto-antibodies)-418.4(were)-413.1(de-)]TJ
T*
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(*)Tj
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[(50%)-342.1(of)-332(pregnant)-341.9(women)-340.4(with)-337.8(SCH)-340.1(and)-341(in)-335.7(more)]TJ
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T*
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(4)Tj
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T*
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(4)Tj
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(4)Tj
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T*
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[(in)-253.5(comparison)-246.1(to)-249.8(euthyroid)-253.5(women)-245.5(or)-250.1(those)-248.1(with)-249.3(SCH.)-248.1(Allan)]TJ
0 -1.2203 TD
[(and)-429.5(colleagues)-432.8(\(36\))-429.9(also)-430.8(describe)-429.4(an)-426.5(increased)-434.2(risk)-427.3(of)-426.9(fetal)]TJ
T*
[(death)-208.6(among)-203.7(pregnant)-209.1(women)-207.6(with)-205(OH.)-208.3(In)-201.5(conclusion,)-213.2(a)-201.8(rm)]TJ
T*
[(association)-409.4(between)-401.6(OH)-407.7(and)-397.9(adverse)-409.7(risk)-402(to)-401.6(the)-402.1(maternal)]TJ
0 -1.2266 TD
[(fetal)-282.1(unit)-287(has)-282.4(been)-279.5(demonstrated.)]TJ
/F10 1 Tf
0 -3.054 TD
[(Question)-338(7:)-335.3(What)-329.8(adverse)-338.3(outcomes)-336(are)-332(associated)]TJ
0 -1.2203 TD
[(with)-336.8(SCH)-332.3(in)-338(pregnancy?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(SC)-11.3(H)-303.5(i)0(s)-302(a)0(s)-7.1(s)-7.6(oc)-8.4(ia)-9.4(te)-13(d)-300.2(wit)-12(h)-300.6(a)0(n)-306.4(i)0(n)-13.2(cre)-12.5(as)-7.1(ed)-306.4(r)-7(i)0(s)-11.2(k)-295.3(o)-9.1(f)-297.6(ad)-8.8(v)-7.1(e)0(r)-13.2(s)0(e)-304.7(p)0(r)-8.4(e)0(g)-10.6(-)]TJ
-1.1128 -1.2266 TD
[(n)-9.7(a)0(n)-9.2(c)0(y)-345.1(c)0(o)-8.4(m)0(p)-11.6(l)0(i)-7.1(c)0(a)-11.4(t)0(i)-10.3(o)0(n)-12.5(s)-342.7(an)-9.2(d)-338.1(p)-7.7(os)-10.4(si)-11.2(bl)-7.9(y)-339.5(w)-7.9(it)-10.3(h)-338.5(a)0(n)-350.7(inc)-12.5(r)-7(e)0(a)-12.1(sed)-352(ris)-11.9(k)-339.5(o)-9.1(f)]TJ
0 -1.2203 TD
[(n)-9.7(eur)-14.6(oc)-8.4(og)-7.2(n)-9.7(i)0(t)-10.3(ive)-351.9(de)-9.2(c)-8.6(it)-10.3(s)-342.8(i)0(n)-342(t)0(h)-16.5(e)-341.3(de)-9.2(vel)-10.5(o)-9.1(p)0(i)-11.2(n)0(g)-342.9(f)0(e)-13(t)0(u)-8.1(s)-7.6(.)-338(I)-8.4(n)-338.5(c)0(o)-14.7(mpa)-11.1(r)-7(i)0(-)]TJ
T*
[(s)-7.6(o)0(n)-252.7(t)0(o)-256.2(O)0(H)-9.3(,)-249.5(how)-14.1(eve)-13.2(r)-7(,)-249.5(da)-8.8(ta)-252.9(reg)-11.3(ar)-12.9(din)-9.9(g)-251(S)0(C)-11.3(H)-246.6(are)-259.3(var)-13.6(ia)-9.4(bl)-8(e.)-249.4(I)-8.4(n)-250(th)-10.2(e)]TJ
T*
[(be)-10.6(s)-7.6(t)-253.4(s)-7.6(t)0(u)-8.1(d)0(y)-260.3(t)0(o)-262.5(d)0(a)-8.8(t)0(e)-13(,)-255.8(Neg)-10.6(r)-7(o)-255.7(an)-9.2(d)-255.9(c)0(o)-8.4(l)-9.9(le)-9.8(agu)-11.6(es)-260.4(\(4)-12.6(0\))-259.2(pu)-9(bl)-8(is)-11.2(he)-9.6(d)-255.9(d)0(a)-8.8(t)0(a)]TJ
0 -1.2266 TD
[(s)-7.6(u)-7.7(gg)-8.8(est)-14.3(ing)-435(SC)-11.3(H)-423.6(i)-9.9(nc)-9(rea)-12.8(s)-7.6(e)0(s)-431.2(t)0(h)-10.2(e)-429.9(ris)-11.9(k)-428.1(o)0(f)-433.2(p)0(r)-8.4(e)0(g)-10.6(n)0(a)-9.2(n)0(c)-9(y)-428.1(co)-8.4(mp)-11.6(li)-7.1(ca)-11.4(-)]TJ
0 -1.2203 TD
[(ti)-10.3(o)-9.1(n)0(s)-226(i)0(n)-228.2(a)0(n)-9.2(t)0(i)-10.3(-)0(t)-13.6(h)0(y)-7.8(r)-7(oid)-230.6(per)-14.6(ox)-11.3(ida)-12.4(se)-228.8(an)-9.2(ti)-10.3(bo)-7.2(dy)-228.7(po)-10.4(si)-11.2(ti)-10.3(ve)-228.3(\(T)-9.8(POA)-12.1(b)]TJ
/F9 1 Tf
25.5762 0 TD
()Tj
/F6 1 Tf
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(\))Tj
-26.3476 -1.2203 TD
[(w)-7.9(ome)-12.9(n.)-246.6(I)-8.4(n)-243.7(a)-239.8(p)-7.7(r)-7(o)0(s)-10.4(pec)-13.2(ti)-10.3(ve,)-250.2(r)-7(a)0(n)-9.2(d)0(o)-12.1(m)0(i)-7.4(zed)-249(tr)-13.8(ia)-9.4(l)-243.8(o)0(f)]TJ
/F11 1 Tf
20.0816 0 TD
(>)Tj
/F6 1 Tf
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[(400)-11.2(0)-239.8(w)-7.9(ome)-12.9(n,)]TJ
-20.853 -1.2266 TD
[(a)-201.8(g)0(r)-11.4(o)0(u)-10.5(p)-197.4(o)-9.1(f)-196.5()74(lo)-14.5(w-)-8.4(r)-7(isk)-9.3()74()-197.9(in)-13.2(div)-13.6(idu)-14.2(al)-9.4(s)-197.3(w)-7.9(as)-203.2(u)-7.7(niv)-14(ers)-14.6(al)-9.4(ly)-204(s)-7.6(cre)-12.5(en)-9.6(ed)-205.2(in)]TJ
0 -1.2203 TD
[(ea)-12.1(r)-7(l)0(y)-267.2(p)-7.7(r)-7(egn)-14(an)-9.2(cy)-269.3(fo)-9.6(r)-272.6(T)0(P)-10.7(OAb)]TJ
/F9 1 Tf
12.2601 0 TD
()Tj
/F6 1 Tf
1.037 0 TD
[(an)-9.2(d)-268.6(T)0(S)-7.8(H)-271.9(el)-9.8(eva)-12.8(ti)-10.3(on)]TJ
/F11 1 Tf
8.479 0 TD
(>)Tj
/F6 1 Tf
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[(2.)-8.8(5)-265.1(m)0(I)-12.3(U)0(/)]TJ
-22.5475 -1.2203 TD
[(L)-9.3(.)-268.5(Wh)-8.7(en)-275.2(th)-16.5(is)-276.7(co)-8.4(mb)-8.3(ina)-12.8(ti)-10.3(on)-278(wa)-7.5(s)-273.2(ide)-12.8(nt)-10.2(i)-12.9(ed)-9.2(,)-268.5(L)0(T)]TJ
6.7246 0 0 5.9768 236.5795 428.3716 Tm
(4)Tj
8.9663 0 0 8.9663 242.3621 429.9023 Tm
[(tre)-13.7(at)-12.6(me)-10.1(nt)-275.7(wa)-7.5(s)]TJ
-20.3661 -1.2266 TD
.0148 Tc
[(initiated)-291.7(i)-1.4(n)-292.1(o)-.6(rder)-295.7(to)-297.8(normalize)-294.9(s).8(erum)-292.6(TSH.)-291.6(In)-298.4(a)-288.2(c)-3.4(ontrol)-298.6(po-)]TJ
0 -1.2203 TD
.0179 Tc
[(pu)3.9(la)5.7(ti)8(on)-219.4(of)-222.8(e)5.4(q).8(u)3.9(a)-.6(l)-213.3(s)-2.4(iz)5.7(e)-215.9(s)-2.4(e)5.4(r)4.6(um)-213.6(sa)]TJ
13.765 0 TD
.0161 Tc
[(mples)-225.5(w)1.8(ere)-217.7(o).7(btai)6.2(ned)-220.8(i)-.1(n)-221.2(e)3.6(arly)]TJ
-13.765 -1.2203 TD
.0165 Tc
[(pregnan)6.8(c)-1.7(y,)-397.4(but)-401.3(m)0(easurement)-401.3(of)-401.3(serum)-404.7(T).9(S)5.4(H)-400.8(and)-403.8(T)7.2(PO)-397.5(Ab)]TJ
0 -1.2266 TD
.0145 Tc
[(w)-6.1(a)2.3(s)-296.6(d)-1.1(ela)-4(y)3.8(e)-4.4(d)-292(u)-5.8(n)-1.5(til)-298.9(a)2.3(ft)-4.9(er)-296(de)-4.4(liv)-5.2(e)2(r)-5.2(y)3.8(,)-298.2(a)2.3(nd)-298.3(thu)-5.8(s)-296.6(no)-291.8(LT)]TJ
6.7246 0 0 5.9768 257.0456 384.5479 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 263.2251 386.0219 Tm
.0133 Tc
[(was)-297.8(p)-.7(r)-6.4(o)-2.1(-)]TJ
-22.6929 -1.2203 TD
.0163 Tc
[(vid)7(e)-2.6(d)-309.2(t)3.2(o)-315.3(t)3.2(his)-307.5(g)-.8(roup.)-309.1(T).7(hi)6.4(s)-313.8(a)4.1(llowed)-309.2(d).7(i)6.4(r)-3.4(ect)-306.6(c)-1.9(ompari)6.4(son)-309.6(o).9(f)-306.6(t)-3.1(he)]TJ
T*
.0188 Tc
[(ef)5.7(fe)6.3(ct)5.7(s)-248.1(o)3.4(f)-247.2(L)3.2(T)]TJ
6.7246 0 0 5.9768 109.0771 362.6645 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 114.8598 364.1385 Tm
.0153 Tc
[(admi)5.4(nistration)-253.6(i)5.4(n)-253.6(women)-253.6(w)1(ho)-253(were)-250.2(TPOAb)]TJ
/F9 1 Tf
19.7528 0 TD
0 Tc
()Tj
/F6 1 Tf
-25.8986 -1.2203 TD
.0169 Tc
[(and)-295.9(h).9(ad)-295.9(TSH)-299.2(v)3.5(a)4.7(l).7(ue)4.4(s)-300.6(a)4.7(bov)3.5(e)-299.1(2.5)-298.8(m)6.7(IU/L)-295.9(wit)3.8(h)-302.6(t)3.8(h).9(e)-299.1()1.3(ndings)-294.2(in)]TJ
0 -1.2266 TD
.0177 Tc
[(unt)4.6(r)4.4(ea)5.5(te)5.2(d)-383.6(c)-.5(ont)4.6(r)-2(ol)7.8(s.)-383.6(The)-380.5(r)-2(e)5.2(s)3.7(ul)7.8(ts)-382(conr)4.4(m)1.2(e)5.2(d)-383.6(a)-386.5(s)3.7(igni)8.4(c)-.5(a)5.5(n)1.7(t)-387.4(r)4.4(e-)]TJ
0 -1.2203 TD
.0162 Tc
[(ducti)6.3(o).8(n)-461.4(i)0(n)-461.4(a)-457.5(combined)-454.7(endpoint)-458.5(of)-458.5(pregnan)6.5(c)-2(y)-462.4(c)4.3(omplica-)]TJ
T*
.0166 Tc
[(tions.)-289.8(In)-290.3(a)-292.7(f)3.5(ollow-)3.5(up)-288.3(a)4.4(n).6(aly)5.9(s)-3.7(i)6.7(s)-294.5(of)-287.4(the)-286.8(s)-3.7(a)4.4(m).1(e)-286.8(d)1(at)3.5(a,)-289.8(N)4(e)-2.3(g)5.9(r)-3.1(o)]TJ
/F8 1 Tf
24.653 0 TD
.0133 Tc
[(et)-297(al.)]TJ
/F6 1 Tf
-24.653 -1.2266 TD
.0137 Tc
[(\()-5.7(4)1.5(1)-4.8(\))-606.4(rep)-6.6(o)-1.7(rte)-5.2(d)-602.6(a)-605.5(s)-6.6(ignica)-4.8(n)-2.3(tly)-604(h)-2.3(igher)-606.6(m)-2.8(is)-6.6(ca)-4.8(rria)-4.8(g)3(e)-605.8(r)-6(ate)-605.8(i)-2.5(n)]TJ
0 -1.2203 TD
.018 Tc
[(TPO)8.6(A)-2.4(b)]TJ
/F9 1 Tf
3.3764 0 TD
0 Tc
()Tj
/F6 1 Tf
.9737 0 TD
.0156 Tc
[(women)-202.8(w)1.3(ith)-196.4(T)0(SH)-199.4(levels)-200.7(b)4.9(e)-3.3(tween)-196.4(2)3.4(.5)-198.9(and)-196.1(5)3.4(.0)-198.9(mIU/)]TJ
-4.3502 -1.2203 TD
.3621 Tc
[(Lc)343.9(o)346.7(m)345.6(p)348.1(a)349.9(r)342.4(e)349.6(dw)347.8(i)345.9(t)349(ht)342.7(h)346.1(o)346.7(s)348.1(e)-4.5(w)347.8(i)345.9(t)349(h)-1.7(T)346.5(S)344.7(Hl)345.9(e)349.6(v)342.4(e)349.6(l)345.9(sb)345(e)343.2(l)352.2(o)346.7(w)-6.3(2)349.9(.)346.5(5m)345.6(I)347.3(U)348.1(/)346.5(L)]TJ
0 -1.2266 TD
.0155 Tc
[(\()-3.9(6)3.3(.1%)-194.8(v)2.1(s)-4.8(.)-196.1(3.6%)-194.8(respect)-3.9(ively,)]TJ
/F8 1 Tf
12.3739 0 TD
0 Tc
(p)Tj
/F9 1 Tf
.6829 0 TD
()Tj
/F6 1 Tf
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.0132 Tc
[(0)-5.3(.)-2.4(006)-5.3(\).)-204.7(The)-201.7(l)-3(a)-5.3(tte)-5.7(r)-196.2(t)-6.2(ria)-5.3(l)-199(had)-198.5(n)-2.8(o)]TJ
-13.9926 -1.2203 TD
0 Tc
[(i)-16.2(n)-16(t)-19.4(e)-12.5(r)-13.3(v)-19.7(e)-12.5(n)-16(t)-19.4(i)-9.9(o)-15.4(n)-16(a)-18.5(l)-357.6(c)-18.3(o)-15.4(m)-10.2(p)-20.3(o)-15.4(n)-16(e)-12.5(n)-16(t)-13.1(.)-363.3(T)-9.3(h)-16(e)-18.9(s)-14(e)-360.3(p)-14(r)-13.3(o)-15.4(s)-20.3(p)-14(e)-12.5(c)-18.3(t)-13.1(i)-16.2(v)-19.7(e)-354(da)22.8(ta)-322.4(ar)18.8(e)-328.7(s)0(u)16.3(p)0(-)]TJ
T*
[(po)21.2(rt)17.8(e)12.8(d)-243.3(b)14.6(y)-238.4(pr)23.2(ev)18.3(io)19(us)-224(re)18.4(t)12.2(r)0(o)21.8(s)0(p)16.3(e)12.8(c)13.4(t)0(i)21.3(v)0(e)-228.3(d)0(a)16.5(t)12.2(a)-239.8(p)0(u)22.6(b)14.6(li)18.2(sh)20.6(e)12.8(d)-243.3(b)14.6(y)-238.4(C)12.5(a)0(s)18.1(e)12.8(y)-238.4(a)0(n)22.4(d)]TJ
T*
[(co)16.9(l)15.4(l)0(e)15.5(a)13.1(g)14.6(u)0(e)17.7(s)-406(\()12.2(3)13.1(5\))19(.)-401.3(I)0(n)-397.5(t)12.2(ha)22.4(t)-405.1(i)0(n)18.4(v)0(e)24.7(s)0(t)17.2(i)0(g)23.7(a)13.1(ti)21.3(on)19.1(,)-407.6(a)-404.2(t)12.2(w)0(o)20.9(-)-405.1(t)12.2(o)-407.4(t)12.2(h)0(r)21.2(e)0(e)19.2(f)12.2(ol)19(d)-401.3(i)0(n)18.4(-)]TJ
0 -1.2266 TD
[(cr)19(e)12.8(a)0(s)18.1(e)12.8(d)-363.4(r)0(i)21.1(s)0(k)-353.5(o)0(f)-351(p)0(r)16.9(e)12.7(gn)17.5(a)13.1(n)0(c)22.6(y)0(-)20.4(r)0(e)18.4(l)15.4(at)19(e)12.8(d)-363.4(co)16.9(m)15.1(p)0(l)20.4(i)0(c)22.5(a)0(t)19(i)0(o)25.3(n)0(s)-358.8(w)0(a)24.2(s)-361.7(de)22.4(mo)18.6(n-)]TJ
0 -1.2203 TD
[(st)17.2(ra)25.1(te)18.6(d)-243.3(i)15.4(n)-243.7(u)0(n)20.6(t)12.2(re)18.4(a)13.1(t)0(e)18.6(d)-243.3(wo)20.9(m)15.1(e)12.8(n)-243.7(w)0(i)20.1(t)12.2(h)-243.7(S)0(C)20.3(H)12.7(.)-243.2(S)14.2(im)17.9(il)24.6(ar)18.8(l)15.4(y)0(,)-235(B)16(en)15.7(ha)22.4(di)-227.8(an)22.4(d)]TJ
T*
[(co)16.9(l)15.4(l)0(e)15.5(a)13.1(g)14.6(u)0(e)17.7(s)-380.7(\()12.2(4)13.1(2\))-373(pe)24(rf)17.8(or)21.8(m)15.1(e)0(d)-369.6(a)-378.9(ca)20.2(se)17.8()13.1(c)13.4(on)19.1(t)12.2(r)0(o)21.8(l)-382.9(st)23.5(ud)20.9(y)-383.8(i)15.4(nv)21.2(es)17.8(t)12.2(i)0(g)23.7(a)0(t)19(i)0(n)18.4(g)]TJ
0 -1.2267 TD
[(ri)21.1(sk)-265(of)-268.8(pr)23.2(eg)21(na)16.1(n)15.6(c)0(y)-269.3(l)0(o)25.3(s)0(s)-268.2(i)0(n)-266.2(2)13.1(49)19.9(7)-277.7(D)0(u)22.5(t)12.2(ch)-268.2(wo)20.9(me)21.5(n.)-265.5(In)-264.7(th)15.1(i)15.4(s)-279.5(c)13.4(o)0(h)19.1(o)0(r)21.8(t)-278.7(of)]TJ
0 -1.2203 TD
[(pr)16.9(e)12.8(g)0(n)23.8(a)0(n)16.1(t)-297.6(wo)20.9(me)21.5(n)-300.6(w)0(i)20.1(t)12.2(ho)19.1(ut)-286.4(OH)15.9(,)-293.8(t)0(h)15.1(e)-297.1(ri)21.1(sk)-290.3(of)-287.8(ch)16.3(i)15.4(l)0(d)-291.1(l)0(o)19(s)0(s)-287.2(i)0(n)18.4(c)13.4(re)18.4(a)13.1(s)0(e)24.1(d)]TJ
T*
[(wi)20.1(t)12.2(h)-275.3(h)15.6(i)0(g)17.3(h)15.6(er)-259.8(le)21.9(ve)18.3(ls)-257.8(of)-262.5(m)15.1(a)13.1(te)18.6(rn)21.2(a)13.1(l)-269.1(TS)17.5(H)12.7(.)]TJ
1.1128 -1.2266 TD
.0177 Tc
[(How)3.4(e)5.2(ve)5.2(r)4.4(,)-314(s)3.7(o)2.3(me)-304.7(pu)3.7(bl)7.8(is)3.7(hed)-307.8(d)2.1(a)5.5(t)-1.7(a)-310.6(d)2.1(e)5.2(m)1.2(ons)3.7(t)4.6(ra)5.5(te)-304.7(cont)4.6(ra)5.5(s)3.7(t)-1.7(ing)]TJ
-1.1128 -1.2203 TD
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[(conclu)-5.2(sions.)-228.1(Clear)-4.6(y)4.4(-)-4.3(G)3.7(oldman)]TJ
/F8 1 Tf
13.5437 0 TD
.019 Tc
[(et)-221.7(al)4.5(.)]TJ
/F6 1 Tf
2.2004 0 TD
[(\(4)6.7(3\))-221.8(re)6.4(p)4.9(o)3.5(rt)5.8(ed)-224.4(no)-224.1(ad)9.6(ve)6.4(rs)4.9(e)]TJ
-15.744 -1.2203 TD
.0148 Tc
[(e)-4.1(f)1.7(f)-4.6(e)2.3(c)-3.4(t)-358.7(from)-355.8(s)-5.5(u).8(bclinica)-3.7(l)-355.5(mate)-4.1(rna)-3.7(l)-355.5(hypothyroidism)-355.8(\()-4.6(d)5.5(e)-4.1(t)1.7(e)-4.1(c)2.9(t)-4.6(e)2.3(d)]TJ
0 -1.2266 TD
.0159 Tc
[(in)-531.3(the)-527.8().3(rst)-534.7(a)3.7(nd)-530.9(second)-530.9(trimester\))-528.3(in)-531.3(a)-533.7(c)-2.3(ohort)-534.7(o).5(f)-528.3(1)-2.6(0,990)]TJ
0 -1.2203 TD
.0152 Tc
[(p)-5.1(r)1.9(egnant)-472.1(women.)-468.3(However,)-468.3(t)-4.2(h)5.5(e)-471.6(s)1.2(t)-4.2(u)1.2(dy)-463.4(analysis)-466.7(was)-466.7(p)1.2(er-)]TJ
T*
.0161 Tc
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T*
.014 Tc
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[(gestation.)-353.9(F)5(u)-4.6(rthermore,)-353.9(wo)]TJ
12.4751 0 TD
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28.0042 74.5598 TD
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13.0884 0 TD
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15.0738 0 TD
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14.9031 0 TD
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T*
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13.746 0 TD
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-14.4036 -1.2203 TD
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6.7246 0 0 5.9768 475.4833 636.6046 Tm
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8.9663 0 0 8.9663 481.7195 638.0786 Tm
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[(l)-4.7(e)-1.1(ve)-7.4(ls)-306(in)-308.1(202)-304.2(sin)-4.6(-)]TJ
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T*
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13.7523 0 TD
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0 -1.2203 TD
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T*
.0196 Tc
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/F8 1 Tf
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(<)Tj
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6.7246 0 0 5.9768 519.3636 570.8408 Tm
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(4)Tj
8.9663 0 0 8.9663 526.7904 572.3715 Tm
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[(level)5.4(s)]TJ
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[(0.05)-5.2(\).)-539.7(At)]TJ
-22.5665 -1.2203 TD
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T*
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(outcomes.)Tj
1.1128 -1.2203 TD
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T*
.0099 Tc
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0 -1.2266 TD
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T*
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[(H)9.3(a)-9.2(ddo)-6.1(w)]TJ
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[(et)-384(al.)]TJ
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T*
.01 Tc
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0 -1.2266 TD
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0 -1.2203 TD
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T*
[(ex)-21(tr)-20.1(a)-12.2(c)0(t)-18.7(a)-12.2(bl)-20.6(e)-322.4(i)-9.9(o)-9.1(d)-9.3(i)-9.9(n)-9.7(e)-328.7(a)0(s)-329.6(o)-15.4(p)-7.7(p)-7.7(o)-15.4(s)-7.6(e)-12.5(d)-325.5(t)0(o)-332(t)-13.1(h)-9.7(y)-10.7(r)-7(o)-9.1(i)-9.9(d)-325.5(f)-13.1(u)-7.7(n)-9.7(c)-11.9(t)-13.1(i)-9.9(o)-9.1(n)-325.9(m)-10.2(e)0(a)-18.4(s)-14(u)-7.7(r)-13.3(e-)]TJ
0 -1.2266 TD
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0 -1.2203 TD
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T*
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T*
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/F11 1 Tf
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(<)Tj
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[(85)-239.3(at)]TJ
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T*
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0 -1.2266 TD
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0 -1.2203 TD
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T*
.0103 Tc
[(outcomes.)-258.2(I)-4.5(n)-258.6(t)-2.8(he)-261.5(sec)10.3(o)-10.7(ndary)-259.7(e)-2.2(ndpoint,)-258.2(which)-258.7(c)-1.6(on)-5.7(sist)10.3(e)-9(d)-258.3(of)-262.1(an)]TJ
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T*
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T*
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T*
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ET
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T*
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[(pr)16.9(e)12.8(g)0(n)23.8(a)0(n)16.1(c)13.4(y,)-222.3(an)16.1(d)-236.9(t)12.2(he)22(re)18.4(a)13.1(f)12.2(te)18.6(r)-234.6(p)0(l)20.4(a)13.1(te)18.6(a)13.1(u)-241.6(un)20.6(t)12.2(i)0(l)-222(t)0(i)21.3(m)0(e)-231.4(o)16.2(f)-240.7(d)0(e)22.4(l)0(i)18.2(v)0(e)24.7(r)0(y)20.2(.)-236.9(T)16(h)0(e)15.7(s)0(e)]TJ
T*
[(da)22.8(ta)-290.8(pr)16.9(o)16.2(v)0(i)21(d)0(e)-293.8(t)12.2(he)-287.8(ba)21.4(si)20.4(s)-298.5(f)0(o)15.7(r)-297.9(re)24.7(co)16.9(m)15.1(m)0(e)21.5(n)0(d)18.9(i)0(n)18.4(g)-295.3(ad)22.8(ju)19(st)23.5(me)21.5(nt)21.4(s)-304.8(t)12.2(o)-299.9(t)12.2(hy)17.5(-)]TJ
0 -1.2266 TD
[(ro)21.8(id)-373.3(ho)19.1(rm)20.7(on)25.5(e)-385.6(i)0(n)-373.6(a)13.1(f)12.2(f)12.2(e)0(c)19.8(t)0(e)18.6(d)-382.4(wo)20.9(m)15.1(e)0(n)-376.3(o)0(n)25.5(c)0(e)-372.2(p)0(r)16.9(e)12.8(gn)23.8(an)16.1(t)-379.8(a)13.1(nd)-373.1(f)12.2(o)0(r)-376.5(t)12.2(he)]TJ
0 -1.2203 TD
[(ti)21.3(mi)17.9(ng)-241.8(of)-243.5(f)12.2(o)0(l)19(l)0(o)19(w)0(-)23.2(u)0(p)-243(i)0(n)18.4(t)12.2(e)12.7(r)0(v)17.5(a)13.1(ls)-245.1(f)12.2(o)0(r)-243.7(T)0(S)17.5(H)-252.9(in)-240.9(tr)17.8(e)12.8(a)13.1(te)18.6(d)-255.9(p)0(a)24.4(t)0(i)21.3(e)0(n)22(t)0(s)17.2(.)]TJ
/F10 1 Tf
0 -2.7758 TD
[(Question)-338(16:)-333.4(What)-336.1(proportion)-338.1(of)-330.2(treated)-333.7(hypothyroid)]TJ
0 -1.2266 TD
[(women)-335.1(\(receiving)-336(LT)]TJ
6.7246 0 0 5.9768 150.0094 387.0424 Tm
(4)Tj
8.9663 0 0 8.9663 153.6944 388.5164 Tm
[(\))-337.2(require)-334.9(changes)-331.8(in)-331.6(their)-338.9(LT)]TJ
6.7246 0 0 5.9768 276.7747 387.0424 Tm
(4)Tj
8.9663 0 0 8.9663 59.7543 377.5747 Tm
[(dose)-336.3(during)-336.6(pregnancy?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Between)-381.2(50%)-380(and)-379(85%)-380(\(38,53,54\))-383.2(of)-376.3(hypothyroid)-384.3(women)]TJ
-1.1128 -1.2203 TD
[(being)-433(treated)-433.9(with)-426.3(exogenous)-435.3(LT)]TJ
6.7246 0 0 5.9768 195.1369 348.6613 Tm
(4)Tj
8.9663 0 0 8.9663 202.3936 350.192 Tm
[(need)-429.8(to)-426.9(increase)-431.2(dosing)]TJ
-15.9084 -1.2203 TD
[(during)-231.4(pregnancy.)-221.6(The)-227.6(incremental)-232.5(increase)-222.5(depends,)-229.8(in)-221.9(part,)]TJ
0 -1.2266 TD
[(on)-480.4(the)-478(etiology)-483.4(of)-477.5(the)-478(hypothyroidism.)-484.5(There)-481.1(is)-479.1(a)-473.7(greater)]TJ
0 -1.2203 TD
[(likelihood)-213.7(that)-212.5(dose)-215.6(increase)-209.9(will)-214.6(be)-206.6(required)-215.8(in)-209.2(those)-216.5(patients)]TJ
T*
[(without)-329.8(functional)-333.9(thyroid)-328.1(tissue)-324(\(e.g.,)-329.7(due)-326.7(to)-325.7(radioablation,)]TJ
0 -1.2266 TD
[(surgery\))-316.8(in)-310.4(comparison)-309.4(with)-312.5(patients)-313.4(with)-306.2(Hashimotos)-318(thy-)]TJ
0 -1.2203 TD
[(roiditis)-284.4(\(55,56\).)]TJ
/F10 1 Tf
0 -2.7252 TD
[(Question)-338(17:)-333.4(In)-331.6(treated)-333.7(hypothyroid)-339.9(women)-335.1(\(receiving)]TJ
0 -1.2203 TD
(LT)Tj
6.7246 0 0 5.9768 70.8094 247.5779 Tm
(4)Tj
8.9663 0 0 8.9663 74.4945 249.0519 Tm
[(\))-324.6(who)-317.8(are)-319.4(planning)-324.3(pregnancy,)-322.7(how)-324.2(should)-321.4(the)-322(LT)]TJ
6.7246 0 0 5.9768 289.1905 247.5779 Tm
(4)Tj
8.9663 0 0 8.9663 59.7543 238.1102 Tm
[(dose)-336.3(be)-332.5(adjusted?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Th)25.2(e)-417.2(L)0(T)]TJ
6.7246 0 0 5.9768 98.5889 220.1952 Tm
(4)Tj
8.9663 0 0 8.9663 105.7322 221.6693 Tm
[(a)19.5(d)0(j)23.7(u)0(s)22.6(t)12.2(m)15.1(e)12.7(n)15.6(t)12.2(,)-420.2(w)17.3(he)22(n)-420.7(n)15.6(e)12.8(c)13.4(e)12.8(s)0(s)22.7(a)13.1(ry)26.5(,)-413.9(s)0(h)20.6(o)16.2(ul)26.7(d)-420.3(b)14.6(e)-417.2(m)15.1(a)13.1(d)0(e)-407.6(a)13.1(s)]TJ
-5.1279 -1.2203 TD
[(so)21.2(o)16.2(n)-408.1(a)13.1(s)-406(p)17.6(o)0(s)21.2(s)17.7(ib)23.7(l)15.4(e)-404.6(a)13.1(f)12.2(t)12.2(e)12.8(r)-405.4(p)0(r)23.2(e)12.8(g)14.6(n)0(a)28.7(n)0(c)22.6(y)-402.8(is)-390.5(co)23.2(n)25.2(rm)27(e)12.8(d)-407.7(t)12.2(o)-401.1(re)24.7(d)16(u)0(c)24.7(e)-404.6(t)12.2(h)0(e)]TJ
0 -1.2267 TD
[(pr)23.2(ob)24.4(a)13.1(b)14.6(i)15.4(l)0(i)24.6(t)12.2(y)-421.7(o)16.2(f)-424.1(h)15.6(y)14.6(p)0(o)21.2(t)12.2(h)15.6(y)14.6(ro)21.8(i)15.4(d)0(i)25.1(s)0(m)26.4(.)-420.2(N)12.7(o)16.2(rm)20.7(a)13.1(l)15.4(i)15.4(z)13.1(a)13.1(t)12.2(i)15.4(o)0(n)-410.8(o)0(f)-407.9(T)0(S)23.8(H)-417.3(le)21.9(ve)24.7(l)15.4(s)]TJ
0 -1.2203 TD
[(t)12.2(h)0(r)21.2(o)16.2(ug)25.8(ho)25.5(ut)-368.6(g)14.6(e)12.8(st)23.5(a)13.1(t)12.2(i)15.4(o)0(n)-372.9(i)15.4(s)-380.7(t)12.2(he)-370(g)14.6(o)0(a)23(l)15.4(.)-382.3(A)-380.8(pr)29.6(os)21.2(pe)24(c)13.4(t)12.2(i)15.4(v)0(e)24.7(,)-382.3(r)18.3(a)13.1(nd)25.2(om)25(i)15.4(z)13.1(e)12.7(d)]TJ
T*
[(st)23.5(ud)27.3(y)-339.5(h)0(a)22.4(s)-336.4(re)24.7(c)13.4(e)12.7(n)15.6(t)12.2(ly)-330.4(p)17.6(r)0(o)21.8(v)0(i)27.3(d)16(e)12.8(d)-344.4(e)12.7(v)18.2(id)25.1(e)12.8(n)0(c)22.6(e)-335(in)-329.4(su)22.6(p)17.6(p)0(o)21.2(r)18.3(t)-341.9(o)0(f)-325.7(o)0(n)25.5(e)-341.3(d)16(o)0(s)21.2(e)]TJ
0 -1.2266 TD
[(a)13.1(d)0(j)23.7(u)0(s)28.9(t)12.2(me)21.5(n)15.6(t)-329.3(st)23.5(ra)25.1(t)12.2(e)12.7(g)14.6(y)-326.9(f)12.2(o)0(r)-319.6(w)17.3(om)25(e)12.8(n)-332.2(re)24.7(c)13.4(e)12.8(i)15.4(v)0(i)27.3(n)0(g)-317.6(L)16(T)]TJ
6.7246 0 0 5.9768 233.7448 165.3732 Tm
(4)Tj
8.9663 0 0 8.9663 240.0377 166.8472 Tm
[(wh)26.6(o)-331.6(a)13.1(re)-316.7(ne)22(w)17.3(l)0(y)]TJ
-20.1069 -1.2203 TD
[(pr)23.2(e)12.8(g)14.6(na)22.4(n)15.6(t)-316.6(\()12.2(5)13.1(7)13.1(\))12.2(.)-312.7(F)14.6(o)16.2(r)-316.8(wo)27.2(me)21.5(n)-313.2(w)17.3(ho)-303.3(a)13.1(r)0(e)-304.1(e)12.8(u)17.6(t)12.2(hy)23.8(ro)28.1(id)-303.7(wh)26.6(i)15.4(l)0(e)-306.9(r)18.3(e)12.8(c)0(e)19.8(i)15.4(vi)27.3(ng)]TJ
T*
[(on)25.5(c)13.4(e)12.7(-)12.2(d)0(a)22.8(i)15.4(ly)-260.9(d)16(o)0(s)21.2(i)15.4(n)15.6(g)-276.3(o)16.2(f)-272.4(LT)]TJ
6.7246 0 0 5.9768 151.1433 143.433 Tm
(4)Tj
8.9663 0 0 8.9663 156.9259 144.9638 Tm
-.0131 Tc
[(\(r)-13.1(e)11.6(g)1.5(ar)-13.1(d)8.5(l)2.3(es)-13.1(s)-268.6(o)-13.1(f)-275.6(a)0(mo)-13.1(u)8.1(n)2.5(t\),)-281.6(a)-284.5(r)-13.1(e)11.6(c).3(o)-13.1(m)11.9(men)-13.1(-)]TJ
-10.8375 -1.2266 TD
0 Tc
[(da)22.8(t)12.2(i)15.4(on)-176.9(t)12.2(o)-186.1(i)15.4(n)15.6(c)13.4(r)0(e)24.7(a)13.1(se)-178.3(b)14.6(y)-181.5(t)12.2(w)0(o)-175.1(a)13.1(d)16(d)0(i)25.1(t)12.2(i)15.4(o)0(n)25.5(a)13.1(l)-186.9(t)12.2(a)13.1(b)14.6(le)21.9(t)12.2(s)-184.7(we)23.8(e)12.8(k)14.6(l)15.4(y)-187.8(\()12.2(n)15.6(in)24.7(e)-189.6(t)12.2(a)13.1(b)14.6(l)15.4(e)12.8(t)12.2(s)]TJ
0 -1.2203 TD
-.014 Tc
[(p)-14(e)10(r)-299.2(w)-14(e)9.8(e)-1.3(k)-296.6(i)1.4(ns)-14(t)9.5(e)-1.2(ad)-295.2(o)-14(f)-289.1(s)-14(e)10.1(v)4.2(e)-1.2(n)-301.9(t)-1.8(ablets)-299.8(p)-14(e)10(r)-292.9(w)-14(e)9.8(e)-1.2(k;)-295.1(29%)-300.2(in)-14(c)8.6(r)-14(e)10.7(a)-.9(se\))-299(c)-.6(an)]TJ
T*
0 Tc
[(e)12.8(f)12.2(f)12.2(e)12.8(c)13.4(t)12.2(iv)21(e)12.7(l)15.4(y)-390.1(p)0(r)29.6(e)12.8(ve)24.7(nt)-376.9(ma)21.9(t)12.2(e)12.8(r)18.3(n)0(a)22.4(l)-389.2(h)15.6(y)0(p)25.8(o)0(t)22.1(h)15.6(yr)26.5(oi)25.3(di)25.1(sm)-378.3(d)16(u)0(r)23.2(i)15.4(ng)-380.9(t)12.2(h)15.6(e)-391.9()16(rs)23.3(t)]TJ
T*
[(t)12.2(r)0(i)21.1(m)15.1(e)12.8(s)0(t)23.5(e)12.7(r)-361.1(a)13.1(nd)-354.1(m)15.1(i)15.4(mi)24.2(c)-366(g)14.6(e)12.8(s)0(t)23.5(a)13.1(t)12.2(i)15.4(on)25.5(a)13.1(l)-363.9(ph)20.5(y)14.6(s)17.7(io)25.3(lo)25.3(g)14.6(y)0(.)-355.1(T)16(hi)24.7(s)-368(a)13.1(u)17.6(g)0(m)23.3(e)12.7(n)15.6(t)12.2(e)12.7(d)]TJ
0 -1.2266 TD
[(do)25.8(se)-260.4(s)17.7(h)0(o)25.5(u)0(l)20.4(d)-262.2(oc)23.2(c)13.4(u)0(r)-255(i)15.4(mm)23.8(e)12.8(d)16(ia)22.3(t)12.2(e)12.8(l)15.4(y)-270(a)13.1(f)12.2(t)12.2(e)12.7(r)-266.3(a)-265.1(m)15.1(i)0(s)20.4(s)17.7(e)12.8(d)-268.6(m)15.1(e)12.7(ns)20.6(t)12.2(r)0(u)29.6(a)13.1(l)-269.1(c)13.4(y)14.6(c)13.4(le)]TJ
0 -1.2203 TD
[(or)-604.1(su)22.6(sp)28.9(e)12.8(c)13.4(t)12.2(e)12.8(d)-616.3(p)0(r)23.2(e)12.7(g)14.6(n)0(a)22.4(n)15.6(c)13.4(y)-617.7(o)16.2(c)13.4(c)13.4(u)0(r)23.2(s)0(.)-604.9(C)12.5(o)16.2(n)0()25.2(r)0(m)27(a)13.1(t)12.2(o)0(r)28.1(y)-617.7(b)14.6(i)0(o)25.3(c)13.4(he)22(m)15.1(i)15.4(c)13.4(a)13.1(l)]TJ
T*
[(t)12.2(e)12.8(st)23.5(i)15.4(n)0(g)-273.4(s)0(h)26.9(o)0(u)27.5(l)0(d)-272.1(a)13.1(l)15.4(s)0(o)-276(o)16.2(c)13.4(c)13.4(u)0(r)-273.9(s)17.7(im)24.2(ul)26.7(t)12.2(a)13.1(ne)22(o)16.2(u)0(s)22.6(l)15.4(y)14.6(.)-281.1(A)-285.9(s)0(e)24.1(p)0(a)24.4(r)18.3(a)13.1(t)12.2(e)-284.4(o)0(p)27.5(t)12.2(io)25.3(n)-287.9(i)15.4(s)]TJ
0 -1.2267 TD
[(t)12.2(o)-205.1(i)15.4(n)15.6(c)13.4(r)0(e)24.7(a)13.1(se)-190.9(t)12.2(h)15.6(e)-202.2(d)16(os)27.5(a)13.1(g)0(e)-187.7(o)0(f)-186.6(d)0(a)22.8(i)15.4(l)15.4(y)-200.4(LT)]TJ
6.7246 0 0 5.9768 185.6125 55.7858 Tm
(4)Tj
8.9663 0 0 8.9663 190.7716 57.2598 Tm
-.0139 Tc
[(by)-214.3(ap)-13.9(p)8.7(r)4.4(o)-13.9(x)6.5(imately)-214.3(25%)-13.9()10.2(30%.)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 310.0535 728.277 Tm
0 Tc
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 320.485 725.7825 Tm
[(RECOMMENDATION)-284.1(13)]TJ
/F6 1 Tf
.0569 -1.2203 TD
[(Treated)-607.2(hypothyroid)-611.9(patients)-610.6(\(receiving)-616.5(LT)]TJ
6.7246 0 0 5.9768 503.2062 713.3101 Tm
(4)Tj
8.9663 0 0 8.9663 506.5511 714.8408 Tm
[(\))-607.5(who)-608.5(are)]TJ
-20.6949 -1.2266 TD
[(newly)-316.4(pregnant)-323(should)-312.5(independently)-326.4(increase)-317.3(their)-317.8(dose)]TJ
0 -1.2203 TD
[(of)-382.6(LT)]TJ
6.7246 0 0 5.9768 342.992 691.4266 Tm
(4)Tj
8.9663 0 0 8.9663 349.7952 692.9006 Tm
(by)Tj
/F13 1 Tf
1.4859 0 TD
(*)Tj
/F6 1 Tf
.999 0 TD
[(25%30%)-380.2(upon)-381.9(a)-385.2(missed)-379.7(menstrual)-387.1(cycle)-385.8(or)]TJ
-5.6969 -1.2203 TD
[(positive)-449.9(home)-439.9(pregnancy)-446.3(test)-451.1(and)-442.2(notify)-445(their)-444.3(caregiver)]TJ
0 -1.2266 TD
[(promptly.)-299.6(One)-297.2(means)-298.9(of)-300.4(accomplishing)-301.1(this)-299.6(adjustment)-302.8(is)]TJ
0 -1.2203 TD
[(to)-376.3(increase)-380.6(LT)]TJ
6.7246 0 0 5.9768 377.9716 658.5447 Tm
(4)Tj
8.9663 0 0 8.9663 384.718 660.0187 Tm
[(from)-374.6(once)-378.4(daily)-374.4(dosing)-378.8(to)-376.3(a)-378.9(total)-373.5(of)-376.3(nine)]TJ
-7.107 -1.2203 TD
[(doses)-280.2(per)-286.5(week)-277.7(\(29%)-279.3(increase\).)]TJ
/F4 1 Tf
13.8788 0 TD
[(Level)-278.8(B-USPSTF)]TJ
/F10 1 Tf
-15.0106 -2.447 TD
[(Question)-331.7(18:)-333.4(In)-338(treated)-333.7(hypothyroid)-333.6(women)-335.1(\(receiving)]TJ
0 -1.2203 TD
(LT)Tj
6.7246 0 0 5.9768 321.8456 614.7211 Tm
(4)Tj
8.9663 0 0 8.9663 325.5873 616.1951 Tm
[(\))-330.9(who)-336.8(are)-332(newly)-337.2(pregnant,)-335(what)-331.4(factors)-333.7(inuence)]TJ
-1.644 -1.2203 TD
[(thyroid)-286.9(status)-295(and)-287.6(LT)]TJ
6.7246 0 0 5.9768 402.4062 603.7227 Tm
(4)Tj
8.9663 0 0 8.9663 408.6991 605.2534 Tm
[(requirements)-288.5(during)-292.4(gestation?)]TJ
/F6 1 Tf
-9.8005 -1.8336 TD
[(The)-455.2(difculties)-462(inherent)-463.6(in)-462.2(trying)-459.5(to)-458.5(achieve)-461.5(rapid)-457(TSH)]TJ
-1.1128 -1.2266 TD
[(normalization)-431.2(following)-430.7(conception)-433.5(have)-433.5(focused)-431.7(attention)]TJ
0 -1.2203 TD
[(upon)-464.1(preconception)-467(TSH)-469.4(modulation.)-463.4(Some)-466.6(advocate)-460.4(that)]TJ
T*
[(TSH)-336.6(levels)-337.7(be)-339.4(lower)-337.3(than)-341.9(2.5)-337.1(mIU/L)-335.9(in)-342(women)-334(planning)-345(to)]TJ
0 -1.2266 TD
[(become)-522.3(pregnant)-531.6(\(1\).)-521.9(Others)-527.3(advocate)-523.7(that)-528.6(preconception)]TJ
0 -1.2203 TD
[(TSH)-279.7(levels)-280.8(be)-282.5(lower)-280.4(than)-285(1.2)-280.1(mIU/L.)-275.6(In)-283.7(a)-277.7(study)-282.5(favoring)-287.4(the)]TJ
T*
[(latter,)-266.7(only)-267(17%)-266.2(of)-268.8(women)-270.8(with)-268.3(TSH)-267(values)-265.6(under)-267.6(this)-267.9(cutoff)]TJ
0 -1.2266 TD
[(ha)22.4(d)-218(t)12.2(o)-217.8(i)0(n)18.4(c)13.4(re)18.4(as)18.1(e)-214.9(L)0(T)]TJ
6.7246 0 0 5.9768 380.8062 510.5762 Tm
(4)Tj
8.9663 0 0 8.9663 386.1353 512.0503 Tm
[(d)16(o)0(s)14.9(e)-214.9(la)22.2(te)18.6(r)-215.7(d)0(u)14.6(r)0(i)21.1(n)0(g)-203.8(p)0(r)16.9(e)12.7(gn)17.5(a)13.1(n)0(c)16.3(y)-213.1(\(5)19(8\))19(.)-217.9(S)0(e)20.6(p)0(a)18.1(r)0(a)18.8(t)12.2(e,)]TJ
-8.3968 -1.2203 TD
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T*
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[(TSH)-235.4(elevation)-235.1(should)-230.3(be)-231.9(avoided)-233.8(during)-231.4(gestation)-230.8(because)]TJ
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T*
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T*
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T*
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[(permetabolism)-214.9(and)-201.9(hyperactivity)-211.4(that)-212.5(results)-210.9(when)-204.3(the)-212.4(serum)]TJ
0 -1.2203 TD
[(concentrations)-456.5(of)-452.2(free)-449.9(thyroxine)-457(hormone)-446.8(\(T)]TJ
6.7246 0 0 5.9768 241.0582 455.8109 Tm
(4)Tj
8.9663 0 0 8.9663 244.4031 457.2849 Tm
[(\))-449.4(and/or)-455(free)]TJ
-20.5937 -1.2203 TD
[(triiodothyronine)-456(\(T)]TJ
6.7246 0 0 5.9768 136.8567 444.8125 Tm
(3)Tj
8.9663 0 0 8.9663 140.2582 446.3432 Tm
[(\))-443.1(are)-442.7(high)78.2()-438.2(\(67\).)-445.5(Graves)-445.4(disease)-451.1(is)-441.1(the)]TJ
-8.9785 -1.2266 TD
[(most)-590.2(common)-585.1(cause)-583.1(of)-584.9(autoimmune)-589.1(hyperthyroidism)-593.2(in)]TJ
0 -1.2203 TD
[(pregnancy,)-518.8(occurring)-514.9(in)-512.8(0.1%1%)-516.4(\(0.4%)-509.9(clinical)-515.1(and)-511.7(0.6%)]TJ
T*
[(subclinical\))-225.5(of)-224.5(all)-221.6(pregnancies)-231.7(\(68,69\).)-219.8(It)-223.9(may)-222.8(be)-219.3(diagnosed)-223.2(for)]TJ
0 -1.2266 TD
[(the)-300.9(rst)-296.3(time)-292.3(in)-297.8(pregnancy)-294.6(or)-294.3(may)-292.3(present)-304.2(as)-291.7(a)-296.7(recurrent)-297.2(ep-)]TJ
0 -1.2203 TD
[(isode)-187.6(in)-184(a)-182.9(woman)-188.2(with)-186.1(a)-182.9(past)-186(history)-187.3(of)-186.6(hyperthyroidism.)-185.1(Less)]TJ
T*
[(common)-433.3(non-autoimmune)-428.4(causes)-432.6(of)-426.9(thyrotoxicosis)-433.6(include)]TJ
T*
[(toxic)-299.1(multinodular)-298.9(goiter,)-299.2(toxic)-299.1(adenoma,)-293.1(and)-296.8(factitious)-303.6(thy-)]TJ
0 -1.2266 TD
[(rotoxicosis.)-402.9(Subacute)-396.8(painful)-392.5(or)-395.5(silent)-397.8(thyroiditis)-400.2(or)-395.5(struma)]TJ
0 -1.2203 TD
[(ovarii)-396.5(are)-392.1(rare)-392.8(causes)-394.7(of)-388.9(thyrotoxicosis)-402(in)-392.6(pregnancy.)-392.3(More)]TJ
T*
[(frequent)-244.5(than)-234.4(Graves)-236.8(disease)-236.1(as)-234.8(the)-237.7(cause)-235.3(of)-237.2(thyrotoxicosis)-243.9(is)]TJ
0 -1.2266 TD
[(the)-610.8(syndrome)-601.1(of)-603.9(gestational)-613.2(hyperthyroidism)-605.8(dened)-606.5(as)]TJ
0 -1.2203 TD
[()80.3(transient)-356(hyperthyroidism,)-349.5(limited)-346.6(to)-351(the)-351.5(rst)-346.9(half)-348.3(of)-351(preg-)]TJ
T*
[(nancy)-496.9(characterized)-495.6(by)-489.4(elevated)-493.8(FT)]TJ
6.7246 0 0 5.9768 206.8157 302.3432 Tm
(4)Tj
8.9663 0 0 8.9663 214.5826 303.8739 Tm
[(or)-490.3(adjusted)-494(TT)]TJ
6.7246 0 0 5.9768 276.0944 302.3432 Tm
(4)Tj
8.9663 0 0 8.9663 283.8614 303.8739 Tm
(and)Tj
-24.9945 -1.2266 TD
[(suppressed)-479.4(or)-465(undetectable)-476.7(serum)-475(TSH,)-466(in)-474.8(the)-471.6(absence)-469.3(of)]TJ
0 -1.2203 TD
[(serum)-209.5(markers)-212.8(of)-205.6(thyroid)-214.3(autoimmunity)77()-204.2(\(70\).)-211.5(It)-211.2(is)-207.2(diagnosed)]TJ
T*
[(in)-215.6(about)-210.9(1%3%)-216.8(of)-211.9(pregnancies,)-215.6(depending)-211.6(on)-214.8(the)-212.4(geographic)]TJ
0 -1.2267 TD
[(area)-202(and)-195.6(is)-194.5(secondary)-197.7(to)-199.3(elevated)-196.6(hCG)-198.3(levels)-198.6(\(70,71\).)-194.5(It)-198.6(may)-197.5(be)]TJ
0 -1.2203 TD
[(associated)-371(with)-363.1(hyperemesis)-367.4(gravidarum,)-361.7(dened)-366.3(as)-361.2(severe)]TJ
T*
[(nausea)-207.3(and)-201.9(vo)21.8(mi)17.9(t)12.2(i)0(n)24.7(g)-194.1(in)-177.6(ea)19.6(rl)21.1(y)-194.1(p)0(r)23.2(e)12.8(gn)17.5(a)13.1(n)0(c)22.6(y)0(,)-184.4(w)0(i)26.5(t)0(h)-180.9(m)0(o)18.6(r)0(e)-177.6(t)0(h)15.1(a)13.1(n)-193.1(5)13.1(%)-191.3(o)0(f)]TJ
T*
[(we)17.4(i)15.4(g)0(h)17.5(t)-392.5(lo)19(ss)22.7(,)-394.9(d)16(eh)15.7(y)14.6(d)0(r)21.6(a)13.1(ti)21.3(on)19.1(,)-394.9(a)13.1(nd)-385.8(k)14.6(e)0(t)18.6(o)0(n)19.1(u)0(r)23.2(i)0(a)22.2(.)-394.9(H)12.7(y)0(p)19.5(e)12.7(re)18.4(m)15.1(e)0(s)17.8(i)0(s)-384.2(g)14.6(ra)18.8(v-)]TJ
0 -1.2266 TD
[(id)18.8(a)13.1(r)0(u)16.9(m)-383.3(oc)16.9(c)13.4(u)0(r)23.2(s)-393.3(i)15.4(n)-389.1(0.)22.9(5)19.9(1)13.1(0)-391.5(pe)24(r)-392.7(1)13.1(0)13.1(0)0(0)-378.4(p)0(r)23.2(e)0(g)21(n)0(a)22.4(n)0(c)16.3(i)15.4(es)-380.6(\()12.2(7)0(2)19.9(,)0(7)22.9(3)13.1(\).)-382.8(O)15.9(t)0(h)15.1(e)12.7(r)]TJ
0 -1.2203 TD
[(co)16.9(nd)25.2(it)21.3(io)19(ns)-162.8(a)13.1(s)0(s)16.3(o)16.2(ci)16.2(a)13.1(t)12.2(ed)-161(wi)20.1(t)12.2(h)-174.1(hC)21.7(G-)19.7(in)18.4(d)16(u)0(c)18.3(e)12.8(d)-173.7(t)0(h)21.4(y)0(r)20.2(o)0(t)22(o)0(x)20.4(i)0(c)22.5(o)0(s)21.2(i)0(s)-162.9(i)0(n)18.4(c)13.4(lu)20.4(de)]TJ
T*
[(mu)20(lt)21.3(ip)20.4(le)-591.5(ge)21(st)17.2(a)13.1(t)12.2(io)19(n,)-588(hy)17.5(da)22.8(t)12.2(i)0(d)18.8(i)15.4(fo)15.7(rm)-592.6(m)15.1(o)0(l)19(e)-600.6(or)-591.5(ch)16.3(or)21.8(io)25.3(ca)20.2(rc)19(i)15.4(n)0(o)19.1(m)0(a)]TJ
0 -1.2266 TD
[(\(7)19(4)13.1(,)0(7)22.9(5)0(\))19(.)-376(Mo)23.7(st)-368.5(of)-370(t)12.2(h)0(e)-363.7(c)0(a)20.2(s)0(e)17.8(s)-374.4(pr)23.2(es)17.8(e)12.8(n)0(t)-370.6(w)0(i)26.5(t)0(h)-370.6(m)15.1(ar)18.8(k)14.6(e)0(d)-369.6(e)12.8(le)21.9(va)18.7(t)12.2(i)0(o)19(n)0(s)-365.1(o)0(f)]TJ
0 -1.2203 TD
[(se)17.8(ru)23.2(m)-174.6(h)0(C)21.7(G)-175.8(\(2)19(0)13.1(\))12.2(.)-180(A)-172.1(TS)17.5(H)-170.7(r)0(e)18.4(c)13.4(ep)17.7(t)12.2(o)0(r)-167.9(m)15.1(ut)17.1(a)13.1(t)12.2(io)19(n)-174.1(l)0(e)21.9(a)0(d)22.8(i)0(n)18.4(g)-175.1(t)12.2(o)-179.8(f)12.2(u)0(n)20.6(c)13.4(ti)21.3(on)19.1(a)13.1(l)]TJ
T*
[(hy)17.5(pe)24(rs)17(e)12.8(n)0(s)20.6(i)0(t)21.3(i)0(v)21(i)0(t)21.3(y)-428.1(to)-426.9(hC)21.7(G)-428.7(a)0(l)22.2(s)0(o)-421.4(h)0(a)16.1(s)-431.3(b)14.6(e)0(e)19.2(n)-433.3(re)24.7(co)16.9(g)14.6(n)0(i)18.4(z)13.1(e)12.8(d)-433(as)-424.5(a)-429.5(r)0(a)18.8(r)0(e)]TJ
0 -1.2266 TD
[(ca)20.2(us)22.6(e)-271.8(o)0(f)-262.5(g)14.6(e)12.7(s)0(t)17.2(a)13.1(t)12.2(i)0(o)19(n)0(a)22.4(l)-269.1(hy)17.5(pe)24(rt)17.8(h)15.6(y)0(r)20.2(o)0(i)19(d)0(i)25.1(s)0(m)-258.1(\()0(7)19(6)13.1(\).)]TJ
/F10 1 Tf
0 -2.4406 TD
[(Question)-338(27:)-333.4(What)-336.1(is)-330.4(the)-334.7(appropriate)-340.1(initial)-329.8(evaluation)]TJ
0 -1.2267 TD
[(of)-336.6(a)-333.2(suppressed)-336.2(serum)-331.5(TSH)-335.2(concentration)-338.9(during)]TJ
0 -1.2203 TD
[(the)-334.7(rst)-335.4(trimester)-338.8(of)-330.2(pregnancy?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Serum)-560.7(TSH)-557.9(levels)-559(fall)-557.1(in)-557(the)-560.2(rst)-555.6(trimester)-561(of)-559.7(normal)]TJ
-1.1128 -1.2203 TD
[(pregnancies)-446.6(as)-443.4(a)-435.8(physiological)-444.4(response)-446.9(to)-439.5(the)-440(stimulating)]TJ
T*
[(effect)-430.4(of)-426.9(hCG)-425.9(on)-423.5(the)-427.4(TSH)-425.1(receptor)-428.7(with)-420(a)-429.5(peak)-422.5(hCG)-425.9(level)]TJ
0 -1.2267 TD
[(between)-351(7)-340.9(and)-347.3(11)-346.8(weeks)-342.3(gestation)-350.9(\(77\).)-344.3(Normal)-345.5(serum)-348.6(TSH)]TJ
28.0042 74.5598 TD
[(values)-278.2(can)-280.4(be)-276.2(as)-279(low)-279.8(as)-279(0.03)-273.3(mIU/mL)-282.9(\(or)-275.8(even)-282.1(undetectable\))]TJ
0 -1.2203 TD
[(with)-236.6(upper)-238.6(limits)-237.6(of)-237.2(2.5)-235.9(mIU/mL)-232.3(in)-234.5(the)-237.7(rst)-239.4(trimester)-238.5(and)-239.8(3.0)]TJ
0 -1.2266 TD
[(mIU/mL)-289.2(in)-285.1(the)-288.3(second)-294.2(and)-284.1(third)-289.3(trimesters.)-293.3(Any)-287.4(subnormal)]TJ
0 -1.2203 TD
[(serum)-411.8(TSH)-406.1(value)-416(should)-413.7(be)-409(evaluated)-412.6(in)-411.6(conjunction)-410.3(with)]TJ
T*
[(serum)-304.3(FT)]TJ
6.7246 0 0 5.9768 348.4912 680.4282 Tm
(4)Tj
8.9663 0 0 8.9663 351.8361 681.9589 Tm
[(.)-300.1(The)-309.8(diagnosis)-301(of)-306.7(clinical)-306.5(hyperthyroidism)-308.7(is)-302(con-)]TJ
-4.5715 -1.2266 TD
[(rmed)-238.1(in)-234.5(the)-237.7(presence)-239.7(of)-237.2(a)-233.5(suppressed)-245.5(or)-231.1(undetectable)-242.7(serum)]TJ
0 -1.2203 TD
[(TSH)-279.7(and)-284.1(an)-274.8(elevated)-285.2(FT)]TJ
6.7246 0 0 5.9768 406.318 658.5447 Tm
(4)Tj
8.9663 0 0 8.9663 409.6629 660.0187 Tm
(.)Tj
/F10 1 Tf
-11.0208 -2.447 TD
[(Question)-331.7(28:)-333.4(How)-334(can)-337(gestational)-336.8(hyperthyroidism)]TJ
0 -1.2203 TD
[(be)-332.5(differentiated)-335.4(from)-337.5(Graves)-334.8(hyperthyroidism)]TJ
T*
[(in)-331.6(pregnancy?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(In)-271.1(the)-269.3(presence)-277.6(of)-268.8(an)-274.8(undetectable)-274.4(or)-269(very)-277.6(low)-267.2(serum)-272.7(TSH)]TJ
-1.1128 -1.2203 TD
[(and)-271.5(elevated)-266.2(FT)]TJ
6.7246 0 0 5.9768 374.0031 587.2817 Tm
(4)Tj
8.9663 0 0 8.9663 377.4046 588.8124 Tm
[(,)-268.5(the)-269.3(differential)-277.6(diagnosis)-269.4(in)-272.5(the)-269.3(majority)-273.2(of)]TJ
-7.4231 -1.2266 TD
[(cases)-475.5(is)-472.7(between)-477.5(Graves)-477(hyperthyroidism)-479.4(and)-473.8(gestational)]TJ
0 -1.2203 TD
[(hyperthyroidism)-308.7(\(70,71\).)-302(In)-302.7(both)-301.9(situations,)-305.1(common)-300.5(clinical)]TJ
T*
[(manifestations)-535.6(include)-526.1(palpitations,)-535.8(anxiety,)-528.4(hand)-534.1(tremor,)]TJ
0 -1.2266 TD
[(and)-366.3(heat)-370(intolerance.)-373.4(A)-368.1(careful)-371.5(history)-370.7(and)-366.3(physical)-370.4(exami-)]TJ
0 -1.2203 TD
[(nation)-297.6(are)-297.3(of)-300.4(utmost)-301.1(importance)-305.7(in)-297.8(establishing)-300.6(the)-300.9(etiology.)]TJ
T*
[(The)-448.9(ndings)-458.3(o)16.2(f)-443.1(no)-429.8(pr)23.2(io)19(r)-437(h)0(i)18.4(s)0(t)23.5(o)0(r)15.5(y)-434.4(of)-433.2(t)12.2(h)0(y)17.5(r)0(o)21.8(i)15.4(d)-439.3(d)0(i)18.8(s)0(e)24.1(a)0(s)18.1(e)-442.5(a)13.1(n)0(d)-430(n)0(o)]TJ
0 -1.2266 TD
[(c)13.4(l)0(i)18.2(n)15.6(ic)16.2(a)13.1(l)-275.4(si)20.4(g)14.5(n)0(s)-263.9(o)0(f)-268.8(G)13.9(ra)18.8(ve)24.7(s)-268.8(di)25.1(se)17.8(a)13.1(s)0(e)-266.8(\()12.2(go)18.1(i)15.4(t)0(e)18.6(r)0(,)-262.9(e)12.7(nd)18.9(oc)23.2(ri)21.1(ne)-268.8(op)21.2(ht)21.4(ha)22.4(lm)24.2(o-)]TJ
0 -1.2203 TD
[(pa)24.4(th)21.4(y\))-321(f)12.2(a)13.1(vo)21.8(r)-329.5(t)12.2(he)-319.4(di)25.1(ag)21.4(no)19.1(si)20.5(s)-323.8(o)0(f)-319.4(g)14.5(es)17.8(t)12.2(a)0(t)19(i)0(o)25.3(n)0(a)16.1(l)-326(hy)23.8(pe)17.7(rt)24.1(hy)17.5(ro)21.8(i)15.4(d)0(i)18.8(s)0(m)20.1(.)-325.4(In)]TJ
T*
[(si)20.4(t)12.2(u)0(a)24.4(t)0(i)21.3(o)0(n)19.1(s)-380.7(in)-367.3(wh)20.3(ic)22.5(h)-382.8(t)12.2(he)-370(cl)22.5(in)18.4(ic)22.5(a)13.1(l)-382.9(d)16(i)0(a)15.9(g)14.6(no)19.1(si)20.4(s)-380.7(i)15.4(s)-380.7(i)0(n)-367.3(d)0(o)19.5(u)0(b)19.5(t)-379.8(t)12.2(h)0(e)-370(d)0(e)22.4(-)]TJ
T*
[(t)12.2(e)12.7(rm)20.7(in)18.4(a)13.1(t)12.2(io)19(n)-313.2(o)0(f)-306.7(T)0(S)23.8(H)-316.1(re)18.4(c)13.4(e)12.7(pt)17.1(or)-300.7(an)16.1(t)12.2(i)0(b)23.7(o)0(d)19.5(y)-314.2(\()12.2(T)0(R)18.1(A)0(b)25.8(\))-316.6(is)-302(in)18.4(di)25.1(ca)20.2(t)12.2(e)0(d)16.1(.)-312.7(In)]TJ
0 -1.2266 TD
[(t)12.2(h)0(e)-287.8(p)0(r)16.9(e)12.7(se)17.8(nc)22.6(e)-303.4(o)16.2(f)-304(a)-296.7(no)19.1(du)20.9(la)22.3(r)-304.2(g)14.5(oi)19(t)12.2(e)12.8(r,)-294.5(a)-296.7(s)0(e)17.8(r)0(u)23.2(m)-301.1(t)12.2(o)0(t)22(a)0(l)-287.6(T)]TJ
6.7246 0 0 5.9768 499.0109 466.7527 Tm
(3)Tj
8.9663 0 0 8.9663 505.077 468.2267 Tm
-.0122 Tc
[(\(T)-12.2(T)]TJ
6.7246 0 0 5.9768 518.5133 466.7527 Tm
0 Tc
(3)Tj
8.9663 0 0 8.9663 521.8015 468.2267 Tm
.2976 Tc
[(\)d)297.6(e)320(t)297.6(e)316.2(r)297.6(-)]TJ
-23.5276 -1.2203 TD
0 Tc
[(m)15.1(i)0(n)18.4(a)13.1(ti)21.3(on)-290.7(is)-289.4(he)22(lp)20.4(f)12.2(u)0(l)-289.4(i)0(n)-285.1(a)0(s)18.1(s)0(e)24.1(s)0(s)16.3(i)15.4(ng)-292.3(t)12.2(h)0(e)-287.8(p)0(o)21.2(s)0(s)22.7(i)0(b)17.3(i)15.4(li)18.2(t)12.2(y)-295.3(of)-294.1(t)12.2(h)0(e)-287.8()93(T)]TJ
6.7246 0 0 5.9768 526.5637 455.8109 Tm
(3)Tj
8.9663 0 0 8.9663 532.5731 457.2849 Tm
[(to)15.7(x)16.8(i)0(-)]TJ
-24.7289 -1.2203 TD
-.0146 Tc
[(co)-14.6(s)6.6(i)-14.6(s)5.8()78.4()-231.5(s)-14.6(y)5(n)-14.6(d)4.3(r)-14.6(o)7.2(m).5(e)-14.6(.)-226.1(To)-14.6(tal)-233.1(T)]TJ
6.7246 0 0 5.9768 405.1274 444.8125 Tm
0 Tc
(3)Tj
8.9663 0 0 8.9663 410.3999 446.3432 Tm
[(de)16.1(t)12.2(e)12.7(rm)20.7(in)18.4(a)13.1(t)12.2(io)19(n)-218.4(m)15.1(ay)-212.6(a)13.1(l)0(s)20.4(o)-217.7(b)14.5(e)-221.2(of)-205.6(be)21(ne)22(t)]TJ
-11.103 -1.2266 TD
-.0163 Tc
[(in)-291.6(di)-16.3(a)5.9(g)-16.3(no)-16.3(s)4.9(i)-16.3(n)8.4(g)-286.3(T)]TJ
6.7246 0 0 5.9768 371.3385 433.8707 Tm
0 Tc
(3)Tj
8.9663 0 0 8.9663 377.1212 435.3448 Tm
[(t)12.2(h)0(y)17.5(r)0(o)21.8(t)12.2(ox)20.4(ic)22.5(os)21.2(is)-257.8(ca)20.2(us)22.6(ed)-262.1(b)14.6(y)-270(G)13.9(r)0(a)18.8(v)0(e)24.7(s)0()-262.4(d)0(i)25.1(s)0(e)17.7(a)13.1(se)17.8(.)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 310.0535 415.9558 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 320.485 413.4613 Tm
[(RECOMMENDATION)-284.1(22)]TJ
/F6 1 Tf
.0569 -1.2266 TD
[(In)-492.4(th)15.1(e)-480.4(p)0(r)23.2(e)0(s)17.8(e)12.7(nc)16.3(e)-480.4(o)0(f)-471.1(a)-486.4(su)22.6(pp)22.6(re)18.4(ss)22.7(e)12.7(d)-483.5(se)17.8(ru)23.2(m)-484.4(T)0(S)23.8(H)-486.8(in)-468.5(th)15.1(e)-480.4()0(r)21.6(s)0(t)]TJ
0 -1.2203 TD
-.0136 Tc
[(tr)-13.6(i)7.5(m)-13.6(e)7.9(s)-13.6(ter)-279.9(\()-13.6(T)8.2(S)-13.6(H)]TJ
/F11 1 Tf
6.6138 0 TD
0 Tc
(<)Tj
/F6 1 Tf
.7714 0 TD
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(&)Tj
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T*
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(&)Tj
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T*
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T*
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[(dehydration)-567.9(and)-562.3(electrolyte)-571.3(abnormalities.)-566.8(In)-561.9(some)-564.3(cases)]TJ
T*
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T*
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6.7246 0 0 5.9768 428.4849 99.6094 Tm
(4)Tj
8.9663 0 0 8.9663 436.1951 101.1401 Tm
[(returns)-482(to)-483.8(normal)-475.4(by)-483.1(1418)]TJ
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[(weeks)-323.3(gestation.)-328.5(The)-322.4(obstetrical)-332.1(outcome)-326.6(was)-324.9(not)-322.8(improved)]TJ
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[(in)-386.3(isolated)-387.1(cases)-387(in)-386.3(which)-384.3(gestational)-391.9(hyperthyroidism)-390.9(was)]TJ
T*
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[(PREGNANCY)-339.6(AND)-337.2(POSTPARTUM)-334.3(THYROID)-341(MANAGEMENT)-335.2(GUIDELINES)-17387(1093)]TJ
ET
endstream
endobj
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T*
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(&)Tj
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[(RECOMMENDATION)-290.5(25)]TJ
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T*
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(&)Tj
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[(RECOMMENDATION)-290.5(26)]TJ
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T*
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[(Level)-278.8(D-USPSTF)]TJ
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T*
[(strongly)-349.8(recommended.)-351.3(Prior)-350.5(to)-351(conception,)-354.2(a)-347.3(hyperthyroid)]TJ
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[(If)-280.8(the)-275.6(patient)-280.5(opts)-277.8(for)-275.8(ablative)-277.2(therapy,)]TJ
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[(the)-370.5(following)-373.8(recommendations)-375.5(should)-375.8(be)-371(given.)-369(First,)-373.8(sur-)]TJ
T*
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[(TRAb)-190.1(titers)-189.7(tend)-190.1(to)-192.9(increase)-190.9(following)]TJ
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(131)Tj
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[(I)-191.8(therapy)-186.8(and)-189.3(remain)]TJ
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[(elevated)-500.1(for)-503.5(many)-498.1(months)-502.1(\(79\).)-496.1(Second,)-502.9(a)-499(pregnancy)-496.9(test)]TJ
T*
[(should)-375.8(be)-377.4(performed)-379.4(48)-378.4(hours)-376.3(before)]TJ
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(131)Tj
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[(I)-375.2(ablation)-377.5(to)-376.3(avoid)]TJ
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[(radiation)-326.2(exposure)-331.9(to)-325.7(the)-326.2(fetus.)-328.9(Third,)-326.4(conception)-332.3(should)-325.2(be)]TJ
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T*
[(of)-370(LT)]TJ
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(4)Tj
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[(to)-376.3(be)-371(adjusted)-367.6(to)-376.3(obtain)-368.2(target)-378.5(values)-366.8(for)-377(pregnancy)]TJ
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[(\(serum)-285.8(TSH)-279.7(between)-281.5(0.3)-280.1(and)-284.1(2.5)-280.1(mIU/L\).)]TJ
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[(Antithyroid)-239.5(drugs.)]TJ
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[(If)-179.6(the)-187.1(patient)-185.7(chooses)-187.8(ATD)-182.8(therapy,)-189.7(the)]TJ
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[(following)-367.5(recommendations)-362.8(should)-363.1(be)-364.7(given:)-362.7(1\))-360.4(Risks)-362.6(asso-)]TJ
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[(ciated)-492.6(with)-489.6(both)-491.6(propylthiouracil)-493.8(\(PTU\))-493.6(and)-486.4(methimazole)]TJ
T*
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T*
[(trimester)-327(of)-325.7(pregnancy,)-329.1(because)-328.1(of)-325.7(the)-326.2(risk)-326.1(of)-325.7(MMI)-328.5(embryo-)]TJ
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[(pathy;)-265(and)-258.8(3\))-265.5(consideration)-263.8(should)-268.3(be)-257.2(given)-264.9(to)-262.5(discontinuing)]TJ
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[(PTU)-233.4(after)-235(the)-237.7(rst)-233.1(trimester)-238.5(and)-233.5(switching)-235.9(to)-230.9(MMI)-233.7(in)-234.5(order)-234.7(to)]TJ
T*
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(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 71.6598 199.729 Tm
[(RECOMMENDATION)-290.5(27)]TJ
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[(Thyrotoxic)-414.5(women)-409.9(should)-407.4(be)-409(rendered)-408.8(euthyroid)-411.6(before)]TJ
T*
[(attempting)-289.3(pregnancy.)]TJ
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10.2558 0 TD
[(Level)-285.1(A-USPSTF)]TJ
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[(Question)-338(31:)-333.4(What)-329.8(is)-336.7(the)-334.7(management)-334.3(of)-336.6(patients)]TJ
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[(with)-336.8(Graves)-334.8(hyperthyroidism)-334.9(in)-331.6(pregnancy?)]TJ
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1.1128 -1.8336 TD
[(Several)-413.8(studies)-409.2(have)-414.5(shown)-410.8(that)-414.8(obstetrical)-414.2(and)-410.6(medical)]TJ
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[(complications)-536.8(are)-531.2(directly)-533.3(related)-531.8(to)-534.4(control)-531.4(of)-534.4(hyperthy-)]TJ
T*
[(roidism)-265.3(and)-265.1(the)-263(duration)-267.6(of)-262.5(the)-269.3(euthyroid)-266.1(state)-267.2(in)-266.2(pregnancy)]TJ
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[(\(8083\).)-564.2(Poor)-564(control)-569.3(of)-566(thyrotoxicosis)-566.3(is)-567.6(associated)-567(with)]TJ
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[(miscarriages,)-292.4(pregnancy-induced)-295.9(hypertension,)-299.3(prematurity,)]TJ
T*
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[(thyroid)-283.8(storm,)-283.9(and)-277.8(maternal)-282.8(congestive)-287.6(heart)-282.2(failure)-280.9(\(84\).)]TJ
29.1107 74.5598 TD
[(ATDs)-424.4(ar)18.8(e)-410.9(t)0(h)21.4(e)-417.2(m)15.1(a)0(i)22.2(n)0(s)20.6(t)0(a)19(y)-409.1(of)-407.9(t)12.2(r)0(e)24.7(a)0(t)19(m)0(e)21.5(n)0(t)-402.2(f)12.2(or)-401.8(hy)17.5(pe)24(rt)17.8(hy)23.8(ro)21.8(id)18.8(i)15.4(s)0(m)]TJ
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[(an)16.1(d)-180(c)0(o)16.9(u)0(p)22.6(l)0(i)24.6(n)0(g)-178.5(o)0(f)-174(m)0(o)18.6(n)15.6(oi)19(od)19.5(ot)22(y)14.5(r)0(o)15.5(s)0(i)26.8(n)0(e)-180.3(a)13.1(nd)-177.1(d)16(i)0(i)18.2(o)0(d)25.8(o)0(t)15.7(y)14.5(ro)21.8(si)20.4(ne)22(,)-186.3(t)12.2(he)15.7(re)24.7(by)]TJ
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T*
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T*
[(MM)21.4(I)-343.5(m)0(a)21.9(y)-339.5(pr)23.2(od)19.5(uc)18.3(e)-341.3(s)0(e)24.1(v)0(e)18.3(r)0(a)25.1(l)-345(c)13.4(o)0(n)19.1(g)14.6(en)15.7(i)15.4(t)0(a)19(l)-338.6(ma)21.9(lf)21.3(or)21.8(ma)21.9(ti)21.3(on)19.1(s,)-333(m)15.1(a)13.1(in)18.4(ly)]TJ
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[(ap)18.1(la)22.2(si)20.4(a)-366.2(c)13.4(ut)23.5(is)-358.9(a)13.1(n)0(d)-354.1(t)12.2(he)-357.4(sy)19.6(nd)25.2(ro)21.8(me)-357.9(of)-351()93()0(M)18.3(M)13.9(I)-368.8(e)12.7(mb)23.3(ry)20.2(op)21.2(a)13.1(t)0(h)15.1(y)14.5()93()-362.3(th)15.1(a)13.1(t)]TJ
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[(in)18.4(c)13.4(l)0(u)20.4(d)0(e)22.4(s)-260.5(ch)22.6(oa)16.7(n)15.6(a)0(l)-249.6(o)0(r)-250.1(e)12.7(so)21.2(ph)20.5(a)13.1(g)0(e)21(a)0(l)-249.6(a)13.1(tr)17.8(e)12.7(s)0(i)20.4(a)-258.7(a)13.1(n)0(d)-246.7(d)0(y)17.9(s)0(m)26.4(o)0(r)15.5(p)0(h)26.9(i)0(c)-249.4(f)0(a)19(c)13.4(ie)21.9(s.)]TJ
T*
[(Al)20.4(th)21.4(ou)14.8(g)14.6(h)-205.7(ve)24.7(ry)-194.8(ra)25.1(re)-190.3(co)16.9(m)15.1(p)0(l)20.4(i)0(c)22.5(a)0(t)19(i)0(o)19(n)15.6(s,)-193.9(t)12.2(h)0(e)15.7(y)-200.4(ha)22.4(ve)-190.3(no)19.1(t)-202.8(b)0(e)21(e)12.7(n)-205.7(r)0(e)18.4(p)0(o)21.2(r)0(t)24.1(e)12.7(d)]TJ
T*
[(wi)20.1(th)-320(t)12.2(h)0(e)-319.4(u)0(s)22.6(e)-328.7(of)-313.1(PT)20.9(U)-330.2(\()12.2(8)13.1(7)0()19.9(8)13.1(9\))19(.)-325.4(R)0(e)21.2(c)0(e)19.8(n)0(t)21.4(l)0(y)23.7(,)-325.4(a)-328.3(r)0(e)18.4(p)0(o)21.2(r)0(t)-317.3(f)12.2(ro)21.8(m)-326.4(t)12.2(he)-319.4(Ad)20.9(-)]TJ
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[(ve)18.3(rs)23.3(e)-278.1(E)0(v)21.5(e)0(n)22(t)-278.7(Re)21.2(po)21.2(rt)17.8(in)24.7(g)-282.6(S)14.2(ys)19.6(t)12.2(e)12.8(m)-282.1(o)0(f)-262.5(t)0(h)15.1(e)-271.8(U.)21(S.)-267(Fo)18.1(od)-265(a)13.1(n)0(d)-265.6(D)0(r)16.9(u)0(g)-265(A)0(d)20.9(-)]TJ
0 -1.2203 TD
[(mi)17.9(ni)24.7(st)17.2(ra)25.1(ti)21.3(on)-195.8(\(F)20.4(DA)16.2(\))-202.8(c)0(a)20.2(l)0(l)18.2(e)12.7(d)-205.3(a)13.1(tt)18(e)12.8(n)0(t)21.4(i)0(o)19(n)-205.7(to)-199.2(t)12.2(h)0(e)-199.3(r)0(i)21.1(s)0(k)-195.4(o)0(f)-199.2(h)15.6(ep)17.7(a)13.1(t)0(o)22.1(t)0(o)15.7(x)0(i)25.9(c)0(i)22.5(t)0(y)]TJ
T*
[(in)-272.5(pa)18.1(t)12.2(i)0(e)21.9(n)0(t)21.4(s)-285.8(e)12.7(x)0(p)21.8(o)0(s)21.2(e)0(d)-274.8(t)12.2(o)-281(P)0(T)20.9(U)-279.6(\(9)19(0)13.1(,)0(9)22.9(1)0(\))19(;)-281.1(a)13.1(n)-281.6(ad)16.5(vi)27.3(so)21.2(ry)-277(c)13.4(o)0(m)25(m)0(i)17.9(t)12.2(t)12.2(e)0(e)-271.7(r)0(e)18.4(-)]TJ
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[(co)16.9(m)15.1(m)0(e)21.5(n)0(d)18.9(e)12.7(d)-376(l)0(i)18.2(m)15.1(it)21.3(in)18.4(g)-377.5(t)12.2(he)-363.7(us)16.3(e)-372.9(o)0(f)-370(P)0(T)20.9(U)-374.4(t)12.2(o)-375.8(th)21.4(e)-379.3()0(r)21.6(s)0(t)-368.5(t)12.2(ri)21.1(m)15.1(e)0(s)17.8(t)12.2(er)-367.3(of)]TJ
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[(pr)16.9(e)12.7(g)0(n)17.5(a)13.1(nc)22.6(y)-238.4(\()0(9)19(2)13.1(\).)-231(Ot)21.8(he)22(r)-241(e)0(x)16.9(c)13.4(e)12.7(p)0(t)17.1(i)0(o)25.3(n)0(s)-232.3(t)12.2(o)-243(a)13.1(vo)21.8(id)18.8(in)18.4(g)-238.4(P)0(T)20.9(U)-241.7(a)13.1(r)0(e)-228.2(p)0(a)18.1(t)12.2(ie)21.9(nt)21.4(s)]TJ
T*
[(wi)20.1(th)-357.9(MM)21.4(I)-375.2(a)13.1(ll)24.5(er)18.4(g)14.5(y)-371.1(a)13.1(n)0(d)-360.5(i)0(n)-361(t)12.2(he)-357.4(ma)21.9(na)22.4(ge)21(me)21.5(nt)-364.3(of)-357.3(t)12.2(h)0(y)17.5(r)0(o)21.8(i)15.4(d)-369.7(s)0(t)17.2(o)0(r)21.8(m)15.1(.)]TJ
0 -1.2266 TD
[(He)19.1(pa)18.1(t)12.2(o)0(t)22(o)0(x)20.4(i)0(c)22.5(i)0(t)21.3(y)-307.9(ma)21.9(y)-307.9(o)0(c)23.2(c)0(u)18.3(r)-304.2(at)-297.2(an)16.1(y)-301.6(t)0(i)15(m)15.1(e)-309.7(d)0(u)20.9(r)0(i)21.1(n)0(g)-292.3(P)0(T)20.9(U)-311.2(t)12.2(r)0(e)18.4(a)13.1(t)12.2(m)0(e)21.5(n)0(t)21.4(.)]TJ
0 -1.2203 TD
[(Mo)17.4(ni)24.7(to)15.7(ri)21.1(n)15.6(g)-472.3(he)15.7(pa)24.4(t)12.2(i)0(c)-464.4(e)12.7(nz)22.4(ym)17(e)12.8(s)-475.5(d)16(u)0(r)16.9(i)15.4(ng)-463.1(ad)22.8(mi)17.9(ni)24.7(st)17.2(ra)25.1(ti)21.3(on)-461.4(of)-464.8(PT)20.9(U)]TJ
T*
[(sh)20.6(ou)21.2(ld)-278.4(be)-276.2(co)16.9(n)15.6(s)0(i)20.4(d)0(e)22.4(r)0(e)18.4(d)0(.)-277.8(H)12.7(ow)20.9(e)12.7(v)0(e)18.3(r)0(,)-275.5(n)0(o)-278(d)0(a)22.8(t)12.2(a)-290.4(e)12.7(xi)19.6(st)-273.7(th)15.1(a)13.1(t)-285(ha)22.4(ve)-278.9(de)22.4(m-)]TJ
T*
[(on)19.1(st)17.2(ra)25.1(t)12.2(e)0(d)-338(t)12.2(ha)22.4(t)-348.2(t)12.2(he)-332.1(mo)18.6(ni)24.7(to)15.7(ri)21.1(n)15.6(g)-345.9(of)-332(li)18.2(ve)24.7(r)-348.5(e)12.7(nz)22.4(ym)23.3(es)-336.3(is)-333.6(ef)18.6(f)12.2(e)12.7(ct)19.2(iv)21(e)-347.7(i)15.4(n)]TJ
0 -1.2266 TD
[(pr)16.9(e)12.7(v)0(e)18.3(n)0(t)21.4(i)0(n)24.7(g)-270(fu)17.1(l)15.4(m)0(i)17.9(n)0(a)22.4(n)0(t)-256.8(P)0(T)20.9(U)-273.3(h)15.6(e)0(p)17.7(a)13.1(to)22.1(to)15.7(xi)25.9(ci)22.5(ty)20.4(.)]TJ
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[(Equivalent)-228.5(doses)-229.6(of)-224.5(PTU)-227.1(to)-224.5(MMI)-221(are)-227.7(10:1)-222.8(to)-224.5(15:1)-229.1(\(100)-163.4(mg)-223.3(of)]TJ
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(PTU)Tj
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2.1371 0 TD
()Tj
/F6 1 Tf
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[(7.5)-223.2(to)-224.5(10)-169.7(mg)-223.3(of)-224.5(MMI\))-227.8(and)-220.9(those)-229.1(of)-224.5(carbimazole)-225.2(to)-224.5(MMI)]TJ
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[(are)-221.4(10:8)-216.4(\(85\).)-217.9(The)-214.9(initial)-219.8(dose)-215.6(of)-218.2(ATDs)-222.1(depends)-220.5(on)-214.8(the)-218.7(severity)]TJ
0 -1.2203 TD
[(of)-426.9(the)-427.4(symptoms)-430.4(and)-423.2(the)-427.4(degree)-431.4(of)-426.9(hyperthyroxinemia.)-432.4(In)]TJ
T*
[(general,)-336.7(initial)-340(doses)-337.1(of)-332(ATDs)-335.9(are)-335.2(as)-335.9(follows:)-335.1(MMI,)-337.7(515)-162.4(mg)]TJ
0 -1.2266 TD
[(daily;)-200.3(carbimazole,)-190.2(1015)-168.3(mg)-198(daily;)-194(and)-195.6(PTU,)-192(50300)-167.8(mg)-191.7(daily)]TJ
0 -1.2203 TD
[(in)-285.1(divided)-282.3(doses.)]TJ
1.1128 -1.2203 TD
[(Beta)-357(adrenergic)-362.1(blocking)-360.9(agents,)-359.7(such)-359.4(as)-354.9(propranolol)-363.8(20)]TJ
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[(40)-169.7(mg)-406.7(every)-410.3(68)-409.5(hours)-414.2(may)-406.2(be)-415.3(used)-410.2(for)-408.6(controlling)-413.5(hyper-)]TJ
0 -1.2203 TD
[(metabolic)-188(symptoms.)-186.7(The)-189.7(dose)-184(should)-186.1(be)-187.7(reduced)-184.2(as)-184.2(clinically)]TJ
T*
[(indicated.)-353.7(In)-346.9(the)-351.5(vast)-349.8(majority)-349(of)-351(cases)-349.1(the)-351.5(drug)-350.9(can)-349.9(be)-345.8(dis-)]TJ
T*
[(continued)-605.1(in)-601.3(26)-599.2(weeks.)-598.1(Long-term)-607(treatment)-603.1(with)-597(beta)]TJ
0 -1.2266 TD
[(blockers)-496.9(has)-491.1(been)-494.5(associated)-497.5(with)-495.9(intrauterine)-497.4(growth)-493.9(re-)]TJ
0 -1.2203 TD
[(striction,)-359.8(fetal)-358(bradycardia)-352.7(and)-353.7(neonatal)-360.2(hypoglycemia)-352.9(\(93\).)]TJ
T*
[(One)-360.4(study)-358.3(suggested)-357.5(a)-359.9(higher)-356.8(rate)-361(of)-357.3(spontaneous)-359(abortion)]TJ
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[(when)-488.8(both)-491.6(drugs)-485(were)-489(taken)-488.2(together,)-495.5(as)-481.4(compared)-491(with)]TJ
0 -1.2203 TD
[(patients)-332.4(receiving)-331.5(only)-323.9(MMI)-328.5(\(94\).)-325.4(However,)-331(it)-326.5(was)-324.9(not)-329.1(clear)]TJ
T*
[(that)-301(this)-299.6(difference)-301.4(was)-293.3(due)-295.1(to)-300.4(the)-294.6(medication)-297.5(as)-298(opposed)-297(to)]TJ
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[(the)-212.4(underlying)-211(condition.)-214.7(Beta)-205.2(blocking)-215.5(drugs)-206.8(may)-210.2(be)-206.6(used)-207.9(as)]TJ
0 -1.2203 TD
[(preparation)-285.1(for)-282.2(thyroidectomy.)]TJ
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5.9777 0 0 5.9777 312.2645 246.0472 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 322.7527 243.6094 Tm
[(RECOMMENDATION)-284.2(28)]TJ
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[(PTU)-353.5(is)-346.3(preferred)-360.7(for)-351.7(the)-351.5(treatment)-356.5(of)-351(hyperthyroidism)-359.2(in)]TJ
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[(the)-294.6(rst)-290(trimester.)-298.3(Patients)-300.8(on)-290.7(MMI)-290.6(should)-299.9(be)-288.8(switched)-297(to)]TJ
T*
[(PTU)-366.2(if)-370.7(pregnancy)-376.8(is)-365.2(conrmed)-370(in)-373.6(the)-370.5(rst)-372.2(trimester.)-374.2(Fol-)]TJ
0 -1.2267 TD
[(lowing)-240.6(the)-250.3(rst)-245.8(trimester,)-241.4(consideration)-251.2(should)-249.3(be)-238.3(given)-245.9(to)]TJ
0 -1.2203 TD
[(switching)-280.2(to)-281.4(MMI.)]TJ
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[(Level)-285.1(I-USPSTF)]TJ
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[(The)-297.1(combination)-298.8(of)-300.4(LT)]TJ
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(4)Tj
8.9663 0 0 8.9663 419.4708 166.8472 Tm
[(and)-296.8(ATDs)-298(has)-295.1(not)-297.5(been)-298.5(shown)-297(to)]TJ
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[(decrease)-363.9(the)-357.8(recurrence)-359.2(rate)-361(of)-357.3(Graves)-356.9(disease)-362.6(postpartum,)]TJ
T*
[(results)-299.4(in)-291.5(a)-290.4(larger)-293.3(dose)-291.5(of)-294.1(ATDs)-291.6(in)-291.4(order)-291.6(to)-294.1(maintain)-295.4(the)-294.6(FT)]TJ
6.7246 0 0 5.9768 548.844 143.433 Tm
(4)Tj
8.9663 0 0 8.9663 313.0582 133.9653 Tm
[(within)-211.9(the)-206.1(target)-207.8(range,)-206.8(and)-208.2(may)-203.8(lead)-208.3(to)-205.6(fetal)-206.2(hypothyroidism)]TJ
T*
[(\(95\).)-205.2(The)-202.3(only)-203.8(indication)-199.5(for)-206.3(the)-199.8(combination)-204(of)-205.6(ATDs)-203.1(and)-201.9(LT)]TJ
6.7246 0 0 5.9768 548.844 121.5496 Tm
(4)Tj
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[(is)-283.1(in)-278.8(the)-288.3(treatment)-280.6(of)-281.4(fetal)-282.1(hyperthyroidism.)]TJ
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5.9777 0 0 5.9777 312.2645 92.6362 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 322.7527 90.1417 Tm
[(RECOMMENDATION)-284.2(29)]TJ
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.0569 -1.2203 TD
[(A)-285.9(combination)-292.5(regimen)-287.6(of)-287.8(LT)]TJ
6.7246 0 0 5.9768 440.4471 77.726 Tm
(4)Tj
8.9663 0 0 8.9663 446.3999 79.2 Tm
[(and)-290.4(an)-287.4(ATD)-284(should)-293.6(not)-291.2(be)]TJ
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(perthyroidism.)Tj
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6.8098 0 TD
[(Level)-278.8(D-USPSTF)]TJ
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(1094)Tj
41.5036 0 TD
[(STAGNARO-GREEN)-337.3(ET)-338.7(AL.)]TJ
ET
endstream
endobj
302 0 obj
<>stream
/GS1 gs
BT
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8.9663 0 0 8.9663 59.7543 725.7825 Tm
0 0 0 1 k
0 Tc
0 Tw
[(Question)-338(32:)-333.4(What)-336.1(tests)-333.6(should)-334(be)-332.5(performed)]TJ
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[(in)-338(women)-335.1(treated)-333.7(with)-330.5(ATDs)-338.2(during)-336.6(pregnancy?)]TJ
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[(What)-336.1(is)-336.7(the)-334.7(target)-329.2(value)-338.6(of)-330.2(FT)]TJ
6.7246 0 0 5.9768 187.8236 702.3683 Tm
(4)Tj
8.9663 0 0 8.9663 191.5086 703.8423 Tm
(?)Tj
/F6 1 Tf
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[(MMI,)-312.4(PTU,)-318.5(and)-315.7(carbimazole)-313.7(all)-310.1(cross)-321.5(the)-313.6(placenta.)-319.7(There-)]TJ
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[(fore,)-259.7(in)-253.5(order)-253.7(to)-256.2(avoid)-249.8(a)-252.4(deleterious)-263(fetal)-256.8(impact,)-251.2(the)-256.7(aim)-253.5(is)-251.4(to)]TJ
T*
[(maintain)-320.7(FT)]TJ
6.7246 0 0 5.9768 108 663.9872 Tm
(4)Tj
8.9663 0 0 8.9663 114.2362 665.5179 Tm
[(values)-316.2(at,)-319(or)-319.6(just)-317.9(above)-323.5(the)-319.9(upper)-320.8(limit)-318.5(of)-319.4(nor-)]TJ
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[(mal,)-288.1(while)-296.5(utilizing)-288.8(the)-288.3(smallest)-291.7(possible)-296.3(dose)-291.5(of)-287.8(ATDs.)-288.2(Free)]TJ
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(T)Tj
6.7246 0 0 5.9768 65.1968 642.1038 Tm
(4)Tj
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[(and)-423.2(TSH)-425.1(should)-426.4(be)-421.6(measured)-426.9(approximately)-421.5(every)-429.3(24)]TJ
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[(weeks)-506.7(at)-505.8(initiation)-511(of)-502.8(therapy)-509.3(and)-505.4(every)-505.2(46)-504.4(weeks)-506.7(after)]TJ
T*
[(achieving)-276.9(the)-269.3(target)-277.4(value)-270.6(\(68,96,97\).)-272.3(When)-271.3(trimester-specic)]TJ
0 -1.2266 TD
(FT)Tj
6.7246 0 0 5.9768 70.1291 609.2219 Tm
(4)Tj
8.9663 0 0 8.9663 77.3291 610.6959 Tm
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[(pregnant)-316.6(patients)-313.4(are)-309.9(recommended.)-313.4(Over-treatment)-317(should)]TJ
T*
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[(and)-423.2(or)-427.1(fetal)-421.2(hypothyroidism)-431(\(98\).)-420.2(Serum)-428(TSH)-425.1(may)-418.8(remain)]TJ
0 -1.2203 TD
[(undetectable)-230.1(through)-225.1(pregnancy.)-221.6(Serum)-225.6(TT)]TJ
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(3)Tj
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[(determination)-226.8(is)]TJ
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[(not)-354.4(recommended)-348.4(in)-348.4(the)-351.5(management)-347.1(of)-351(Graves)-350.6(hyperthy-)]TJ
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[(roidism)-448.7(because)-448.3(normalization)-443.8(of)-445.8(maternal)-447.2(serum)-449.8(TT)]TJ
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(3)Tj
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(has)Tj
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[(been)-323.7(reported)-318.6(to)-313.1(cause)-323.8(elevated)-316.8(serum)-317(TSH)-317.6(in)-316.7(the)-319.9(infants)-321.9(at)]TJ
T*
[(birth)-233.8(\(99\).)-230.5(The)-233.9(exception)-234.1(is)-232.5(the)-231.4(woman)-226.2(with)-236.6(T)]TJ
6.7246 0 0 5.9768 236.296 521.5179 Tm
(3)Tj
8.9663 0 0 8.9663 241.7385 523.0487 Tm
(thyrotoxicosis,)Tj
-20.2965 -1.2266 TD
[(such)-283.5(as)-279(in)-285.1(the)-282(presence)-283.9(of)-281.5(a)-277.7(nodular)-286.1(goiter.)]TJ
1.1128 -1.2203 TD
[(In)-568.2(the)-566.5(rst)-568.2(trimester)-573.6(of)-566(pregnancy)-566.5(some)-570.6(women)-568(with)]TJ
-1.1128 -1.2203 TD
[(Graves)-217.8(disease)-217.1(will)-214.6(experience)-218.7(an)-211.5(exacerbation)-224.2(of)-211.9(symptoms.)]TJ
T*
[(Afterwards,)-473.6(the)-471.6(natural)-470(course)-473.2(of)-471.1(Graves)-470.7(disease)-470(is)-466.4(for)-471.8(a)]TJ
0 -1.2266 TD
[(gradual)-517.9(improvement)-520(in)-519.1(the)-515.9(second)-521.8(and)-511.7(third)-516.9(trimesters.)]TJ
0 -1.2203 TD
[(Typically,)-392.2(this)-388.1(will)-385.3(result)-393(in)-386.3(a)-385.2(need)-391.9(to)-388.9(decrease)-389.2(the)-389.5(dose)-386.4(of)]TJ
T*
[(ATDs.)-250.3(Discontinuation)-251.4(of)-243.5(all)-246.8(ATD)-246.1(therapy)-250(is)-245.1(feasible)-246.5(in)-247.2(20%)]TJ
0 -1.2266 TD
[(30%)-449.6(of)-439.5(patients)-452.5(in)-443.2(the)-446.4(last)-447.4(trimester)-447.1(of)-445.8(gestation)-452.1(\(99\).)-445.5(The)]TJ
0 -1.2203 TD
[(exceptions)-406.1(are)-392.1(women)-397.3(with)-401(high)-394.1(levels)-400.9(of)-395.3(TRAb)-392.4(values,)-401.3(in)]TJ
T*
[(which)-238.8(cases)-235.3(ATD)-233.4(therapy)-231(should)-236.7(be)-231.9(continued)-238.4(until)-233.6(delivery.)]TJ
0 -1.2266 TD
[(Aggravation)-286.4(of)-281.5(symptoms)-285(often)-278.9(occurs)-282.9(after)-285.6(delivery)-281.3(\(100\).)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 58.9606 380.5794 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 69.4488 378.085 Tm
[(RECOMMENDATION)-284.2(30)]TJ
/F6 1 Tf
.0569 -1.2203 TD
[(In)-258.4(women)-258.2(being)-255.9(treated)-263.2(with)-261.9(ATDs)-260(in)-253.5(pregnancy,)-265.9(FT)]TJ
6.7246 0 0 5.9768 278.192 365.6125 Tm
(4)Tj
8.9663 0 0 8.9663 283.8614 367.1432 Tm
(and)Tj
-23.8563 -1.2266 TD
[(TSH)-235.4(should)-230.3(be)-238.3(monitored)-235.4(approximately)-238.1(every)-233.3(26)-232.5(weeks.)]TJ
0 -1.2203 TD
[(The)-202.3(primary)-203.8(goal)-206.2(is)-200.9(a)-201.8(serum)-209.5(FT)]TJ
6.7246 0 0 5.9768 190.148 343.7291 Tm
(4)Tj
8.9663 0 0 8.9663 195.307 345.2031 Tm
[(at)-202.3(or)-205.8(moderately)-207.8(above)-203.4(the)]TJ
-13.98 -1.2203 TD
[(normal)-279.4(reference)-282.3(range.)]TJ
/F4 1 Tf
10.6984 0 TD
[(Level)-285.1(B-USPSTF)]TJ
/F10 1 Tf
-11.8365 -2.7821 TD
[(Question)-338(33:)-333.4(What)-336.1(are)-332(the)-334.6(indications)-333.1(and)-338.2(timing)]TJ
0 -1.2203 TD
[(for)-337.3(thyroidectomy)-333.5(in)-338(the)-334.6(management)-334.3(of)-330.2(Graves)]TJ
T*
[(disease)-334.8(during)-336.6(pregnancy?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Thyroidectomy)-265.5(should)-262(be)-257.2(considered)-263.4(in)-259.8(cases)-260.6(of)-262.5(allergies/)]TJ
-1.1128 -1.2267 TD
[(contraindications)-440.8(to)-433.2(both)-434.7(ATDs,)-433.7(in)-436.9(women)-435.2(requiring)-432.9(large)]TJ
0 -1.2203 TD
[(doses)-305.5(of)-300.4(ATDs,)-294.6(and)-303.1(for)-301.1(patients)-300.8(who)-298.6(are)-303.6(not)-297.5(compliant)-302.3(with)]TJ
T*
[(drug)-319.3(therapy.)-316.2(If)-312.4(surgery)-316.3(is)-321(indicated,)-315.7(second)-313.2(trimester)-320.7(is)-314.7(the)]TJ
T*
[(optimal)-464(time.)-466(A)-463(determination)-467.1(of)-458.5(serum)-462.4(TRAb)-462(titers)-468(is)-460.1(of)]TJ
0 -1.2266 TD
[(value)-359.1(at)-360.4(the)-357.8(time)-355.5(of)-357.3(surgery)-360.6(in)-361(order)-354.8(to)-357.3(assess)-358.7(the)-364.2(potential)]TJ
0 -1.2203 TD
[(risk)-452.6(of)-452.2(fetal)-452.8(hyperthyroidism)-454.1(\(101\).)-451.3(Preparation)-455.8(with)-451.6(beta-)]TJ
T*
[(blocking)-379.8(agents)-375.7(and)-372.6(a)-378.9(short)-375.4(course)-378.4(of)-376.3(potassium)-375.9(iodine)-376.5(so-)]TJ
0 -1.2266 TD
[(lution)-286.9(\(50100)-168.3(mg/d\))-280.3(are)-278.3(recommended)-285.2(\(102\).)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 58.9606 163.8991 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 69.4488 161.4047 Tm
[(RECOMMENDATION)-284.2(31)]TJ
/F6 1 Tf
.0569 -1.2266 TD
[(Thyroidectomy)-556.4(in)-557(pregnancy)-553.8(is)-554.9(rarely)-558.9(indicated.)-556(If)-559(re-)]TJ
0 -1.2203 TD
[(quired,)-224.5(the)-225.1(optimal)-230(time)-229.1(for)-225.2(thyroidectomy)-231.3(is)-226.1(in)-228.2(the)-225.1(second)]TJ
T*
(trimester.)Tj
/F4 1 Tf
4.4513 0 TD
[(Level)-285.1(A-USPSTF)]TJ
/F10 1 Tf
-5.5895 -2.447 TD
[(Question)-338(34:)-333.4(What)-336.1(is)-330.4(the)-334.7(value)-332.3(of)-336.6(TRAb)-333.1(measurement)]TJ
0 -1.2203 TD
[(in)-338(the)-334.7(evaluation)-334.7(of)-330.2(a)-333.2(pregnant)-337.7(woman)-335.1(with)-336.8(Graves)]TJ
T*
(hyperthyroidism?)Tj
/F6 1 Tf
1.1128 -1.8336 TD
[(Fetal)-216.5(risks)-213.6(for)-212.6(women)-213.9(with)-217.7(active)-212.1(Graves)-217.8(hyperthyroidism)]TJ
-1.1128 -1.2267 TD
[(and)-353.7(those)-349.3(who)-349.2(received)-348.4(ablation)-352.3(therapy)-351.2(are)-347.9(1\))-347.7(fetal)-351.6(hyper-)]TJ
28.0042 74.5598 TD
[(thyroidism,)-674.9(2\))-676.5(neonatal)-676.4(hyperthyroidism,)-684.6(3\))-670.2(fetal)-680.4(hypo-)]TJ
0 -1.2203 TD
[(thyroidism,)-700.2(4\))-701.8(neonatal)-701.7(hypothyroidism,)-705.8(and)-695.1(5\))-701.8(central)]TJ
0 -1.2266 TD
[(hypothyroidism.)-358(The)-360.4(above)-355.1(potential)-356.4(complications)-359.7(depend)]TJ
0 -1.2203 TD
[(on)-720.6(several)-726.4(factors:)-728.3(1\))-720.8(poor)-722.1(control)-727.4(of)-724.1(hyperthyroidism)]TJ
T*
[(throughout)-463.7(pregnancy)-465.3(may)-456.7(induce)-459.4(transient)-467.9(central)-462(hypo-)]TJ
0 -1.2266 TD
[(thyroidism)-381.1(\(103,104\);)-383.2(2\))-385.7(excessive)-387.4(amounts)-385.8(of)-382.6(ATDs)-386.5(are)-379.5(re-)]TJ
0 -1.2203 TD
[(sponsible)-249.1(for)-250.5(fetal)-250.5(and)-246.2(neonatal)-246.4(hypothyroidism)-253.9(\(105\),)-249(and)-246.2(3\))]TJ
T*
[(high)-223.4(titers)-221.4(of)-224.5(serum)-222.1(TRAb)-221.7(between)-224.6(22)-226.6(and)-220.9(26)-220.3(weeks)-222.1(gestation)]TJ
0 -1.2266 TD
[(are)-398.5(risk)-402(factors)-402.9(for)-396(fetal)-402.2(or)-401.8(neonatal)-404.5(hyperthyroidism)-403.5(\(106)]TJ
0 -1.2203 TD
[(109\).)-381.3(TRAb)-386.1(are)-385.8(present)-392.7(in)-386.3(over)-383.5(95%)-386.3(of)-388.9(patients)-389.3(with)-382.1(active)]TJ
T*
[(Graves)-300(hyperthyroidism)-302.3(and)-296.8(high)-299.3(titers)-303.6(may)-298.7(remain)-295.4(still)-303.2(el-)]TJ
T*
[(evated)-477.7(following)-475(ablation)-478.7(therapy)-477.6(\(79\).)-477.1(Indications)-483.9(for)-478.2(or-)]TJ
0 -1.2266 TD
[(dering)-229.9(a)-233.5(TRAb)-234.4(test)-236.1(in)-228.2(Graves)-236.8(disease)-236.1(include:)-231.9(1\))-233.9(mother)-232.4(with)]TJ
0 -1.2203 TD
[(active)-597.8(hyperthyroidism,)-608.8(2\))-600.7(previous)-606(history)-598.3(of)-603.9(treatment)]TJ
T*
[(with)-331.5(radioiodine,)-332.1(3\))-328.8(previous)-334.1(history)-339.1(of)-325.7(delivering)-338.8(an)-325.4(infant)]TJ
0 -1.2266 TD
[(with)-243(hyperthyroidism,)-248.4(and)-239.8(4\))-246.6(thyroidectomy)-244(for)-244.2(treatment)-249(of)]TJ
0 -1.2203 TD
[(hyperthyroidism)-308.7(in)-304.1(pregnancy)-307.2(\(101\).)-305.9(The)-309.8(titers)-303.6(of)-306.7(antibodies)]TJ
T*
[(decrease)-484(with)-483.2(the)-484.3(progression)-490.1(of)-483.8(the)-484.3(pregnancy.)-487.2(The)-480.5(pre-)]TJ
0 -1.2266 TD
[(valence)-259.2(of)-256.2(fetal)-263.1(and)-258.8(neonatal)-259.1(hyperthyroidism)-264.4(is)-257.8(between)-256.2(1%)]TJ
0 -1.2203 TD
[(and)-347.3(5%)-342.6(of)-344.7(all)-348(women)-346.7(with)-344.1(active)-351.2(or)-344.9(past)-344.1(history)-351.7(of)-344.7(Graves)]TJ
T*
[(hyperthyroidism)-384.5(and)-385.3(is)-384.2(associated)-390(with)-382.1(increased)-389.9(fetal)-383.3(and)]TJ
T*
[(neonatal)-436.1(morbidity)-431.4(and)-435.9(mortality)-430.3(if)-434(unrecognized)-438.5(and)-435.9(un-)]TJ
0 -1.2266 TD
[(treated)-282.2(\(110\).)]TJ
1.1128 -1.2203 TD
[(A)-254.3(determination)-264.7(of)-262.5(serum)-260.1(TRAb)-259.6(by)-261.7(2428)-256.8(weeks)-260.1(gestation)]TJ
-1.1128 -1.2203 TD
[(is)-264.1(helpful)-272.8(in)-266.2(detecting)-267.3(pregnancies)-275.9(at)-265.5(risk.)-265.8(A)-267(value)-270.6(over)-263.4(three)]TJ
0 -1.2266 TD
[(times)-470.7(the)-471.6(upper)-466.2(limit)-470.2(of)-471.1(normal)-469(is)-466.4(an)-470.8(indication)-471.3(for)-471.8(close)]TJ
0 -1.2203 TD
[(follow-up)-340.4(of)-338.4(the)-345.2(fetus,)-341.5(optimally)-339.2(with)-344.1(the)-338.9(collaboration)-342.3(of)-338.4(a)]TJ
T*
[(maternalfetal)-488.5(medicine)-484.3(physician.)-490.5(Some)-485.6(clinicians)-488.2(recom-)]TJ
0 -1.2266 TD
[(mend)-408.5(to)-414.2(perform)-414.4(the)-408.4(test)-419.5(in)-411.6(the)-408.4(rst)-416.5(trimester)-409.2(\(106\))-416.8(and)-410.6(if)]TJ
0 -1.2203 TD
[(elevated)-342.1(repeat)-349.6(the)-345.2(determination)-346.9(at)-347.7(2226)-339(weeks)-348.6(gestation,)]TJ
T*
[(while)-448.3(others)-444.8(prefer)-451.9(a)-448.4(single)-446(determination)-454.4(at)-442.6(2428)-446.5(weeks)]TJ
0 -1.2266 TD
[(g)14.5(e)0(s)17.8(t)0(a)19(t)0(i)15(o)0(n)-309.7(\()12.2(68)19.9(\))-322.9(b)0(e)21(c)0(a)20.2(u)0(s)16.3(e)-316(of)-313.1(t)12.2(h)0(e)-313.1(n)0(o)19.1(r)0(m)20.7(a)0(l)-312.9(d)0(e)22.4(c)0(l)16.2(i)0(n)18.4(e)-316(in)-310.4(an)16.1(t)12.2(i)0(b)17.3(o)0(d)19.5(y)-320.6(c)13.4(o)0(n)19.1(-)]TJ
0 -1.2203 TD
[(c)13.4(e)0(n)15.7(t)12.2(ra)18.8(ti)15(on)19.1(,)-268.5(w)0(h)20.3(i)0(c)16.2(h)-268.9(st)17.2(a)13.1(r)0(t)17.8(s)-273.2(a)13.1(t)-272.4(a)13.1(p)0(p)16.3(r)0(o)21.8(x)0(i)19.6(m)0(a)15.6(t)12.2(el)15.5(y)-270(2)13.1(0)-271.4(w)0(e)17.4(e)12.7(ks)-258.6(ge)14.7(st)23.5(at)19(io)19(n.)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 310.0535 353.1967 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 320.485 350.7023 Tm
[(RECOMMENDATION)-284.1(32)]TJ
/F6 1 Tf
.0569 -1.2266 TD
[(If)-325.1(the)-326.2(patient)-324.8(has)-320.4(a)-322(past)-325.1(or)-325.9(present)-329.5(history)-326.4(of)-319.4(Graves)-325.3(dis-)]TJ
0 -1.2203 TD
[(ease,)-326(a)-328.3(maternal)-327(serum)-323.3(determination)-334.3(of)-325.7(TRAb)-322.9(should)-331.5(be)]TJ
T*
[(obtained)-282.6(at)-278.2(2024)-282.1(weeks)-285.4(gestation.)]TJ
/F4 1 Tf
15.5354 0 TD
[(Level)-278.8(B-USPSTF)]TJ
/F10 1 Tf
-16.6672 -2.7821 TD
[(Question)-331.7(35:)-333.4(Under)-335.4(what)-337.7(circumstances)-333.3(should)]TJ
0 -1.2203 TD
[(additional)-335(fetal)-332.7(ultrasound)-334.3(monitoring)-341.8(for)-330.9(growth,)]TJ
T*
[(heart)-333.4(rate,)-331.3(and)-338.2(goiter)-331.9(be)-332.5(performed)-339.3(in)-331.6(women)]TJ
0 -1.2267 TD
[(with)-330.5(Graves)-334.8(hyperthyroidism)-341.2(in)-331.7(pregnancy?)]TJ
/F6 1 Tf
1.1128 -1.8273 TD
[(Serial)-321.8(ultrasound)-327.2(examinations)-326.9(may)-324(be)-320.5(performed)-328.8(for)-326.4(the)]TJ
-1.1128 -1.2266 TD
[(assessment)-398(of)-388.9(gestational)-398.2(age,)-392.4(fetal)-395.9(viability,)-393.3(amniotic)-395.8(uid)]TJ
0 -1.2203 TD
[(volume,)-249.1(fetal)-250.5(anatomy,)-250.8(and)-246.2(detection)-253(of)-249.8(malformations.)-250(Fetal)]TJ
T*
[(well-being)-315.6(may)-317.6(be)-314.1(compromised)-319.6(in)-310.4(the)-319.9(presence)-315.6(of)-319.4(elevated)]TJ
0 -1.2267 TD
[(TRAb,)-692.5(uncontrolled)-694.3(hyperthyroidism,)-697.3(and)-695.1(pre-eclampsia)]TJ
0 -1.2203 TD
[(\(80,83,111,112\).)-317.6(Signs)-321(of)-319.4(potential)-324.8(fetal)-320(hyperthyroidism)-327.6(that)]TJ
T*
[(may)-197.5(be)-194(detected)-201.9(by)-198.5(ultrasonography)-200.3(include)-203.7(fetal)-199.9(tachycardia)]TJ
0 -1.2266 TD
(\(bpm)Tj
/F11 1 Tf
2.9275 0 TD
(>)Tj
/F6 1 Tf
.7714 0 TD
[(170,)-583.2(persistent)-587.7(for)-585.7(over)-585.8(10)-587.1(minutes\),)-586.3(intrauterine)]TJ
-3.6989 -1.2203 TD
[(growth)-310.6(restriction,)-309.8(presence)-315.6(of)-306.7(fetal)-313.7(goiter)-309(\(the)-314(earliest)-306(sono-)]TJ
T*
[(graphic)-385.2(sign)-392(of)-382.6(fetal)-389.6(thyroid)-391.3(dysfunction\),)-393.5(accelerated)-390.7(bone)]TJ
0 -1.2266 TD
[(maturation,)-435.8(signs)-431.3(of)-426.9(congestive)-439.4(heart)-433.9(failure,)-429.2(and)-435.9(fetal)-427.5(hy-)]TJ
0 -1.2203 TD
[(drops)-268.4(\(106,111114\).)-261.1(A)-267(team)-269.3(approach)-267.1(to)-262.5(the)-269.3(management)-271.2(of)]TJ
T*
[(these)-340.1(patients)-345.1(is)-340(required)-342.3(including)-347.9(an)-338(experienced)-348.1(obstetri-)]TJ
T*
[(cian)-258.6(or)-262.7(maternalfetal)-267.2(medicine)-263(specialist,)-269.6(neonatologist,)-265.1(and)]TJ
0 -1.2266 TD
[(anesthesiologist.)-344.3(In)-346.9(most)-337.2(cases,)-345.7(the)-345.2(diagnosis)-338.9(of)-344.7(fetal)-339(hyper-)]TJ
0 -1.2203 TD
[(thyroidism)-482.3(should)-483.3(be)-484.9(made)-480.5(on)-480.4(clinical)-483.5(grounds)-484.9(based)-482.4(on)]TJ
T*
[(maternal)-402.9(history,)-405.2(interpretation)-412.1(of)-401.6(serum)-405.5(TRAb)-405.1(levels,)-403.9(and)]TJ
0 -1.2267 TD
[(fetal)-282.1(ultrasonography)-282.5(\(68,106,112,113\).)]TJ
/F3 1 Tf
-28.0042 77.228 TD
[(PREGNANCY)-339.6(AND)-337.2(POSTPARTUM)-334.3(THYROID)-341(MANAGEMENT)-335.2(GUIDELINES)-17387(1095)]TJ
ET
endstream
endobj
306 0 obj
<>stream
/GS1 gs
BT
/F12 1 Tf
5.9777 0 0 5.9777 61.2283 728.277 Tm
0 0 0 1 k
0 Tc
0 Tw
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 71.6598 725.7825 Tm
[(RECOMMENDATION)-290.5(33)]TJ
/F6 1 Tf
.0569 -1.2203 TD
[(Fetal)-399.8(surveillance)-402.4(with)-401(serial)-400.5(ultrasounds)-404.4(should)-401.1(be)-402.7(per-)]TJ
0 -1.2266 TD
[(formed)-194.1(in)-190.3(women)-188.6(who)-191.2(have)-193.2(uncontrolled)-194.8(hyperthyroidism)]TJ
0 -1.2203 TD
[(and/or)-303.2(women)-296.1(with)-299.9(high)-299.3(TRAb)-303.9(levels)-299.8(\(greater)-296.9(than)-303.9(three)]TJ
T*
[(times)-369.5(the)-370.5(upper)-371.4(limit)-362.7(of)-370(normal\).)-371.3(A)-368.1(consultation)-369.6(with)-369.4(an)]TJ
0 -1.2266 TD
[(experienced)-443(obstetrician)-436.6(or)-439.7(maternalfetal)-437.9(medicine)-440.1(spe-)]TJ
0 -1.2203 TD
[(cialist)-238.8(is)-238.8(optimal.)-233(Such)-236.5(monitoring)-237.5(may)-235.4(include)-241.6(ultrasound)]TJ
T*
[(for)-452.9(heart)-459.2(rate,)-452.4(growth,)-452.6(amniotic)-452.7(uid)-453.5(volume,)-451.4(and)-454.8(fetal)]TJ
0 -1.2266 TD
(goiter.)Tj
/F4 1 Tf
3.0856 0 TD
[(Level)-278.8(I-USPSTF)]TJ
/F10 1 Tf
-4.2174 -2.7189 TD
[(Question)-338(36:)-333.4(When)-333.3(should)-334(umbilical)-338(blood)-335.9(sampling)]TJ
0 -1.2203 TD
[(be)-332.5(considered)-335.4(in)-338(women)-335.1(with)-330.5(Graves)-334.8(disease)]TJ
0 -1.2266 TD
[(in)-331.6(pregnancy?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Umbilical)-433.6(cord)-429.4(blood)-433.8(sampling)-431.9(\(cordocentesis\))-435.9(is)-428.5(associ-)]TJ
-1.1128 -1.2203 TD
[(ated)-274.8(with)-274.6(both)-276.6(fetal)-275.8(mortality)-272.2(and)-271.5(morbidity)-279.7(\(114,115\).)-269.4(It)-274.5(has)]TJ
T*
[(been)-481.8(utilized)-489.1(when)-482.5(a)-480.1(mother)-485.3(is)-485.4(TRAb)]TJ
/F9 1 Tf
17.6915 0 TD
()Tj
/F6 1 Tf
1.2519 0 TD
[(and)-486.4(treated)-484.5(with)]TJ
-18.9434 -1.2266 TD
[(ATDs,)-332.5(a)-328.3(fetal)-332.7(goiter)-334.3(is)-333.6(present,)-332.4(and)-328.4(the)-332.5(thyroid)-334.4(status)-333.2(of)-332(the)]TJ
0 -1.2203 TD
[(fetus)-439.8(is)-434.8(unclear)-437.6(\(106,116\).)-433.8(The)-436.2(presence)-435.7(of)-433.2(TRAb)-436.7(is)-434.8(not)-436.6(an)]TJ
T*
[(indication)-281.7(for)-282.1(cordocentesis)-289.5(\(117\).)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 61.2283 501.1085 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 71.6598 498.614 Tm
[(RECOMMENDATION)-290.5(34)]TJ
/F6 1 Tf
.0569 -1.2203 TD
[(Cordocentesis)-435.8(should)-432.7(be)-427.9(used)-429.2(in)-430.6(extremely)-432.2(rare)-430.8(circum-)]TJ
T*
[(stances)-409.8(and)-397.9(performed)-411(in)-398.9(an)-401.2(appropriate)-409.5(setting.)-408.4(It)-400.9(may)]TJ
0 -1.2266 TD
[(occasionally)-528.7(be)-516.5(of)-521.7(use)-527.4(when)-520.5(fetal)-522.4(goiter)-523.9(is)-523.3(detected)-524.4(in)]TJ
0 -1.2203 TD
[(women)-213.9(taking)-205.4(ATDs)-209.4(to)-205.6(help)-210.5(determine)-210.7(whether)-211.7(the)-212.4(fetus)-205.8(is)]TJ
T*
[(hyperthyroid)-287.3(or)-281.7(hypothyroid.)]TJ
/F4 1 Tf
13.373 0 TD
[(Level)-278.8(I-USPSTF)]TJ
/F10 1 Tf
-14.5048 -2.7821 TD
[(Question)-338(37:)-327.1(What)-336.1(are)-332(the)-334.6(etiologies)-333.8(of)-336.6(thyrotoxicosis)]TJ
0 -1.2203 TD
[(in)-331.6(the)-334.6(postpartum)-340.1(period?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(The)-328.8(most)-324.6(common)-332.1(cause)-330.2(of)-325.7(thyrotoxicosis)-332.4(in)-329.4(the)-326.2(postpar-)]TJ
-1.1128 -1.2203 TD
[(tum)-334.5(period)-340.1(is)-333.6(postpartum)-335.7(thyroiditis)-343.3(\(PPT\).)-332(Specically,)-341.2(the)]TJ
T*
[(prevalence)-349.6(of)-351(PPT)-340.8(thyrotoxicosis)-357.7(is)-346.3(4.1%)-345(vs.)-346.4(0.2%)-345(for)-345.4(thyro-)]TJ
0 -1.2266 TD
[(toxicosis)-251.1(re)24.7(la)22.2(te)18.6(d)-230.6(t)0(o)-224.5(G)0(r)19.5(a)13.1(ve)18.3(s)-224.5(di)25.1(se)17.8(a)13.1(s)0(e)-222.5(\()0(1)19(1)13.1(8\))19(.)-230.5(P)0(P)16.3(T)-230.6(ma)21.9(y)-232(m)0(a)21.9(n)0(i)18.4(f)12.2(e)12.7(s)0(t)-223.1(a)0(s)]TJ
0 -1.2203 TD
[(a)-227.1(h)0(y)17.5(p)0(e)24(r)0(t)17.8(h)0(y)23.8(r)0(o)21.8(i)0(d)-221.5(p)0(h)20.5(a)13.1(se)17.8(,)-224.2(o)0(c)16.9(c)13.4(ur)16.9(ri)27.4(ng)-222.8(wi)20.1(t)12.2(h)0(i)24.7(n)-231(th)21.4(e)-233.8()0(r)21.6(s)0(t)-216.8(6)-233.5(m)15.1(o)0(n)19.1(t)12.2(hs)-219.7(af)19(t)12.2(e)0(r)]TJ
T*
[(de)22.4(li)18.2(ve)24.7(ry)20.2(,)-274.8(w)0(i)20.1(t)12.2(h)-281.6(a)-277.7(sp)22.6(on)19.1(t)12.2(a)0(n)16.1(e)12.8(ou)21.2(s)-279.5(r)0(e)24.7(m)0(i)17.9(s)0(s)22.7(i)0(o)19(n)15.6(.)-281.1(T)0(h)25.2(i)0(s)-270.4(i)0(s)-270.4(f)12.2(re)24.7(qu)19.5(e)12.8(n)0(t)15.1(l)15.4(y)-282.6(f)12.2(ol)19(-)]TJ
0 -1.2266 TD
[(lo)19(we)23.8(d)-224.3(b)14.6(y)-219.4(a)-227.1(h)15.6(y)0(p)19.5(o)0(t)22.1(h)0(y)17.5(r)0(o)21.8(i)15.4(d)-224.3(p)0(h)20.6(a)13.1(se)-209.9(be)21(fo)15.7(re)-209.3(a)-220.8(r)0(e)24.7(t)0(u)17.1(r)0(n)-212.7(t)12.2(o)-224.1(e)12.7(ut)23.5(hy)17.5(ro)21.8(id)25.1(is)20.5(m)]TJ
0 -1.2203 TD
[(in)-177.6(t)12.2(h)0(e)-174(m)0(a)21.9(j)14(or)15.5(i)15.4(t)0(y)-175.6(o)0(f)-174(w)0(o)20.9(m)0(e)21.5(n)-186.7(b)14.6(y)-187.8(1)-182.9(y)0(e)21(a)13.1(r)-184.1(p)0(o)21.2(s)0(t)17.2(p)0(a)24.4(r)0(t)17.8(u)0(m)-169.6(\()0(1)19(1)13.1(8,)22.9(11)19.9(9)13.1(\))0(.)-174.1(S)0(o)17.7(m)0(e)]TJ
T*
[(wo)20.9(me)21.5(n)-256.3(w)0(i)26.5(l)0(l)-247.3(p)0(r)23.2(e)12.8(se)17.8(nt)-244.1(wi)26.5(th)-244.1(mi)17.9(l)15.4(d)-255.9(hy)23.8(pe)17.7(rm)20.7(e)12.8(t)12.2(ab)21.4(ol)19(ic)-243.1(sy)25.9(mp)20.1(to)22.1(ms)-245.5(a)13.1(n)0(d)]TJ
0 -1.2266 TD
[(ma)21.9(y)-276.3(n)0(e)22(e)0(d)-268.5(a)-277.7(sh)20.6(or)21.8(t)-278.7(c)13.4(ou)21.2(rs)17(e)-278.1(o)0(f)-268.8(b)14.6(e)12.8(t)0(a)-271.9(b)14.6(lo)19(c)13.4(k)0(e)21(r)0(s)17(.)-274.8(W)13.6(o)0(m)18.6(e)12.7(n)-281.6(w)0(i)26.5(t)0(h)-269.4(a)-277.7(pa)24.4(st)]TJ
0 -1.2203 TD
[(hi)18.4(st)23.5(or)21.8(y)-314.2(o)0(f)-306.7(G)13.9(ra)18.8(ve)24.7(s)-306.7(d)16(i)0(s)20.4(e)0(a)19.6(s)0(e)-304.7(t)12.2(re)18.4(a)13.1(t)12.2(ed)-306.4(wi)20.1(t)12.2(h)-313.2(AT)20.9(Ds)-306.2(o)16.2(r)-316.8(wo)20.9(me)21.5(n)-313.2(w)0(h)20.3(o)]TJ
T*
[(ha)22.4(d)-230.6(a)-233.5(t)12.2(h)0(y)17.5(r)0(o)21.8(t)12.2(ox)20.4(ic)-217.8(ph)20.6(as)18.1(e)-233.8(i)15.4(n)-237.3(e)12.8(a)13.1(r)0(l)21.1(y)-232(pr)23.2(eg)21(na)22.4(nc)16.3(y)-232(a)13.1(re)-221.9(a)13.1(t)-234.4(in)24.7(cr)19(e)12.7(a)0(s)18.1(e)12.8(d)-230.6(r)0(i)21.1(s)0(k)]TJ
0 -1.2267 TD
[(of)-249.8(d)16(e)0(v)18.3(e)12.8(lo)19(pi)20.4(ng)-241.8(\(G)19.7(ra)18.8(ve)24.7(s)22.1(\))-259.7(h)0(y)23.8(p)0(e)17.7(r)0(t)24.1(h)0(y)17.5(r)0(o)21.8(i)0(d)25.1(i)0(s)20.4(m)-256.8(po)21.2(st)17.2(pa)24.4(rt)24.1(um)-245.5(\(1)19(2)13.1(0)0(\))19(.)-255.8(In)]TJ
0 -1.2203 TD
[(on)19.1(e)-208.6(s)0(t)23.5(u)0(d)20.9(y)-206.7(th)21.4(e)-208.5(o)0(v)21.8(e)0(r)18.4(a)13.1(ll)-196.8(re)18.4(la)22.2(ps)22.6(e)-208.6(r)0(a)18.8(t)12.2(e)-208.5(o)0(f)-199.3(G)13.9(ra)18.8(ve)24.7(s)-210(d)0(i)25.1(s)0(e)17.8(a)13.1(se)-197.2(fo)15.7(l)15.4(l)0(o)19(w)0(i)20.1(n)15.6(g)-213.1(a)]TJ
T*
[(pr)23.2(eg)21(na)22.4(nc)16.3(y)-238.4(w)0(a)17.8(s)-241.6(8)13.1(4)0(%)-235.1(a)13.1(s)-247.9(c)13.4(om)18.6(pa)24.4(re)18.4(d)-243.3(w)0(i)26.5(t)0(h)-237.8(a)-239.8(re)18.4(la)22.3(ps)22.6(e)-246.5(r)0(a)25.1(t)12.2(e)-246.5(o)0(f)-230.9(5)0(6)19.9(%)-241.9(in)]TJ
T*
[(wo)20.9(me)21.5(n)-281.6(w)0(h)26.6(o)-281(di)25.1(d)-281.2(n)0(o)19.1(t)-278.7(b)14.6(e)0(c)19.8(o)0(m)18.6(e)-278.1(pr)23.2(e)12.8(g)0(n)17.5(a)13.1(nt)-269.4(\()12.2(1)0(2)19.9(0)13.1(\))12.2(.)-281.1(It)-268.1(sh)20.6(ou)21.2(ld)-265.8(a)13.1(l)0(s)20.4(o)-281(b)14.6(e)]TJ
0 -1.2266 TD
[(no)19.1(t)12.2(e)12.8(d)-312.8(t)12.2(ha)22.4(t)-310.3(a)13.1(n)-306.9(i)0(n)18.4(c)13.4(re)18.4(a)13.1(s)0(e)24.1(d)-306.5(pr)16.9(e)12.7(v)0(a)18.7(l)15.4(en)15.7(c)13.4(e)-309.7(of)]TJ
/F8 1 Tf
16.5913 0 TD
-.0131 Tc
[(de)-323.6(n)-13.1(o)8.5(vo)]TJ
/F6 1 Tf
3.3828 0 TD
-.0175 Tc
[(Gr)-17.5(av)-17.5(es)-17.5()-311.6(d)-17.5(is)-17.5(e)6.6(a)-4.4(s)-17.5(e)]TJ
-19.9741 -1.2203 TD
0 Tc
[(ha)22.4(s)-184.7(b)0(e)21(e)0(n)-180.3(r)0(e)24.7(p)0(o)21.2(r)0(t)17.8(e)12.7(d)-186.4(i)0(n)-177.6(t)12.2(he)-174(po)21.2(st)17.2(pa)24.4(rt)17.8(um)-176(pe)24(ri)21.1(od)-176.5(\()12.2(1)13.1(21)19.9(\))12.2(,)-186.3(al)22.2(th)21.4(ou)21.2(gh)-178.5(t)12.2(h)0(i)18.4(s)]TJ
T*
[(a)13.1(s)0(s)16.3(o)0(c)23.2(i)0(a)22.2(t)12.2(io)19(n)-269(h)0(a)22.4(s)-273.2(b)14.6(e)0(e)19.2(n)-268.9(qu)19.5(e)12.7(s)0(t)23.5(i)0(o)19(n)0(e)22(d)-268.6(\(1)19(2)13.1(2)0(\))19(.)]TJ
/F10 1 Tf
0 -2.447 TD
[(Question)-338(38:)-333.4(How)-334(should)-334(the)-334.6(etiology)]TJ
0 -1.2203 TD
[(of)-336.6(new)-329.3(thyrotoxicosis)-341.2(be)-332.5(determined)]TJ
0 -1.2266 TD
[(in)-331.6(the)-334.6(postpartum)-340.1(period?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(The)-252.9(ma)21.9(j)14(o)0(r)-237.4(c)13.4(ha)22.4(ll)18.2(e)12.7(n)0(g)23.8(e)-246.5(i)15.4(s)-247.9(t)12.2(o)-243(di)25.1(ff)18(e)12.8(r)0(e)18.4(n)0(t)21.4(i)0(a)22.2(t)12.2(e)-246.5(t)12.2(hy)23.8(ro)15.5(t)12.2(o)0(x)20.4(i)15.4(co)16.9(si)20.4(s)-241.6(c)13.4(a)13.1(u)0(s)16.3(e)12.7(d)]TJ
-1.1128 -1.2203 TD
[(by)-268.1(PP)16.3(T)-274.9(f)0(r)17.8(o)0(m)-265.9(t)0(h)15.1(y)14.6(ro)21.8(to)22.1(xi)19.6(co)23.2(si)20.4(s)-285.8(c)13.4(a)13.1(u)0(s)16.3(e)12.7(d)-281.2(b)14.6(y)-282.6(G)13.9(ra)18.8(ve)24.7(s)-275.1(di)25.1(se)17.8(a)13.1(s)0(e)17.8(.)-274.8(Th)18.9(is)-270.4(is)]TJ
T*
[(a)13.1(n)-262.6(im)24.2(po)21.2(rt)17.8(a)13.1(n)0(t)-250.4(d)0(i)25.1(f)0(f)18(e)12.7(re)18.4(nt)21.4(ia)22.3(t)12.2(i)0(o)19(n)-256.3(as)-253.7(t)12.2(h)0(e)-249.9(t)12.2(wo)-251(d)16(i)0(s)20.4(e)0(a)19.6(s)0(e)-247.8(e)12.8(nt)21.4(it)21.3(ie)15.5(s)-254.2(r)0(e)18.4(q)14.6(ui)20.4(re)]TJ
T*
[(di)18.8(f)12.2(f)12.2(e)0(r)18.4(e)12.8(nt)-357.9(t)12.2(r)0(e)18.4(a)13.1(t)12.2(m)0(e)21.5(n)0(t)15.1(s)-361.7(an)16.1(d)-363.4(a)-366.2(ha)22.4(ve)-354.7(a)-366.2(m)0(a)21.9(r)0(k)20.2(e)12.8(dl)18.8(y)-364.8(d)0(i)18.8(f)12.2(f)12.2(e)0(r)18.4(e)12.8(nt)-357.9(c)13.4(l)0(i)18.2(n)0(i)24.7(c)0(a)20.2(l)]TJ
0 -1.2266 TD
[(co)23.2(ur)16.9(se)24.1(.)-224.2(T)0(R)24.4(A)0(b)-214.5(i)15.4(s)-222.6(p)0(o)21.2(s)0(i)20.4(t)12.2(iv)21(e)-221.2(i)0(n)-215.6(G)13.9(ra)18.8(ve)24.7(s)-211.9(di)18.8(se)24.1(a)13.1(s)0(e)-216.2(i)15.4(n)-224.7(t)12.2(he)-211.9(va)18.7(st)-210.4(m)15.1(a)0(j)20.8(o)0(r)21.8(i)0(t)21.3(y)]TJ
0 -1.2203 TD
[(of)-249.8(c)13.4(a)13.1(se)17.8(s)-254.2(a)13.1(nd)-246.7(ne)22(ga)21.4(ti)21.3(ve)-247.2(in)-247.2(PP)22.6(T)-255.9(i)0(n)-247.2(t)12.2(he)-249.9(m)15.1(a)0(j)20.8(o)0(r)21.8(i)0(t)21.3(y)-257.3(of)-243.5(ca)20.2(se)24.1(s)-260.5(\()12.2(1)13.1(1)0(8)19.9(,)0(1)22.9(1)13.1(9\))19(.)]TJ
T*
[(An)-257.7(el)15.5(e)12.8(v)0(a)25(t)0(e)18.6(d)-268.6(T)]TJ
6.7246 0 0 5.9768 116.3905 66.7276 Tm
(4)Tj
8.9663 0 0 8.9663 119.6787 68.2583 Tm
(:T)Tj
6.7246 0 0 5.9768 127.1055 66.7276 Tm
(3)Tj
8.9663 0 0 8.9663 132.8881 68.2583 Tm
[(ra)18.8(t)12.2(i)0(o)-259.2(s)0(u)16.3(g)14.6(ge)21(st)23.5(s)-273.2(t)12.2(he)-262.5(pr)23.2(es)17.8(e)12.8(n)0(c)22.6(e)-271.8(of)-262.5(PP)22.6(T.)-258.8(Ph)20.5(ys)19.6(i)15.4(c)0(a)20.2(l)]TJ
-7.9036 -1.2267 TD
[(st)17.2(i)15.4(g)0(m)23.3(a)0(t)19(a)-347.3(of)-338.4(G)13.9(r)0(a)18.8(v)0(e)24.7(s)0()-338.3(d)0(i)18.8(s)0(e)24.1(a)0(s)18.1(e)-347.7(m)15.1(a)0(y)-339(b)0(e)-339.4(d)16(ia)22.2(gn)17.5(os)21.2(t)12.2(i)0(c)-337.9(\()12.2(go)18.1(i)15.4(t)0(e)18.6(r)-348.5(wi)20.1(t)12.2(h)-351.1(a)]TJ
27.9978 74.5598 TD
[(br)20.2(ui)20.4(t)12.2(,)-350.7(en)15.7(d)16(o)0(c)16.9(r)0(i)21.1(n)0(e)-338.4(o)0(p)21.2(h)0(t)21.4(h)0(a)16.1(l)15.4(mo)18.6(pa)24.4(th)21.4(y\))20.4(.)-350.7(T)0(h)18.9(e)-354(ra)25.1(di)18.8(oi)25.3(od)19.5(in)18.4(e)-347.7(u)0(p)22.6(t)0(a)19(k)0(e)-339.4(i)0(s)]TJ
0 -1.2203 TD
[(el)15.5(e)12.7(v)0(a)25(t)0(e)18.6(d)-274.9(or)-262.7(no)19.1(rm)20.7(a)13.1(l)-275.4(in)-266.2(G)13.9(r)0(a)18.8(v)0(e)24.7(s)0()-268.8(d)16(is)20.4(ea)19.6(se)-266.8(a)13.1(n)0(d)-265.6(l)15.4(ow)-270(i)15.4(n)-275.3(PP)16.3(T)16(.)-274.8(Du)16.2(e)-271.8(t)12.2(o)]TJ
0 -1.2266 TD
[(th)15.1(e)12.7(i)0(r)-295.1(s)0(h)20.6(o)0(r)21.8(t)12.2(er)-297.8(ha)22.4(lf)21.3(-l)21.3(if)21.3(e)]TJ
6.7246 0 0 5.9768 395.5463 707.8676 Tm
-.0195 Tc
[(12)-19.5(3)]TJ
8.9663 0 0 8.9663 405.3542 703.8423 Tm
0 Tc
[(I)-305.6(o)0(r)-294.3(t)12.2(ec)19.8(hn)18.5(e)12.7(t)12.2(iu)20.4(m)-307.4(s)0(c)18.4(a)13.1(ns)-295.6(a)13.1(r)0(e)-297.8(p)0(r)23.2(e)0(f)18.6(e)12.8(rr)17.6(e)12.7(d)-306.5(t)12.2(o)]TJ
6.7246 0 0 5.9768 313.0582 696.8691 Tm
[(13)22(1)]TJ
8.9663 0 0 8.9663 322.866 692.9006 Tm
[(I)-463.7(i)0(n)-449.5(w)0(o)20.9(m)15.1(en)-452.2(wh)20.3(o)-458(a)13.1(re)-449.5(br)20.2(e)12.8(a)0(s)18.1(t)12.2(f)12.2(e)0(e)19.2(d)0(i)18.8(n)15.6(g.)-449.9(Nu)17.6(rs)23.3(in)18.4(g)-453.3(c)0(a)20.2(n)-458.6(re)18.4(su)22.6(me)]TJ
-1.0939 -1.2203 TD
[(se)17.8(ve)18.3(ra)25.1(l)-269.1(d)0(a)22.8(y)0(s)-258.6(a)13.1(ft)18(e)12.8(r)-272.6(a)]TJ
6.7246 0 0 5.9768 390.0471 685.9274 Tm
[(12)22(3)]TJ
8.9663 0 0 8.9663 399.855 681.9589 Tm
[(I)-274(o)0(r)-256.4(t)12.2(ec)19.8(hn)18.5(e)12.7(t)12.2(iu)20.4(m)-269.4(s)0(c)18.4(a)13.1(n.)]TJ
/F10 1 Tf
-9.6804 -2.7821 TD
[(Question)-338(39:)-333.4(How)-334(should)-334(Graves)-334.8(hyperthyroidism)]TJ
0 -1.2203 TD
[(be)-338.9(treated)-333.7(in)-331.6(lactating)-339.4(women?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
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T*
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[(no)19.1(rm)20.7(a)13.1(l)-224.8(T)]TJ
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(4)Tj
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T*
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T*
[(mo)18.6(t)12.2(h)0(e)22(r)0(s)-242.3(o)0(n)-240.1(A)0(T)20.9(D)0(s)-236.7(a)13.1(t)-253.4(m)15.1(od)19.5(e)12.8(r)0(a)18.8(t)12.2(e)-252.8(d)16(os)21.2(es)-241.5(\()12.2(P)0(T)20.9(U)-248(le)15.5(ss)-236.6(t)12.2(h)0(a)22.4(n)-250(30)19.9(0)-157.6(m)15.1(g/)24.2(d)]TJ
0 -1.2266 TD
[(or)-180.5(m)15.1(e)0(t)18.6(h)0(i)24.7(m)0(a)21.9(z)0(o)16.7(l)15.4(e)-189.6(2)13.1(0)13.1()0(3)19.9(0)-157.6(m)15.1(g)0(/)24.2(d)0(\))15.5(.)-180(It)-179.6(i)15.4(s)-191(c)13.4(u)0(r)23.2(r)0(e)18.4(n)0(t)21.4(l)0(y)-172.3(r)0(e)18.4(c)13.4(om)18.6(m)15.1(e)0(n)15.7(d)16(ed)-173.6(th)15.1(a)13.1(t)]TJ
0 -1.2203 TD
[(br)20.2(ea)19.6(st)23.5(-f)18(e)12.7(e)0(d)22.4(i)0(n)18.4(g)-466(in)18.4(f)12.2(a)13.1(nt)15.1(s)-462.9(o)0(f)-458.5(m)0(o)18.6(t)12.2(he)22(rs)-457.3(ta)19(k)14.6(i)0(n)18.4(g)-466(AT)20.9(Ds)-458(be)-459.6(sc)24.7(re)18.4(e)12.7(n)0(e)22(d)]TJ
T*
[(wi)20.1(th)-440.1(t)12.2(h)0(y)17.5(r)0(o)21.8(i)15.4(d)-451.9(f)12.2(un)20.5(ct)19.2(io)25.3(n)-452.3(t)12.2(es)17.8(t)12.2(s)-450.2(a)13.1(n)0(d)-436.3(t)0(h)21.4(a)0(t)-442.6(t)12.2(he)-439.6(m)15.1(o)0(t)15.7(h)15.6(er)18.4(s)-450.2(t)12.2(a)13.1(k)0(e)-440.6(t)12.2(he)22(ir)]TJ
0 -1.2266 TD
[(AT)20.9(Ds)-261.9(in)-259.8(di)25.1(vi)21(de)22.4(d)-268.6(d)0(o)19.5(s)0(e)17.8(s)-266.9(im)24.2(me)21.5(di)18.8(a)13.1(t)12.2(el)21.9(y)-270(f)0(o)22.1(l)0(l)18.2(o)0(w)20.9(i)0(n)24.7(g)-270(ea)19.6(c)13.4(h)-268.9(fe)18.6(e)12.7(d)0(i)18.8(n)0(g)23.8(.)]TJ
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5.9777 0 0 5.9777 312.2645 476.7306 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 322.7527 474.2361 Tm
[(RECOMMENDATION)-284.2(35)]TJ
/F6 1 Tf
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[(MMI)-581.4(in)-582.3(doses)-590(up)-584.4(to)-578.6(2030)-168.3(mg/d)-583.4(is)-586.6(safe)-582.9(for)-585.7(lactating)]TJ
0 -1.2203 TD
[(mothers)-202.1(and)-201.9(their)-204(infants.)-204.7(PTU)-208.1(at)-202.3(doses)-198(up)-205(to)-205.6(300)-162.9(mg/d)-204(is)-200.9(a)]TJ
T*
[(second-line)-456.8(agent)-456.6(due)-459.5(to)-458.5(concerns)-459(about)-451.1(severe)-464(hepato-)]TJ
0 -1.2267 TD
[(toxicity.)-240.9(ATDs)-241.1(should)-249.3(be)-238.3(administered)-243.4(following)-247.3(a)-239.8(feeding)]TJ
0 -1.2203 TD
[(and)-277.8(in)-285.1(divided)-276(doses.)]TJ
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9.7499 0 TD
[(Level)-285.1(A-USPSTF)]TJ
/F3 1 Tf
-10.8881 -2.7758 TD
[(Clinical)-341.3(Guidelines)-334.7(for)-330.9(Iodine)-338.2(Nutrition)]TJ
/F10 1 Tf
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[(Question)-338(40:)-333.4(Why)-334(is)-336.7(increased)-334.8(iodine)-331.9(intake)-334.4(required)]TJ
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[(in)-338(pregnancy)-331.8(and)-338.2(lactation,)-336.6(and)-331.9(how)-336.8(is)-330.4(iodine)]TJ
0 -1.2266 TD
[(intake)-334.4(assessed?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Because)-598.6(of)-591.3(increased)-592.2(thyroid)-593.7(hormone)-598.5(production,)-596.9(in-)]TJ
-1.1128 -1.2203 TD
[(creased)-269.2(renal)-259.9(iodine)-262.7(excretion,)-267.9(and)-258.8(fetal)-269.4(iodine)-262.7(requirements,)]TJ
T*
[(dietary)-188.6(iodine)-180.5(requirements)-190.2(are)-183.5(higher)-179.7(in)-184(pregnancy)-187.1(than)-183.8(they)]TJ
0 -1.2266 TD
[(are)-335.2(for)-339.1(nonpregnant)-338.8(adults)-338(\(125\).)-331.2(Women)-337.8(with)-337.8(adequate)-336.9(io-)]TJ
0 -1.2203 TD
[(dine)-344.9(intake)-340(before)-343.3(and)-341(during)-338.9(pregnancy)-345.2(have)-338.7(adequate)-343.2(in-)]TJ
T*
[(trathyroidal)-312.9(iodine)-307(stores)-303.6(and)-309.4(have)-300.7(no)-309.7(difculty)-303.6(adapting)-306(to)]TJ
0 -1.2266 TD
[(the)-269.3(increased)-269.8(demand)-265.6(for)-269.5(thyroid)-271.2(hormone)-269.7(during)-263(gestation.)]TJ
0 -1.2203 TD
[(In)-618.8(these)-612(women,)-615.2(total)-613.8(body)-615.3(iodine)-616.8(levels)-615.9(remain)-611.6(stable)]TJ
T*
[(throughout)-286.7(pregnancy)-275.6(\(126\).)-280.6(However,)-274.1(in)-278.8(areas)-279.1(of)-275.1(even)-275.8(mild)]TJ
T*
[(to)-445.8(moderate)-440.1(iodine)-446.1(deciency,)-442.3(total)-443(body)-444.6(iodine)-439.8(stores,)-445.7(as)]TJ
0 -1.2266 TD
[(reected)-240.1(by)-230.1(urinary)-234.9(iodine)-237.4(values,)-230.6(decline)-240.2(gradually)-228.6(from)-235.5(the)]TJ
0 -1.2203 TD
[(rst)-220.5(to)-218.2(the)-212.4(third)-219.7(trimester)-219.5(of)-211.9(pregnancy)-218.7(\(127\).)-217.4(Iodine,)-220(required)]TJ
T*
[(for)-427.6(infant)-428.1(nutrition,)-427.2(is)-422.2(secreted)-428.1(into)-421.1(breast)-423.6(milk.)-423(Therefore,)]TJ
0 -1.2266 TD
[(lactating)-336.6(women)-327.7(also)-335.9(have)-332.3(increased)-333(dietary)-327.7(iodine)-332.3(require-)]TJ
0 -1.2203 TD
[(ments)-287.2(\(128,129\).)]TJ
1.1128 -1.2203 TD
[(Spot)-426.7(urinary)-424.6(iodine)-420.8(values)-423.7(are)-423.7(used)-422.9(most)-425.8(frequently)-423.2(for)]TJ
-1.1128 -1.2266 TD
[(determination)-574.5(of)-559.7(iodine)-566.2(status)-567.2(in)-563.3(general)-567.8(populations.)-568.1(A)]TJ
0 -1.2203 TD
[(limitation)-321.8(of)-313.1(urinary)-317.1(iodine)-319.6(testing)-317(is)-314.7(that)-320(identifying)-314.6(partic-)]TJ
T*
[(ular)-390.8(individuals)-393.2(at)-392(risk)-389.3(for)-389.6(iodine)-389.2(deciency)-395.1(is)-384.2(problematic)]TJ
T*
[(because)-277.6(there)-269.9(is)-270.4(substantial)-278.1(diurnal)-267.9(and)-271.5(day-to-day)-277.3(variation)]TJ
0 -1.2266 TD
[(in)-285.1(urinary)-279.2(iodine)-281.7(excretion)-290.3(\(129\).)]TJ
/F10 1 Tf
0 -2.7758 TD
[(Question)-338(41:)-333.4(What)-336.1(is)-330.4(the)-334.6(impact)-336.5(of)-336.6(severe)-332.6(iodine)]TJ
0 -1.2203 TD
[(deciency)-339.8(on)-333.8(the)-334.6(mother,)-332.1(fetus,)-338.4(and)-331.9(child?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Maternal)-600.2(dietary)-593.2(iodine)-597.8(deciency)-603.7(results)-596.6(in)-595(impaired)]TJ
-1.1128 -1.2267 TD
[(maternal)-358.7(and)-353.7(fetal)-351.6(thyroid)-353.4(hormone)-358.2(synthesis.)-357.1(Low)-348.8(thyroid)]TJ
/F3 1 Tf
-27.9978 77.2217 TD
(1096)Tj
41.5036 0 TD
[(STAGNARO-GREEN)-337.3(ET)-338.7(AL.)]TJ
ET
endstream
endobj
310 0 obj
<>stream
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BT
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8.9663 0 0 8.9663 59.7543 725.7825 Tm
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0 Tc
0 Tw
[(hormone)-408.8(values)-411(stimulate)-406(increased)-408.9(pituitary)-413.7(TSH)-406.1(produc-)]TJ
0 -1.2203 TD
[(tion,)-405.1(and)-404.2(the)-402.1(increased)-402.5(TSH)-399.8(stimulates)-407.3(thyroid)-404(growth,)-402(re-)]TJ
0 -1.2266 TD
[(sulting)-599.7(in)-595(maternal)-592.6(and)-593.9(fetal)-598.2(goiter)-593.5(\(130\).)-596.7(Severe)-594(iodine)]TJ
0 -1.2203 TD
[(deciency)-369.8(in)-361(pregnant)-367.2(women)-365.7(has)-364.6(been)-361.7(associated)-371(with)-363.1(in-)]TJ
T*
[(creased)-212.3(rates)-204.2(of)-205.6(miscarriage,)-208.9(stillbirth,)-204.8(and)-208.2(increased)-206.5(perinatal)]TJ
0 -1.2266 TD
[(and)-284.1(infant)-282.6(mortality)-284.9(\(131\).)]TJ
1.1128 -1.2203 TD
[(Normal)-351.8(levels)-426.2(of)-420.6(thyroid)-422.9(hormone)-427.8(are)-423.7(essential)-423.8(for)-421.3(neu-)]TJ
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[(ronal)-370.3(migration)-370(and)-372.6(myelination)-369.8(of)-370(the)-370.5(fetal)-370.6(brain.)-368.5(Thyroid)]TJ
0 -1.2266 TD
[(hormones)-397.5(are)-392.1(needed)-394.8(throughout)-400.5(pregnancy)-395.7(and)-391.6(in)-392.6(partic-)]TJ
0 -1.2203 TD
[(ular)-365.5(between)-370(the)-364.2(third)-365.2(and)-360(fth)-367.7(months)-363(of)-370(intrauterine)-364.6(life.)]TJ
T*
[(As)-318.9(iodine)-319.6(deciency)-319.2(affects)-323.9(both)-320.9(maternal)-320.7(and)-315.7(fetal)-320(thyroid,)]TJ
T*
[(both)-548.5(sources)-550.4(of)-547(thyroid)-549.4(hormone)-554.3(production)-549.8(may)-545.3(be)-548.1(af-)]TJ
0 -1.2266 TD
[(fected.)-518.1(Maternal)-518(and)-511.7(fetal)-516(iodine)-515.6(deciency)-515.2(in)-512.8(pregnancy)]TJ
0 -1.2203 TD
[(and)-416.9(neonatal)-417.1(iodine)-414.5(deciency)-420.4(have)-414.5(adverse)-416.1(effects)-419.1(on)-410.8(the)]TJ
T*
[(cognitive)-511.2(function)-514.2(of)-509.1(offspring)-511.6(\(132135\).)-512.6(Children)-510.8(whose)]TJ
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[(mothers)-537.2(were)-533.2(severely)-535.2(iodine)-534.6(decient)-537.3(during)-534.9(pregnancy)]TJ
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[(may)-557.9(exhibit)-554.8(cretinism,)-556.4(characterized)-558.8(by)-552.6(profound)-553.3(mental)]TJ
T*
[(retardation,)-516.4(deaf-mutism,)-507.6(and)-511.7(motor)-510.1(rigidity.)-507.1(Iodine)-514.2(de-)]TJ
0 -1.2266 TD
[(ciency)-281.7(is)-283.1(the)-282(leading)-282.8(cause)-279.6(of)-281.4(preventable)-285.7(mental)-276.3(retardation)]TJ
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[(worldwide)-354.8(\(136\).)]TJ
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0 -3.054 TD
[(Question)-338(42:)-333.4(What)-336.1(is)-330.4(the)-334.7(impact)-336.5(of)-330.2(mild)-335.4(to)-336.6(moderate)]TJ
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[(iodine)-338.3(deciency)-333.4(on)-333.8(the)-334.7(mother,)-338.4(fetus,)-332.1(and)-331.9(child?)]TJ
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1.1128 -1.8336 TD
[(Groups)-290.8(of)-281.4(pregnant)-291.3(women)-283.5(whose)-287.2(median)-285.1(urinary)-285.5(iodine)]TJ
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12.0768 0 TD
(m)Tj
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[(g/L)-592.1(are)-588.1(dened)-593.9(as)-588.9(mildly)-591(to)]TJ
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[(moderately)-346.9(iodine)-338.6(decient.)-344.2(Women)-337.8(with)-337.8(mild)-342.7(to)-338.4(moderate)]TJ
T*
[(iodine)-338.6(deciency)-338.2(during)-332.5(pregnancy)-338.8(are)-335.2(at)-335.1(increased)-339.3(risk)-332.4(for)]TJ
0 -1.2266 TD
[(the)-345.2(development)-354(of)-338.4(goiter)-346.9(\(130\).)-343.8(In)-346.9(addition,)-344.6(decreased)-347.9(thy-)]TJ
0 -1.2203 TD
[(roid)-319.8(hormone)-314(associated)-314.1(with)-318.8(even)-313.7(mild)-311.1(to)-319.4(moderate)-313.6(iodine)]TJ
T*
[(deciency)-243.3(may)-235.4(have)-243.8(adverse)-239(effects)-242.1(on)-240.1(the)-237.7(cognitive)-239.3(function)]TJ
0 -1.2266 TD
[(of)-287.8(the)-282(offspring)-290.3(\(132134\).)-285(Mild)-280.7(to)-287.8(moderate)-288.3(maternal)-282.8(iodine)]TJ
0 -1.2203 TD
[(deciency)-274.9(has)-269.8(also)-272.7(been)-266.8(associated)-276.2(with)-268.3(attention)-273.1(decit)-274.8(and)]TJ
T*
[(hyperactivity)-287.3(disorders)-281.8(\(137\).)]TJ
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0 -3.054 TD
[(Question)-338(43:)-333.4(What)-336.1(is)-330.4(the)-334.7(iodine)-338.2(status)-333(of)-330.2(pregnant)]TJ
0 -1.2266 TD
[(and)-338.2(breastfeeding)-337.7(women)-328.8(in)-338(the)-334.6(United)-334(States?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Surveillance)-209.9(of)-211.9(urinary)-209.6(iodine)-205.8(values)-208.7(of)-211.9(the)-206.1(U.S.)-208(population)]TJ
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[(has)-288.7(been)-285.8(carried)-284.8(out)-289.1(at)-284.5(intervals)-291.3(since)-285.6(1971.)-285.5(Following)-289.2(a)-284(pre-)]TJ
T*
[(cipitous)-203.3(drop)-197.5(in)-196.6(urinary)-197(iodine)-199.5(values)-202.4(between)-199.3(1971)-194.1(and)-195.6(1994,)]TJ
0 -1.2266 TD
[(U.S.)-353.5(dietary)-346.6(iodine)-351.2(intake)-352.7(has)-352(stabilized)-347.5(\(138142\).)-348.2(The)-354(U.S.)]TJ
0 -1.2203 TD
[(population)-374.1(overall)-364.8(remains)-366.3(iodine)-363.9(sufcient.)-369.7(However,)-368.9(U.S.)]TJ
T*
[(women)-245.5(of)-243.5(reproductive)-247.7(age)-244.1(are)-240.4(the)-250.3(most)-242.4(likely)-240.6(group)-244.6(to)-243.5(have)]TJ
T*
[(low)-286.1(urinary)-279.2(iodine)-281.7(values.)]TJ
1.1128 -1.2266 TD
[(According)-498.3(t)-13.1(o)-628.7(th)-22.8(e)-625.9(W)-11.7(o)-9.1(r)-13.3(l)-9.9(d)-629(He)-18.8(a)-12.2(l)-9.9(t)-13.1(h)-629.4(O)-9.4(r)-13.3(g)-10.7(a)-12.2(n)-9.7(i)-9.9(z)-12.2(a)-12.2(t)-13.1(i)-9.8(o)-9.1(n)-629.4(\()-13.1(W)-11.7(H)-12.6(O)-9.4(\))]TJ
-1.1128 -1.2203 TD
.0103 Tc
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T*
.0118 Tc
[(women)-623.9(b)1.1(etween)-623.9(149)-620(and)-623.5(249)]TJ
/F14 1 Tf
14.549 0 TD
0 Tc
(m)Tj
/F6 1 Tf
.5627 0 TD
.0127 Tc
[(g/L)-622.6(a).5(re)-619.5(cons)5.1(is)5.1(tent)-626.4(w)4.8(i)2.8(th)]TJ
-15.1118 -1.2267 TD
.012 Tc
[(optima)12(l)-623.3(i)-4.2(odine)-620.2(i)2.1(ntake)-613.9(\()-1.1(132\).)-616.9(I)3.6(n)-617.4(t)-1.1(he)-620.2(200)12(1)-6(2006)-613.5(Nationa)12(l)]TJ
0 -1.2203 TD
[(Health)-756.4(and)-756(N)-.5(utrition)-750(Examina)12.1(t)-6.8(ion)-756.4(S)1(urvey)-751.1(\()-1(NHAN)12.1(E)-9.9(S\))]TJ
T*
.0123 Tc
[(sur)5.3(veys,)-464.8(t)-.8(he)-468.1(me)12.3(d)-9.6(i)2.4(an)-465.3(urinary)-466.3(i)2.4(odine)-468.1(c).4(oncent)12.3(r)-7.8(a).1(tion)-471.6(among)]TJ
0 -1.2266 TD
[(326)-429.9(pr)5.2(egna)12.2(n)-9.7(t)-430.9(women)-427.5(w)-2.1(a)12.2(s)-437.5(marginal)-433.9(a)12.2(t)-436.7(153)]TJ
/F14 1 Tf
19.8856 0 TD
0 Tc
(m)Tj
/F6 1 Tf
.5627 0 TD
.0118 Tc
[(g/L)-427.5(a)-.4(nd)-427.5(17%)]TJ
-20.4483 -1.2203 TD
.0109 Tc
[(o)-4.5(f)-666.1(pregnant)-666.1(women)-669(h)1.2(ad)-662.3(uri)-5.3(n)1.2(ary)-663.7(i)1(od)-4.7(ine)-665.5(c)-1(on)-5.1(centratio)-4.5(n)1.2(s)]TJ
/F11 1 Tf
T*
0 Tc
(<)Tj
/F6 1 Tf
.7714 0 TD
.0122 Tc
(50)Tj
/F14 1 Tf
1.1887 0 TD
0 Tc
(m)Tj
/F6 1 Tf
.5627 0 TD
[(g)-10.7(/)-15.6(L)-382.4(\()-13.1(14)-18(3)-12.2(\))-13.1(.)-382.3(I)-14.8(t)-379.8(i)-9.9(s)-387(n)-9.7(o)-15.4(t)-379.8(c)-11.9(l)-16.2(ea)-18.4(r)-386.4(w)-7.9(h)-16(e)-12.5(th)-22.8(e)-12.5(r)-380.1(t)-13.1(h)-9.7(e)-12.5(s)-14(e)-385.6(w)-7.9(o)-9.1(m)-16.5(en)-395.3(w)-8(e)-12.5(r)-13.3(e)]TJ
-2.5228 -1.2266 TD
.0119 Tc
[(truly)-409.8(i)2(odine)-411.6(d)2.6(ecie)11.9(n)-10.3(t)-405.9(o)-3.5(r)-406.1(w)-2.4(hether)-412.4(their)-412.4(l)2(ow)-413.4(v)4.8(a)-.3(lues)-406.7(just)-405.9(re-)]TJ
0 -1.2203 TD
.0126 Tc
[(pres)5(ented)-420.4(r)-.7(a)12.6(n)-9.3(dom)-414.9()3.3(uctua)12.6(t)-6.3(ion.)-420.3(Cu)4.9(rrent)-417.8(da)12.6(t)-6.3(a)-423.2(r)5.6(e).1(garding)-415.4(i)2.7(o-)]TJ
T*
.0117 Tc
[(dine)-626.8(s)4.1(u)-2.3(fciency)-625(among)-618.7(l)1.8(actating)-625(U)4(.)-3.9(S.)-623.5(w)3.8(o)-3.7(men)-617.7(a)-.5(re)-620.5(very)]TJ
T*
[(limited.)-484.4(I)3.3(t)-488.3(is)-482.8(poss)4.1(ible)-481.4(that)-488.3(a)-481(s)-2.3(u)4(b)1(set)-482(o)2.6(f)-488.3(p)4(regnant)-482(a)-.5(nd)-484.5(lac-)]TJ
0 -1.2266 TD
.0104 Tc
[(tating)-442.9(U.S)-7(.)-435.1(women)-435.6(m).2(ay)-436.6(h)-5.6(a)-1.8(ve)-438.4(mi)-5.8(ldly)-442.9(t)10.4(o)-448.1(mod)-5.2(e)-2.1(rately)-436.6(in)-5.6(ad-)]TJ
0 -1.2203 TD
.0118 Tc
[(equate)-848(dietar)4.8(y)-846.2(i)-4.4(odine)-848(i)1.9(ntak)]TJ
13.8092 0 TD
.0127 Tc
[(e)-847.1(r)-.6(es)5.1(ulting)-845.3(in)-844.3(insu)5(fcie)12.7(n)-9.6(t)]TJ
-13.8092 -1.2203 TD
.0116 Tc
[(amounts)-438.6(o)2.5(f)-444.1(i)1.7(odine)-443.5(i)1.7(n)-440.7(t)-1.5(he)-437.2(breast)-444.1(milk)-441.7(to)-440.1(meet)-437.8(infa)11.6(n)-10.3(t)11.6(s)-9.1()-439.2(di-)]TJ
0 -1.2267 TD
.0119 Tc
[(etary)-397.2(r)-1.4(e)11.9(q)-11.4(uirements)-400.4(\()-1.2(14)11.9(4)-6.1(,)-3.7(1)11.9(4)-6.1(5\).)]TJ
/F10 1 Tf
28.0042 74.5598 TD
0 Tc
[(Question)-331.7(44:)-333.4(What)-336.1(is)-336.7(the)-334.6(iodine)-331.9(status)-333(of)-336.5(pregnant)]TJ
0 -1.2203 TD
[(and)-331.9(breastfeeding)-337.7(women)-335.1(worldwide?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Since)-301.8(1)13.1(9)0(9)19.9(0)13.1(,)-293.8(t)12.2(he)-281.5(nu)20.5(m)15.1(b)0(e)21(r)-291.6(of)-281.5(ho)19.1(us)22.6(e)12.7(h)0(o)19.1(l)0(d)18.8(s)-285.8(wo)20.9(rl)21.1(dw)20.7(id)18.8(e)-290.7(u)0(s)22.6(i)0(n)24.7(g)-295.3(i)15.4(o)0(-)]TJ
-1.1128 -1.2266 TD
[(di)25.1(ze)19.6(d)-218(s)0(a)18.1(l)0(t)-212.7(h)0(a)22.4(s)-222.6(ri)21.1(se)24.1(n)-224.7(f)12.2(ro)21.8(m)-225.2(l)15.4(es)17.8(s)-222.6(t)12.2(ha)22.4(n)-224.7(2)13.1(0)13.1(%)-222.9(t)12.2(o)-224.1(mo)18.6(re)-209.3(t)12.2(h)0(a)22.4(n)-224.7(7)13.1(0)13.1(%)-222.9(\(1)19(4)13.1(6)13.1(\))0(.)]TJ
0 -1.2203 TD
[(De)24(sp)16.3(i)15.4(t)0(e)-177.4(t)12.2(he)15.7(se)-171.9(a)13.1(d)0(v)21.6(a)0(n)22.4(c)0(e)19.8(s)0(,)-174.9(h)0(o)19.1(w)0(e)23.8(v)0(e)18.3(r)0(,)-174.3(i)0(o)19(d)16(in)18.4(e)-183.3(d)0(e)16.1()16(ci)22.5(en)15.7(c)13.4(y)-187.8(a)13.1(f)12.2(fe)18.6(c)13.4(t)0(s)-178.8(o)0(v)21.8(e)12.8(r)]TJ
T*
[(2)13.1(.)0(2)-249(b)14.6(il)18.2(li)24.6(on)-252.8(i)15.4(n)0(d)18.9(i)0(v)21(i)0(d)25.1(u)0(a)18.1(l)0(s)-245.1(g)0(l)17.3(o)16.2(ba)21.4(ll)18.2(y)14.6(,)-262.2(e)12.7(s)0(p)22.6(e)0(c)19.8(i)0(a)22.2(l)0(l)18.2(y)-257.3(in)-247.2(So)17.7(ut)23.5(h)-256.3(A)0(s)16.3(i)15.4(an)16.1(,)-255.8(E)0(a)22.8(s)0(t)]TJ
0 -1.2266 TD
[(As)22.6(ia)-256(Pa)24.4(ci)22.5(c)16.7(,)-262.2(a)13.1(nd)-259.3(E)16(a)0(s)18.1(t)-266(a)13.1(n)0(d)-259.3(S)14.2(ou)21.2(t)12.2(h)-268.9(Af)23.4(ri)21.1(ca)20.2(n)-268.9(r)0(e)24.7(g)0(i)23.7(o)0(n)19.1(s)0(,)-257.1(a)13.1(nd)-253(re)18.4(ma)21.9(in)24.7(s)]TJ
0 -1.2203 TD
[(t)12.2(h)0(e)-262.5(l)15.4(ea)19.6(di)25.1(ng)-260.7(ca)20.2(us)22.6(e)-271.8(o)0(f)-256.2(p)0(r)16.9(e)12.7(ve)24.6(nt)15.1(a)13.1(b)14.5(le)-262.7(in)24.7(te)18.6(ll)24.5(ec)19.8(tu)17.1(a)13.1(l)-269.1(de)22.4(c)23(it)21.3(s)-273.2(\()12.2(1)13.1(3)0(4)19.9(\))12.2(.)]TJ
/F10 1 Tf
0 -2.4406 TD
[(Question)-331.7(45:)-333.4(Does)-339.8(iodine)-331.9(supplementation)]TJ
0 -1.2266 TD
[(in)-331.6(pregnancy)-338.1(and)-331.9(lactation)-333(improve)-340.7(outcomes)]TJ
0 -1.2203 TD
[(in)-331.6(severe)-332.6(iodine)-338.3(deciency?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(In)-365.9(areas)-367.7(of)-363.7(severe)-369.2(iodine)-370.2(deciency,)-366.4(iodine)-370.2(supplementa-)]TJ
-1.1128 -1.2203 TD
[(tion)-288.4(of)-294.1(mothers)-290.6(prior)-293.6(to)-294.1(conception)-294.4(or)-294.3(in)-291.4(early)-286.3(pregnancy)-294.6(re-)]TJ
0 -1.2266 TD
[(sults)-716.2(in)-715.1(children)-718.6(with)-717.2(improved)-717.7(cognitive)-713.6(performance)]TJ
0 -1.2203 TD
[(relative)-254.9(to)-249.8(those)-254.4(given)-252.3(a)-252.4(placebo)-251(\(147149\).)-253.4(The)-252.9(prevalence)-254.8(of)]TJ
T*
[(cretinisim)-582.3(and)-587.6(other)-582.6(severe)-584.2(neurological)-587.4(abnormalities)-589.2(is)]TJ
0 -1.2266 TD
[(signicantly)-244.8(reduced)-247.4(\(150\).)-242.7(Maternal)-246.1(iodine)-243.8(supplementation)]TJ
0 -1.2203 TD
[(in)-291.5(severely)-294.9(iodine-decient)-301(areas)-291.8(also)-298(decreases)-295.7(rates)-292.7(of)-294.1(still-)]TJ
T*
[(birth)-278.1(and)-284.1(neonatal)-284.4(and)-277.8(infant)-282.6(mortality)-284.9(\(151,152\).)]TJ
/F10 1 Tf
0 -2.447 TD
[(Question)-331.7(46:)-333.4(Does)-339.8(iodine)-331.9(supplementation)]TJ
0 -1.2203 TD
[(in)-331.6(pregnancy)-338.1(and)-331.9(lactation)-333(improve)-340.7(outcomes)]TJ
T*
[(in)-331.6(mildly)-337(to)-330.2(moderately)-339(iodine-decient)-338.3(women?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Eight)-191.9(c)13.4(o)0(n)19.1(t)12.2(ro)21.8(ll)18.2(e)12.7(d)-180(t)12.2(r)0(i)21.1(a)13.1(ls)-169.2(of)-167.6(io)19(di)18.8(n)15.6(e)-183.3(su)22.6(pp)22.6(le)21.9(me)21.5(nt)21.4(at)19(io)19(n)-180.4(i)15.4(n)-180.4(m)0(i)17.9(l)15.4(dl)18.8(y)-175.1(t)0(o)]TJ
-1.1128 -1.2266 TD
[(m)15.1(o)0(d)19.5(e)12.7(ra)18.8(t)12.2(e)0(l)21.9(y)-339.5(io)19(di)18.8(n)15.6(e)0(-)18.6(d)0(e)22.4()0(c)23(i)0(e)21.9(n)0(t)-332.6(p)0(r)16.9(e)12.7(g)14.6(n)0(a)16.1(n)15.6(t)-341.9(E)0(u)20.9(r)0(o)21.8(p)0(e)17.7(a)13.1(n)-344.8(w)0(o)27.2(m)0(e)21.5(n)-344.8(ha)22.4(ve)]TJ
0 -1.2203 TD
[(b)14.5(e)0(e)19.2(n)-224.7(pu)22.6(bl)23.7(is)20.5(he)22(d)-224.3(\()12.2(15)19.9(3)13.1()13.1(1)0(6)19.9(0)13.1(\),)-212(al)22.2(th)21.4(ou)14.8(g)14.6(h)-224.7(do)25.8(se)17.8(s)-222.6(a)13.1(nd)-215(t)12.2(i)0(m)24.2(i)0(n)18.4(g)-219.4(of)-211.9(io)19(di)25.1(ne)]TJ
T*
[(su)22.6(pp)22.6(le)21.9(me)21.5(nt)21.4(at)19(io)19(n)-344.8(v)0(a)25(r)0(i)21.1(e)12.7(d)-344.4(a)13.1(nd)-335.2(on)19.1(l)15.4(y)-345.9(t)12.2(w)0(o)-333.2(t)12.2(ri)21.1(al)22.2(s)-342.8(e)0(x)16.9(a)13.1(mi)24.2(ne)15.7(d)-338.1(e)0(f)18.6(f)12.2(ec)19.8(t)12.2(s)]TJ
0 -1.2266 TD
[(on)-284.4(of)15.7(f)12.2(s)0(p)22.6(r)0(i)21.1(n)0(g)-286(d)0(e)22.4(v)0(e)18.3(l)0(o)19(p)0(m)26.4(e)0(n)22(t)0(.)-287.9(I)0(o)20.4(d)0(i)18.8(n)0(e)-287.8(s)0(u)22.6(p)0(p)22.6(l)0(e)21.9(m)0(e)21.5(n)0(t)21.4(a)0(t)19(i)0(o)19(n)-294.2(of)-287.8(mo)18.6(de)22.4(r-)]TJ
0 -1.2203 TD
[(a)13.1(t)12.2(el)21.9(y)-440.7(d)0(e)16.1()16(ci)16.2(e)12.8(n)0(t)-433.8(p)0(r)23.2(e)12.7(gn)17.5(a)13.1(n)0(t)-433.8(w)0(o)27.2(m)0(e)21.5(n)-446(a)13.1(p)0(p)22.6(e)0(a)19.6(r)0(s)-432(t)12.2(o)-439(c)0(o)16.9(n)0(s)20.6(i)15.4(st)17.2(e)12.8(n)0(t)21.4(l)0(y)-431.6(d)0(e)22.4(-)]TJ
T*
[(c)13.4(r)0(e)18.4(a)13.1(se)-311(m)15.1(a)0(t)19(e)12.7(rn)21.2(al)-312.9(a)13.1(n)0(d)-309.9(n)0(e)22(o)0(n)19.1(a)13.1(t)12.2(a)0(l)-312.9(t)12.2(hy)23.8(ro)21.8(id)-310(vo)21.8(lu)20.4(me)21.5(s)-323.8(a)13.1(nd)-309.9(T)16(g)-320.6(le)21.9(ve)18.3(ls)20.4(.)]TJ
T*
[(Ef)21.8(f)12.2(e)0(c)19.8(t)12.2(s)-393.3(o)0(n)-385.5(m)15.1(at)19(e)12.7(r)0(n)21.2(a)0(l)-382.4(t)12.2(hy)17.5(ro)21.8(id)-379.6(f)12.2(u)0(n)20.5(c)0(t)19.2(i)0(o)19(n)-389.1(ha)22.4(ve)-386.3(b)14.5(e)0(e)19.2(n)-395.4(m)15.1(i)0(x)19.6(e)12.8(d,)-385.3(wi)26.5(th)]TJ
0 -1.2266 TD
[(si)20.4(g)14.6(n)0(i)18.4()0(c)23(a)13.1(nt)-288.4(ma)21.9(te)18.6(rn)21.2(a)13.1(l)-300.7(TS)17.5(H)-297.2(d)0(e)22.4(c)0(r)19(e)12.7(as)18.1(e)12.7(s)-298.5(wi)20.1(t)12.2(h)-300.6(su)22.6(pp)16.3(l)15.4(e)0(m)21.5(e)0(n)15.7(t)12.2(a)13.1(t)0(i)21.3(o)0(n)-290.7(d)0(e)22.4(-)]TJ
0 -1.2203 TD
-.0141 Tc
[(s)-14.1(c)10.6(r)-14.1(i)7(b)-14.1(e)6.9(d)-358.5(i)1.3(n)-358.9(f)-1.9(o)-14.1(u)7.1(r)-356.2(\()-1.9(14)-14.1(9)5.9(,)-14.1(1)8.8(5)-1(1)-14.1(,)2.4(152,)-14.1(154\))-356(o)-14.1(f)-346.1(th)-14.1(e)-346.2(e)-1.4(i)-14.1(g)3.2(ht)-356(p)-14.1(u)2.2(bl)-14.1(i)4.1(s)-14.1(h)6.5(e)-1.3(d)-352.2(t)-14.1(ri)-14.1(a)8.2(l)-14.1(s)6.3(,)]TJ
T*
0 Tc
[(a)13.1(n)0(d)-221.4(i)0(n)24.7(c)0(r)19(e)12.7(as)18.1(e)12.7(s)-228.9(in)-221.9(ma)21.9(t)12.2(e)0(r)18.4(n)0(a)22.4(l)-231.2(T)]TJ
6.7246 0 0 5.9768 415.729 335.2251 Tm
(4)Tj
8.9663 0 0 8.9663 421.1715 336.7558 Tm
-.0154 Tc
[(or)-250(FT)]TJ
6.7246 0 0 5.9768 441.581 335.2251 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 447.0235 336.7558 Tm
-.0132 Tc
[(n)-13.2(o)5.9(ted)-243.8(i)-13.2(n)-235.1(j).8(u)-13.2(s)3.1(t)-241.3(t)-1(w)-13.2(o)-238.9(\(151)-13.2(,154\))-13.2(.)]TJ
-14.0748 -1.2266 TD
0 Tc
[(In)-328(both)-333.5(studies)-333.4(where)-334.3(assessed,)-339.3(neurodevelopmental)-339.8(out-)]TJ
-1.1128 -1.2203 TD
[(comes)-266.4(were)-274(improved)-268.8(in)-266.2(children)-269.6(from)-273.4(mildly)-268.5(to)-268.8(moderately)]TJ
T*
[(iodine-decient)-471.7(areas)-468.8(whose)-470.6(mothers)-467.7(received)-468.5(iodine)-471.4(sup-)]TJ
0 -1.2266 TD
[(plementation)-527.9(early)-520.2(in)-525.4(pregnancy)-522.2(\(148,154\).)-522.3(The)-524.8(timing)-525.1(of)]TJ
0 -1.2203 TD
[(supplementation)-304.3(is)-295.7(likely)-297.5(to)-294.1(be)-301.5(critical)-294.4(because)-302.9(the)-294.6(benecial)]TJ
T*
[(effects)-210.5(of)-211.9(iodine)-205.8(on)-208.5(offspring)-214.4(development)-214.9(appeared)-207.6(to)-211.9(be)-206.6(lost)]TJ
0 -1.2267 TD
[(if)-282.2(supplementation)-285.4(is)-283.1(started)-283.6(after)-279.3(1020)-282.1(weeks)-279(gestation.)]TJ
1.1128 -1.2203 TD
[(No)-331.5(trials)-337.8(to)-338.4(date)-338(have)-338.7(specically)-334.8(examined)-337.7(the)-338.9(effects)-343.2(of)]TJ
-1.1128 -1.2203 TD
[(iodine)-281.7(supplementation)-285.4(in)-285.1(lactation.)]TJ
/F10 1 Tf
0 -2.447 TD
[(Question)-331.7(47:)-333.4(What)-336.1(is)-336.7(the)-334.6(recommended)-332.2(daily)-337.7(iodine)]TJ
0 -1.2203 TD
[(intake)-334.4(in)-331.7(women)-335.1(planning)-336.9(pregnancy,)-335.4(women)-335.1(who)]TJ
T*
[(are)-332(pregnant,)-335(and)-338.2(women)-328.8(who)-336.8(are)-332(breastfeeding?)]TJ
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T*
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T*
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0 -1.2266 TD
[(iodine)-332.3(per)-324.4(milliliter.)-326.2(Some)-327.5(topical)-326.6(antiseptics)-336.5(contain)-328.5(iodine,)]TJ
0 -1.2203 TD
[(although)-372.9(systemic)-374.5(absorption)-374.3(is)-365.2(generally)-373.4(not)-367(clinically)-371.3(sig-)]TJ
T*
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[(\(176\).)-407.1(Iodine-containing)-405.6(anti-asthmatic)-410.8(medications)-400(and)-404.2(ex-)]TJ
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T*
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(&)Tj
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[(RECOMMENDATION)-284.2(39)]TJ
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[(Pharmacologic)-232.6(doses)-229.6(of)-230.9(iodine)-231.1(exposure)-230.8(during)-231.4(pregnancy)]TJ
T*
[(should)-331.5(be)-333.1(avoided,)-337.8(except)-338.2(in)-329.4(preparation)-342(for)-332.7(thyroid)-334.4(sur-)]TJ
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[(gery)-237.1(for)-244.2(Graves)-243.1(disease.)-245.3(Clinicians)-242.5(should)-243(carefully)-246.6(weigh)]TJ
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T*
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(&)Tj
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T*
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(Spontaneous)Tj
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T*
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T*
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(1098)Tj
41.5036 0 TD
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ET
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T*
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T*
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T*
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T*
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T*
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[(th)15.1(o)16.2(s)0(e)-260.4(t)12.2(ha)16.1(t)-266(w)0(e)17.4(n)15.6(t)-272.4(t)12.2(o)-274.7(t)12.2(e)12.8(r)0(m)20.7(.)]TJ
1.1128 -1.2203 TD
[(A)-564.1(meta-analysis)-570.9(of)-566(8)-562.3(casecontrol)-568.9(and)-562.3(10)-561.8(longitudinal)]TJ
-1.1128 -1.2203 TD
[(studies)-529.4(demonstrated)-530.5(a)-524.3(clear)-527.7(association)-529.6(between)-528.1(thyroid)]TJ
0 -1.2266 TD
[(antibodies)-293.7(and)-290.4(spontaneous)-295.8(abortion)-295.8(\(OR)-292.3(2.30,)-288.9(95%)-291.5(CI)-286.8(1.80)]TJ
0 -1.2203 TD
[(2.95\))-665.8(\(187\).)-660(The)-657.5(meta-analysis)-665.7(also)-664.7(reported)-660.1(that)-661.4(TAb)]TJ
/F9 1 Tf
25.8986 0 TD
()Tj
/F6 1 Tf
-25.8986 -1.2203 TD
[(women)-485.8(were)-489(slightly)-486.2(older)-484.1(\(0.7)-483(years\))-486.9(and)-480.1(had)-486.4(a)-480(slightly)]TJ
0 -1.2266 TD
[(higher)-325.1(TSH)-317.6(\(0.81\))-324.9(than)-316.6(antibody-negative)-331(women.)-318(A)-323.9(review)]TJ
0 -1.2203 TD
[(of)-186.6(the)-187.1(studies)-194.3(also)-184.2(reveals)-189(that)-187.2(there)-187.7(was)-185.8(an)-186.3(unusually)-190.5(low)-185(rate)]TJ
T*
[(of)-287.8(pregnancy)-288.2(loss)-293.5(in)-285.1(the)-288.3(control)-291.1(groups.)-286.7(Although)-292.6(a)-284(clear)-287.5(as-)]TJ
T*
[(sociation)-522.4(has)-516.4(been)-519.8(made)-512.1(between)-521.8(thyroid)-517.8(antibodies)-521.4(and)]TJ
0 -1.2266 TD
[(abortion,)-349.3(it)-345.4(does)-342.1(not)-348.1(prove)-340.6(causality.)-351(Three)-342(research)-346.1(groups)]TJ
0 -1.2203 TD
[(have)-294.4(demonstrated)-302.8(a)-290.4(possible)-296.3(mechanism)-296.3(through)-294.7(increased)]TJ
T*
[(fetal)-206.2(resorption)-206.6(in)-202.9(an)-198.9(active)-205.8(immunization)-205.8(murine)-202.4(model)-202.8(with)]TJ
0 -1.2266 TD
[(either)-286.1(Tg)-279.3(or)-281.7(TPO)-279.3(antibodies)-287.4(\(188190\).)]TJ
/F10 1 Tf
0 -2.8327 TD
[(Question)-338(50:)-333.4(Should)-333.9(women)-335.1(be)-332.5(screened)-337.6(for)-330.9(TPO)]TJ
0 -1.2203 TD
[(antibodies)-335.9(before)-339.1(or)-335.1(during)-330.3(pregnancy)-338.1(with)-336.8(the)-328.3(goal)]TJ
T*
[(of)-336.6(treating)-332.1(TPOAb+)-336.2(euthyroid)-341.3(women)-328.8(with)-336.8(LT)]TJ
6.7246 0 0 5.9768 255.5716 276.9448 Tm
(4)Tj
8.9663 0 0 8.9663 59.7543 267.4771 Tm
[(to)-336.6(decrease)-336.4(the)-334.6(rate)-327.8(of)-336.6(spontaneous)-338.2(miscarriage?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Negro)-507.3(and)-511.7(colleagues)-508.7(\(28\))-512.1(reported)-508.3(a)-505.3(prospective,)-513.8(ran-)]TJ
-1.1128 -1.2203 TD
[(domized)-230.6(interventional)-240.2(trial)-229(of)-230.9(LT)]TJ
6.7246 0 0 5.9768 192.1889 238.6204 Tm
(4)Tj
8.9663 0 0 8.9663 197.6314 240.0944 Tm
[(in)-234.5(euthyroid)-228.2(patients)-237.6(who)]TJ
-15.3773 -1.2203 TD
[(were)-185.5(TPOAb)]TJ
/F9 1 Tf
5.64 0 TD
()Tj
/F6 1 Tf
.7714 0 TD
[(.)-180(They)-187.7(reported)-185.8(a)-176.5(signicantly)-187.9(decreased)-183.5(rate)-183.9(of)]TJ
-6.4114 -1.2266 TD
[(pregnancy)-288.2(loss)-280.8(in)-278.8(the)-288.3(treated)-282.2(group)-282.5(\(3.5%)-282.2(vs.)-283.2(13.8%,)]TJ
/F8 1 Tf
23.243 0 TD
(p)Tj
/F11 1 Tf
.6639 0 TD
(<)Tj
/F6 1 Tf
.9421 0 TD
(.05\).)Tj
-24.849 -1.2203 TD
[(A)-330.2(limitation)-328.1(of)-325.7(the)-326.2(study)-326.7(is)-327.3(that)-326.3(the)-326.2(mean)-329.1(gestational)-328.6(age)-326.3(of)]TJ
T*
[(starting)-304.7(LT)]TJ
6.7246 0 0 5.9768 103.3511 194.7401 Tm
(4)Tj
8.9663 0 0 8.9663 109.474 196.2708 Tm
[(was)-299.6(10)-302.5(weeks)-304.3(estimated)-302.8(gestational)-303.4(age,)-303.9(and)-303.1(all)]TJ
-5.5452 -1.2266 TD
[(but)-284.5(one)-284.3(of)-281.4(the)-282(losses)-282(had)-277.8(occurred)-285.2(at)-278.2(less)-284.3(than)-285(11)-277.2(weeks.)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 58.9606 163.8991 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 69.4488 161.4047 Tm
[(RECOMMENDATION)-284.2(41)]TJ
/F6 1 Tf
.0569 -1.2266 TD
[(There)-272.4(is)-276.7(insufcient)-278.9(evidence)-275.2(to)-275.1(recommend)-276(for)-275.8(or)-269(against)]TJ
0 -1.2203 TD
[(screening)-306.7(all)-297.4(women)-302.4(for)-307.4(thyroid)-302.8(antibodies)-306.4(in)-304.1(the)-300.9(rst)-302.7(tri-)]TJ
T*
[(mester)-278.1(of)-281.4(pregnancy.)]TJ
/F4 1 Tf
9.5223 0 TD
[(Level)-278.8(I-USPSTF)]TJ
/F10 1 Tf
-10.6604 -2.447 TD
[(Question)-338(51:)-333.4(Is)-330.4(there)-339.8(an)-332.5(association)-332.8(between)-333.2(thyroid)]TJ
0 -1.2203 TD
[(antibodies)-335.9(and)-338.2(recurrent)-332.3(spontaneous)-338.2(abortion)-336.9(in)]TJ
T*
[(euthyroid)-341.3(women?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Recurrent)-332.4(p)17.6(r)0(e)24.7(g)14.6(n)15.6(a)13.1(n)15.6(c)13.4(y)-314.2(l)15.4(o)16.2(s)0(s)-299.8(i)15.4(s)-311.1(d)16(e)12.8()0(n)25.2(e)12.8(d)-306.5(a)13.1(s)-311.1(e)12.8(i)15.4(t)12.2(h)15.6(e)12.8(r)-310.5(t)12.2(wo)-295.3(c)13.4(o)0(n)25.5(s)0(e)30.4(c)13.4(u-)]TJ
-1.1128 -1.2267 TD
[(t)12.2(i)15.4(ve)-158.7(l)15.4(o)16.2(ss)22.7(e)19.1(s)-172(or)-155.2(t)12.2(h)15.6(re)24.7(e)-170.6(t)18.5(ot)22(a)19.5(l)-174.2(s)17.7(p)0(o)27.5(n)0(t)27.8(a)13.1(n)15.6(e)12.8(ou)27.5(s)-172(l)15.4(o)16.2(s)0(s)22.7(e)19.1(s)-172(a)13.1(n)15.6(d)-167.4(ma)28.2(y)-168.8(o)0(c)23.2(c)13.4(u)17.6(r)-171.4(i)15.4(n)-167.8(up)]TJ
28.0042 74.5598 TD
[(t)12.2(o)-318.9(1)13.1(%)-317.8(of)-313.1(a)19.5(l)0(l)-310.6(w)17.3(om)25(e)12.7(n)-319.5(\()12.2(1)13.1(9)19.5(1)13.1(\))12.2(.)-319.1(S)14.2(e)12.7(ve)24.7(r)18.3(a)13.1(l)-326(c)19.7(a)13.1(u)0(s)28.9(e)12.7(s)-323.8(h)15.6(a)13.1(v)0(e)-310.5(b)14.6(e)19.1(e)12.7(n)-325.9(r)18.3(e)12.8(p)0(o)27.5(r)0(t)24.1(e)19.1(d,)]TJ
0 -1.2203 TD
[(i)15.4(n)15.6(c)13.4(l)15.4(ud)27.3(i)15.4(n)0(g)-317.6(p)0(a)24.4(r)18.3(e)12.7(n)15.6(t)12.2(a)13.1(l)-332.3(c)19.7(hr)27.5(om)25(o)16.2(s)0(o)27.5(m)15.1(a)13.1(l)-332.3(a)19.5(n)0(o)25.5(m)15.1(a)13.1(l)15.4(i)15.4(e)12.7(s,)-314(im)24.2(m)15.1(u)17.6(no)25.5(l)15.4(o)0(g)24.4(i)15.4(c)-328.1(d)16(e)12.7(-)]TJ
0 -1.2266 TD
[(r)18.3(a)13.1(ng)23.8(e)19.1(m)15.1(e)12.7(n)0(t)27.8(s)0(,)-567(u)0(t)23.5(e)12.7(r)18.3(i)15.4(ne)-572.3(p)17.6(a)13.1(t)12.2(h)15.6(ol)25.3(o)16.2(g)14.6(y)14.6(,)-584.6(a)19.5(n)0(d)-569.1(e)12.8(n)15.6(d)16(oc)23.2(r)18.3(i)0(n)24.7(e)-581.6(d)16(y)14.6(sf)23.5(u)17.6(n)15.6(c)13.4(t)12.2(i)15.4(o)0(n)]TJ
0 -1.2203 TD
-.0137 Tc
[(\(1)5.8(92\).)-332.8(I)-13.7(n)-329(a)-335.7(casecontr)-13.7(o)14.4(l)-339.7(s)-13.7(t)16.1(u)-13.7(d)13.6(y,)-339.1(Ir)-13.7(i)13.7(v)-13.7(a)11.3(n)1.9(i)-339.7(a)5.8(n)-13.7(d)-323.6(co)-13.7(l)11.6(l)1.7(eagues)-337.5(\(193)5.8(\))-343(r)4.6(e-)]TJ
T*
0 Tc
[(p)17.6(o)0(r)28.1(t)12.2(e)12.7(d)-344.4(t)12.2(h)15.6(a)13.1(t)-348.2(pa)30.7(t)12.2(i)15.4(e)12.7(n)0(t)27.8(s)-349.1(wi)26.5(t)18.5(h)-351.1(p)17.6(r)0(i)27.4(m)15.1(a)13.1(r)0(y)-333.9(r)0(e)31(c)13.4(ur)23.2(r)18.3(e)12.7(n)15.6(t)-348.2(pr)23.2(e)19.1(g)14.6(na)28.7(nc)22.6(y)-345.9(l)15.4(o)16.2(s)0(s)22.7(e)19.1(s)]TJ
0 -1.2266 TD
[(\()12.2(t)18.5(hr)27.5(e)12.7(e)-379.3(o)16.2(r)-380.1(m)15.1(o)16.2(re)31(\))-379.8(h)15.6(a)13.1(d)-376.1(a)-378.9(h)15.6(i)15.4(g)14.6(h)15.6(e)12.7(r)-380.1(p)17.6(re)24.7(v)18.2(a)13.1(l)15.4(e)12.8(nc)28.9(e)-379.3(o)16.2(f)-379.8(t)12.2(h)15.6(y)14.5(ro)28.2(i)15.4(d)-376.1(a)13.1(n)15.6(t)12.2(i)15.4(b)14.5(o)0(d)25.8(y)]TJ
0 -1.2203 TD
-.0139 Tc
[(po)-13.9(s)13.6(i)-13.9(t)13.7(i)1.5(v)-13.9(i)13.4(ty)-227(\()4.6(O)-13.9(R)-210.9(2)-.8(.24,)-219.1(95%)-224.2(C)4.9(L)-225.6(1.53)5.6(.)-13.9(3)15.3(\).)-225.5(Ku)-13.9(t)9.6(t)4.6(eh)]TJ
/F8 1 Tf
18.6589 0 TD
0 Tc
[(et)-197.2(a)13.4(l)17.1(.)]TJ
/F6 1 Tf
2.0423 0 TD
-.0138 Tc
[(\(1)5.7(94\))-222.9(r)-13.8(e)10.9(po)-13.8(r)14.3(t)-1.6(ed)]TJ
-20.7012 -1.2203 TD
-.0147 Tc
[(si)-14.7(m)9.5(ilar)-477()1.3(nd)-14.7(i)10.4(n).9(gs)-477.6(wi)-14.7(t)12.9(h)-479.7(an)-473.3(in)-14.7(c)7.9(r)3.6(eased)-479.3(r)3.6(ate)-476.2(o)1.5(f)-476.7(t)-2.5(h)-14.7(y)9.1(r)3.6(o)-14.7(i)10.6(d)-472.9(antibo)-14.7(d)11.1(y)]TJ
0 -1.2266 TD
0 Tc
[(p)17.6(o)0(s)27.5(i)0(t)27.6(i)15.4(vi)27.3(t)12.2(y)-301.6(in)-291.5(7)13.1(0)13.1(0)-303(w)17.3(o)16.2(me)27.8(n)-306.9(w)17.3(it)27.6(h)-306.9(r)18.3(e)12.7(c)13.4(ur)29.6(re)24.7(n)15.6(t)-304(a)13.1(b)14.5(o)16.2(r)0(t)24.1(i)15.4(o)16.2(n)-306.9(a)13.1(s)-304.8(c)19.7(o)0(m)25(p)17.6(a)13.1(r)0(e)24.7(d)]TJ
0 -1.2203 TD
-.0142 Tc
[(with)-384.3(200)-386.8(healthy)-385.3(c)-.8(on)-14.2(t)13.6(r)-14.2(o)13.9(l)-14.2(s)-373.1(\()-2(22)5.3(.)-14.2(5)15(%)-388.9(v)-14.2(s)15.4(.)-383.8(14.5%,)]TJ
/F8 1 Tf
19.4113 0 TD
0 Tc
(p)Tj
/F9 1 Tf
.6513 0 TD
()Tj
/F6 1 Tf
.9358 0 TD
-.0142 Tc
[(0.01\))4.3(.)-390.2(O)1.7(n)-384.3(t)-2(he)]TJ
-20.9984 -1.2203 TD
0 Tc
[(o)16.2(t)12.2(h)15.6(e)12.7(r)-373.7(h)15.6(a)13.1(n)15.6(d,)-360(i)15.4(n)-376.4(a)-372.6(p)17.6(ro)28.1(sp)22.6(e)19.1(c)13.4(t)12.2(i)15.4(ve)-361(o)16.2(b)14.6(se)24.1(r)18.3(v)0(a)25(t)12.2(i)15.4(o)16.2(n)15.6(a)13.1(l)-376.6(s)17.7(t)12.2(u)0(d)27.3(y)14.6(,)-369.6(E)0(s)27.3(p)0(l)26.7(i)15.4(n)-376.4(a)19.5(nd)]TJ
T*
-.014 Tc
[(colleagu)-14(e)16.4(s)-445.3(\()-1.8(1)5.5(95\))-444.4(demons)-14(t)9.5(r)4.3(ated)-440.6(no)-440.4(d)-14(i)11.1(ff)4.5(er)-14(e)10.7(n)1.6(ce)-437.5(i)-14(n)-431.9(thyr)-14(o)14.1(i)1.4(d)-440.6(a)-.9(nti-)]TJ
0 -1.2266 TD
-.0137 Tc
[(body)-226.8(p)3.9(o)-13.7(s)13.8(i)1.7(tiv)-13.7(i)13.6(ty)-220.5(betw)3.6(een)-219.4(p)-13.7(a)10.7(tients)-217.3(w)-13.7(i)12.8(th)-219.4(r)-13.7(e)11(cu)3.9(r)-13.7(r)10.2(e)5.4(n)-13.7(t)-213.6(p)3.9(r)-13.7(e)11(gnancy)-220.4(lo)-13.7(s)13.8(s)]TJ
0 -1.2203 TD
0 Tc
[(a)13.1(n)15.6(d)-167.4(h)15.6(e)12.7(a)13.1(l)15.4(t)12.2(h)15.6(y)-168.8(c)13.4(o)16.2(nt)27.8(ro)28.1(ls)26.8(.)-167.3(P)0(r)23.2(a)19.5(t)12.2(t)-171.2(a)13.1(n)15.6(d)-167.4(c)13.4(o)16.2(l)0(l)24.5(e)12.7(a)19.5(g)14.6(ue)24(s)-165.7(r)0(e)24.7(p)17.6(or)28.1(t)12.2(e)12.7(d)-167.4(a)-170.2(h)15.6(i)15.4(g)14.6(h)0(e)28.3(r)-171.4(ra)31.4(t)12.2(e)]TJ
T*
-.0155 Tc
[(of)-306.8(su)-15.5(b)10.3(s)-15.5(e)14.9(q)-.9(u)-15.5(e)8.5(nt)-306.8(pr)-15.5(e)9.2(g)-1(nancy)-304.4(l)-.1(os)-15.5(s)-290(i)-15.5(n)-294.3(p)2.1(atients)-301.3(w)-15.5(i)11(t)-3.3(h)-303.4(r)2.8(ecu)-15.5(r)14.1(r)-15.5(e)9.2(nt)-306.8(los)-15.5(s)7.2(es)]TJ
0 -1.2266 TD
-.0138 Tc
[(and)-370.9(t)-1.6(hyr)-13.8(o)14.3(i)-13.8(d)-361.8(antibo)-13.8(d)12(y)-372.3(p)-13.8(o)13.7(s)-13.8(i)13(tiv)4.4(i)-13.8(t)13.8(y)-378.6(\()4.7(196\).)-370.8(I)3.1(n)-377.6(a)-373.7(lar)-13.8(g)12.7(e)5.3(r)-374.9(tr)-13.8(i)13.6(a)-.7(l)-371.4(w)-13.8(i)12.7(t)-1.6(h)-371.3(a)]TJ
0 -1.2203 TD
0 Tc
[(s)17.7(i)0(m)24.2(i)15.4(l)15.4(a)13.1(r)-367.4(p)17.6(op)27.5(ul)26.7(a)13.1(t)12.2(i)15.4(o)16.2(n,)-354.1(R)14.7(u)0(s)28.9(h)0(w)26.6(o)0(r)28.1(t)12.2(h)-370.1(a)19.5(nd)-354.1(c)13.4(o)16.2(ll)24.5(e)12.7(a)19.5(g)14.5(u)0(e)24(s)-368(\()12.2(1)19.5(9)13.1(7)13.1(\))-367.2(re)31(po)27.5(rt)24.1(e)12.8(d)]TJ
T*
[(n)15.6(o)-186.1(si)26.8(g)14.6(n)15.6(i)15.4()0(c)23(a)19.5(nt)-174.6(d)16(i)0(f)27.6(f)12.2(e)12.7(r)0(e)31(n)0(c)22.6(e)-183.3(i)15.4(n)-186.7(l)15.4(i)0(v)27.3(e)-189.6(b)14.6(i)15.4(rt)30.4(h)-186.8(r)0(a)25.1(t)12.2(e)19.1(s)-191(b)14.6(e)12.8(t)18.5(w)0(e)23.8(e)12.7(n)-186.8(w)17.3(o)16.2(m)15.1(e)12.7(n)-186.8(wi)26.5(t)12.2(h)]TJ
0 -1.2266 TD
[(r)18.3(e)12.8(c)13.4(u)0(r)29.6(r)0(e)24.7(n)15.6(t)-310.3(l)15.4(o)16.2(s)0(s)29(e)12.7(s)-304.8(w)0(h)26.6(o)-306.3(we)30.1(re)-291.5(po)27.5(si)26.8(t)12.2(i)15.4(ve)-291.5(f)12.2(o)16.2(r)-310.5(t)18.5(hy)23.8(r)18.3(o)0(i)25.3(d)-306.5(a)13.1(n)15.6(t)12.2(i)15.4(b)14.5(o)16.2(d)16(i)0(e)28.2(s)-311.1(a)19.5(n)0(d)]TJ
0 -1.2203 TD
[(t)12.2(h)15.6(o)16.2(s)0(e)-254.1(w)17.3(ho)-252.8(we)23.8(r)18.3(e)-265.5(no)25.5(t)12.2(.)]TJ
1.1128 -1.2203 TD
[(The)-208.6(data)-211.2(for)-212.6(an)-211.6(association)-213.4(between)-218.3(thyroid)-214.3(antibodies)-211.5(and)]TJ
-1.1128 -1.2203 TD
[(recurrent)-221.4(pregnancy)-225(loss)-217.6(are)-221.4(less)-221(robust)-226(than)-221.7(for)-218.9(sporadic)-220.1(loss)]TJ
0 -1.2266 TD
[(and)-290.4(somewhat)-297.4(contradictory.)-295.1(This)-295.8(may)-292.3(be)-295.2(because)-290.2(recurrent)]TJ
0 -1.2203 TD
[(pregnancy)-490.6(loss)-489.5(has)-484.7(many)-491.7(potential)-489.2(causes,)-492.5(and)-486.4(endocrine)]TJ
T*
[(dysfunction)-251(may)-241.8(only)-241.7(account)-246.3(for)-250.5(15%20%)-241.1(of)-243.5(all)-246.8(cases)-241.6(\(192\).)]TJ
0 -1.2266 TD
[(Many)-341.2(of)-338.4(the)-338.9(previously)-342.1(mentioned)-342.7(trials)-344.2(did)-338.3(not)-341.7(control)-341.7(for)]TJ
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[(other)-538.3(potential)-546.1(causes)-540.1(of)-540.7(recurrent)-537.5(losses.)-544.2(One)-537.5(intriguing)]TJ
T*
[(study)-326.7(reported)-337.6(an)-325.4(apparent)-335(interaction)-333.1(of)-332(anti-phospholipid)]TJ
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[(antibodies)-489.7(and)-492.8(thyroid)-492.5(antibodies)-489.7(in)-487.5(the)-496.9(risk)-484.2(of)-490.1(recurrent)]TJ
0 -1.2203 TD
[(pregnancy)-281.9(loss)-280.8(\(198\).)]TJ
/F10 1 Tf
0 -2.7189 TD
[(Question)-331.7(52:)-333.4(Should)-340.2(women)-335.1(with)-330.5(recurrent)-338.6(abortion)]TJ
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[(be)-332.5(screened)-331.3(for)-337.3(thyroid)-337.5(antibodies)-335.9(before)-332.8(or)-335.1(during)]TJ
0 -1.2203 TD
[(pregnancy)-331.8(with)-336.8(the)-334.6(goal)-335.4(of)-330.2(treating)-338.4(TAb+)-335.3(euthyroid)]TJ
T*
[(women)-335.1(with)-330.5(LT)]TJ
6.7246 0 0 5.9768 376.781 349.1716 Tm
(4)Tj
8.9663 0 0 8.9663 383.4708 350.7023 Tm
[(or)-335.1(intravenous)-337.5(immunoglobulin)]TJ
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[(therapy)-330.9(\(IVIG\))-334.7(to)-336.6(decrease)-336.4(the)-334.7(rate)-334.1(of)-330.2(recurrent)]TJ
0 -1.2203 TD
[(spontaneous)-331.9(abortion?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Three)-455.8(small)-454.4(nonrandomized)-465(case)-455.3(series)-461.9(have)-458.8(been)-456.5(pub-)]TJ
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[(lished)-545.8(on)-549.9(the)-547.5(use)-546.3(of)-547(intravenous)-548.2(immunoglobulin)-551.6(\(IVIG\))]TJ
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[(therapy)-484(for)-484.5(the)-484.3(prevention)-490.4(of)-483.8(recurrent)-486.9(pregnancy)-484.3(loss)-483.2(in)]TJ
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[(women)-213.9(with)-217.7(thyroid)-220.6(antibodies)-217.8(\(199201\).)-215.4(The)-221.3(live)-216.4(birth)-214.8(rates)]TJ
T*
[(ranged)-358.7(from)-368.2(80%)-361.1(to)-357.3(95%,)-364(and)-360(the)-364.2(one)-366.5(study)-358.3(with)-369.4(a)-359.9(control)]TJ
T*
[(group)-358.4(\(consisting)-365.3(of)-363.7(women)-365.7(who)-355.5(refused)-367(IVIG)-359.9(therapy\))-364.3(re-)]TJ
0 -1.2266 TD
[(ported)-305.4(a)-309.3(highly)-307.2(signicant)-312.7(improvement)-305.1(in)-310.4(live)-304.9(births)-311(in)-310.4(the)]TJ
0 -1.2203 TD
[(IVIG-treated)-307.4(cohort)-306.6(\(95%)-304.6(vs.)-302.2(0%)]TJ
/F8 1 Tf
14.5743 0 TD
(p)Tj
/F9 1 Tf
.6639 0 TD
()Tj
/F6 1 Tf
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[(.001\))-305.4(\(200\).)-305.9(Comparison)]TJ
-16.174 -1.2203 TD
[(of)-186.6(LT)]TJ
6.7246 0 0 5.9768 331.0865 223.1432 Tm
(4)Tj
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[(intervention)-192.9(with)-192.4(IVIG)-189.2(in)-184(one)-189.4(study)-187.6(resulted)-193.5(in)-190.3(a)-182.9(higher)]TJ
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(4)Tj
8.9663 0 0 8.9663 429.6755 213.6755 Tm
[(-treated)-213.1(group)-206.6(\(201\).)-211(However,)]TJ
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[(all)-461.8(three)-472.2(studies)-466.1(had)-467.5(serious)-472.5(design)-464.5(aws)-467(including)-468(small)]TJ
T*
[(sample)-445.8(size,)-449.8(heterogeneous)-456.5(patient)-451.2(populations,)-454.2(lack)-443(of)-452.2(or)]TJ
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[(initiated.)-266.8(In)-264.7(summary,)-264.6(intervention)-268.8(trials)-262(with)-268.3(IVIG)-265(or)-262.7(LT)]TJ
6.7246 0 0 5.9768 536.5416 168.3779 Tm
(4)Tj
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1.9222 0 TD
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/F6 1 Tf
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[(women)-213.9(with)-205(recurrent)-215(abortion)-213.6(have)-205.9(shown)-208.5(a)-208.2(decrease)]TJ
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[(in)-417.9(the)-421.1(recurrent)-423.7(abortion)-422.2(rate)-417.9(but)-423.6(are)-417.4(limited)-416.2(by)-419.8(methodo-)]TJ
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[(logical)-282.1(problems.)]TJ
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5.9777 0 0 5.9777 310.0535 114.5763 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 320.485 112.0819 Tm
[(RECOMMENDATION)-284.1(42)]TJ
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[(There)-278.8(is)-270.4(insufcient)-278.9(evidence)-275.2(to)-275.1(recommend)-276(for)-275.8(or)-275.4(against)]TJ
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0 -1.2203 TD
[(trimester)-504.1(of)-502.8(pregnancy)-509.5(with)-502.2(LT)]TJ
6.7246 0 0 5.9768 452.3526 77.726 Tm
(4)Tj
8.9663 0 0 8.9663 460.2329 79.2 Tm
[(or)-503(IVIG,)-501.9(in)-506.4(euthyroid)]TJ
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[(women)-346.7(with)-344.1(sporadic)-352.9(or)-344.9(recurrent)-347.8(abortion)-346.4(or)-344.9(in)-348.4(women)]TJ
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(undergoing)Tj
/F8 1 Tf
5.4061 0 TD
[(in)-278.2(vitro)]TJ
/F6 1 Tf
3.2942 0 TD
[(fertilization)-286.9(\(IVF\).)]TJ
/F4 1 Tf
8.1249 0 TD
[(Level)-278.8(I-USPSTF)]TJ
/F3 1 Tf
-45.9612 77.228 TD
[(PREGNANCY)-339.6(AND)-337.2(POSTPARTUM)-334.3(THYROID)-341(MANAGEMENT)-335.2(GUIDELINES)-17387(1099)]TJ
ET
endstream
endobj
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<>stream
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/F10 1 Tf
8.9663 0 0 8.9663 62.022 725.7825 Tm
0 0 0 1 k
0 Tc
0 Tw
[(Question)-306.4(53:)-308.1(Should)-302.2(euthyroid)-309.7(women)-303.5(who)-305.2(are)-306.7(known)]TJ
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[(to)-336.6(be)-332.5(positive)-337.2(for)-330.9(thyroid)-337.5(antibodies)-335.9(either)-330.7(before)-339.1(or)]TJ
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[(during)-336.6(pregnancy)-338.1(be)-332.5(treated)-333.7(with)-330.5(LT)]TJ
6.7246 0 0 5.9768 219.5716 702.3683 Tm
(4)Tj
8.9663 0 0 8.9663 226.2614 703.8423 Tm
[(in)-338(order)-333.3(to)]TJ
-18.3175 -1.2203 TD
[(decrease)-336.4(the)-334.6(chance)-332.5(of)-330.2(sporadic)-337.9(or)-335.1(recurrent)]TJ
T*
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(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 71.6598 660.0187 Tm
[(RECOMMENDATION)-290.5(43)]TJ
/F6 1 Tf
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[(There)-278.8(is)-270.4(insufcient)-278.9(evidence)-281.5(to)-275.1(recommend)-276(for)-269.5(or)-275.4(against)]TJ
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(4)Tj
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[(therapy)-218.4(in)-221.9(TAb)]TJ
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/F6 1 Tf
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[(euthyroid)-215.5(women)-220.2(during)-218.7(pregnancy.)]TJ
/F4 1 Tf
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[(Level)-285.1(I-USPSTF)]TJ
/F10 1 Tf
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[(Question)-338(54:)-333.4(Is)-330.4(there)-333.4(an)-338.9(association)-332.7(between)-333.2(thyroid)]TJ
0 -1.2203 TD
[(antibody)-334.3(positivity)-336.6(and)-331.9(pregnancy)-338.1(loss)-334.2(in)-331.6(euthyroid)]TJ
T*
[(women)-335.1(undergoing)-339(IVF?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Several)-394.8(authors)-395.2(have)-389.2(reported)-400.8(an)-388.6(increased)-396.2(risk)-395.7(of)-388.9(preg-)]TJ
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[(nancy)-326.1(loss)-325.1(after)-329.8(assisted)-326.5(reproductive)-329.9(procedures)-326.4(in)-323.1(women)]TJ
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[(who)-317.6(are)-309.9(positive)-317.1(for)-313.8(thyroid)-321.8(antibodies)-312.7(\(202204\).)-316.6(Other)-317.3(au-)]TJ
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[(thors)-248.9(have)-250.1(found)-251.3(no)-246.4(association)-251.4(\(205,206\).)-250.4(A)-241.7(meta-analysis)-254.7(of)]TJ
T*
[(four)-232.9(trials)-236.7(of)-230.9(patients)-237.6(undergoing)-235.5(IVF)-237(found)-232.3(an)-230.5(increased)-238.1(risk)]TJ
0 -1.2267 TD
[(of)-458.5(pregnancy)-465.3(loss)-457.9(with)-457.9(the)-459(presence)-461(of)-464.8(thyroid)-454.6(antibodies)]TJ
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[(\(RR)-280.8(1.99,)-282.6(95%)-278.9(CI)-280.5(1.422.79\))-281.1(\(207\).)]TJ
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[(Question)-338(55:)-333.4(Should)-333.9(women)-335.1(undergoing)-339(IVF)]TJ
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[(be)-332.5(screened)-337.6(for)-330.9(TPO)-335.4(antibodies)-335.9(before)]TJ
T*
[(or)-335.1(during)-336.6(pregnancy?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
(Negro)Tj
/F8 1 Tf
3.4902 0 TD
[(et)-728.3(al.)]TJ
/F6 1 Tf
3.1109 0 TD
[(\(208\))-726.6(performed)-727.2(a)-720.3(prospective)-732.1(placebo-)]TJ
-7.714 -1.2266 TD
[(controlled)-639(intervention)-641.8(trial)-633.7(of)-635.5(LT)]TJ
6.7246 0 0 5.9768 207.0425 424.403 Tm
(4)Tj
8.9663 0 0 8.9663 216.0566 425.877 Tm
[(in)-639.2(TPOAb)]TJ
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4.7928 0 TD
()Tj
/F6 1 Tf
1.4037 0 TD
(women)Tj
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[(undergoing)-817.2(assisted)-813.4(reproduction)-815.9(technologies.)-817.9(Though)]TJ
T*
[(underpowered)-466.5(for)-465.5(its)-460.6(proposed)-462.1(endpoint,)-463.3(no)-461.4(difference)-472.1(in)]TJ
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[(pregnancy)-395.7(loss)-394.6(was)-388.2(observed.)-395(Patients)-395.6(undergoing)-399.9(assisted)]TJ
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[(reproductive)-254(procedures)-250.5(for)-244.2(infertility)-251.6(may)-241.8(have)-250.1(a)-246.1(number)-247.6(of)]TJ
T*
[(reasons)-261.8(for)-256.9(infertility)-264.2(or)-256.4(subfertility,)-267.3(and)-258.8(this)-255.3(may)-260.7(explain)-260(the)]TJ
T*
[(conicting)-282.3(data.)]TJ
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5.9777 0 0 5.9777 61.2283 340.7243 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 71.6598 338.2298 Tm
[(RECOMMENDATION)-290.5(44)]TJ
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[(There)-278.8(is)-270.4(insufcient)-278.9(evidence)-281.5(to)-275.1(recommend)-276(for)-269.5(or)-275.4(against)]TJ
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(LT)Tj
6.7246 0 0 5.9768 82.9984 314.8157 Tm
(4)Tj
8.9663 0 0 8.9663 90.2551 316.2897 Tm
[(therapy)-439.7(in)-430.6(euthyroid)-436.8(TAb)]TJ
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11.7986 0 TD
()Tj
/F6 1 Tf
1.2014 0 TD
[(women)-435.2(undergoing)-437.9(as-)]TJ
-15.0169 -1.2203 TD
[(sisted)-287.7(reproduction)-284.8(technologies.)]TJ
/F4 1 Tf
14.7893 0 TD
[(Level)-278.8(I-USPSTF)]TJ
/F10 1 Tf
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[(Question)-338(56:)-333.4(Is)-330.4(there)-333.4(an)-338.9(association)-332.7(between)]TJ
0 -1.2203 TD
[(thyroid)-337.5(antibodies)-335.9(and)-331.9(preterm)-334.4(delivery)]TJ
0 -1.2267 TD
[(in)-331.6(euthyroid)-341.3(women?)]TJ
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1.1128 -1.8273 TD
[(Preterm)-190.3(delivery,)-189.4(or)-193.2(birth)-189.5(prior)-186.1(to)-192.9(37)-188.7(weeks,)-187.1(affects)-197.4(12.3%)-186.4(of)]TJ
-1.1128 -1.2266 TD
[(pregnancies)-332.8(in)-329.4(the)-326.2(United)-327.8(States)-328.9(\(209\).)-331.2(It)-325.1(remains)-328.4(one)-328.5(of)-332(the)]TJ
0 -1.2203 TD
[(most)-311.9(prevalent)-313(and)-315.7(morbid)-309.2(perinatal)-315.4(complications.)-312.1(It)-312.4(is)-314.7(the)]TJ
T*
[(leading)-238.6(cause)-241.6(of)-237.2(neonatal)-246.4(death)-240.2(and)-233.5(the)-244(second)-237.3(leading)-238.6(cause)]TJ
0 -1.2267 TD
[(of)-192.9(infant)-194.1(death)-189.6(\(210\).)-192.1(The)-189.7(cost)-193.5(of)-192.9(preterm)-190.3(delivery)-192.8(to)-192.9(the)-193.4(health)]TJ
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[(care)-385.1(system)-390.7(is)-384.2(enormous)-389.1(\(211\).)-388.1(Preterm)-386.3(birth)-385.6(has)-383.6(remained)]TJ
T*
[(difcult)-242.3(to)-243.5(predict,)-245.1(prevent,)-243.3(and)-239.9(treat)-241.3(primarily)-242.5(because)-245.9(there)]TJ
0 -1.2266 TD
[(are)-328.9(multiple)-327.4(potential)-331.1(causes)-331.5(and)-328.4(pathways)-327.7(that)-332.6(end)-328.8(in)-329.4(pre-)]TJ
0 -1.2203 TD
[(mature)-328.3(labor)-327.1(\(212\).)-331.2(Examples)-324.5(include)-330.1(infection,)-335.8(trauma,)-324.5(cer-)]TJ
T*
[(vical)-499.8(insufciency,)-500(premature)-501(rupture)-499(of)-496.4(membranes,)-494(and)]TJ
0 -1.2266 TD
[(maternal)-282.8(medical)-284.5(conditions.)]TJ
1.1128 -1.2203 TD
[(Medical)-197.2(conditions)-206.8(such)-201.3(as)-196.8(hypertension)-207.9(and)-201.9(diabetes)-201.7(have)]TJ
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[(been)-399.6(associated)-402.6(with)-401(a)-397.9(risk)-402(of)-401.6(preterm)-398.9(delivery,)-404.3(either)-399.9(due)]TJ
T*
[(to)-540.7(the)-541.2(spontaneous)-548.7(onset)-545.3(of)-540.7(labor)-535.7(or)-540.9(from)-545.3(complications)]TJ
0 -1.2266 TD
[(prompting)-464.5(medically)-463.2(indicated)-464.5(delivery.)-461.2(Patients)-465.2(with)-464.3(un-)]TJ
0 -1.2203 TD
[(controlled)-247(hyperthyroidism)-245.4(also)-247.4(have)-243.8(higher)-243(rates)-242.2(of)-243.5(preterm)]TJ
T*
[(delivery,)-777.4(most)-779.8(commonly)-776.4(due)-775.7(to)-774.6(medical)-777.7(intervention)]TJ
0 -1.2267 TD
[(\(80,213\).)-484.9(The)-486.8(most)-489(severe)-483(example)-490.8(of)-483.8(uncontrolled)-492(hyper-)]TJ
27.9978 74.5598 TD
[(thyroidism,)-428.3(thyroid)-422.9(storm,)-416.7(results)-425.9(in)-424.2(high)-419.4(rates)-419.2(of)-426.9(preterm)]TJ
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[(labor)-282.8(and)-284.1(delivery)-281.3(\(214\).)]TJ
1.1128 -1.2266 TD
[(The)-335.1(relationship)-339.5(of)-332(thyroid)-340.8(antibodies)-331.7(and)-334.7(preterm)-335.7(deliv-)]TJ
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[(ery)-201(has)-193.9(also)-196.8(been)-197.3(investigated.)-200.1(Glinoer)]TJ
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16.762 0 TD
[(et)-197.2(al.)]TJ
/F6 1 Tf
2.0549 0 TD
[(\(183\))-195.5(reported)-198.5(in)-196.6(a)]TJ
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[(prospective)-314.8(cohort)-312.9(that)-313.7(women)-308.8(who)-305(were)-311.9(positive)-310.8(for)-313.8(either)]TJ
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[(TPOAb)-335.7(or)-338.6(TgAb)-335.7(had)-334.7(a)-334.6(signicantly)-333.3(increased)-339.3(prevalence)-337(of)]TJ
0 -1.2203 TD
[(preterm)-474.8(birth)-474.1(\(16%)-469(vs.)-466.5(8%,)]TJ
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12.9304 0 TD
(p)Tj
/F11 1 Tf
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(<)Tj
/F6 1 Tf
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[(0.005\).)-465.9(Ghafoor)]TJ
/F8 1 Tf
7.3852 0 TD
[(et)-469.1(al.)]TJ
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2.605 0 TD
(\(215\))Tj
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[(evaluated)-381(1500)-371.1(euthyroid)-379.9(women)-372(and)-372.6(found)-377.7(an)-375.9(increase)-374.3(in)]TJ
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12.1273 0 TD
()Tj
/F6 1 Tf
1.0622 0 TD
[(women)-289.8(as)-291.7(compared)-294.9(with)-287.2(wo-)]TJ
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[(men)-380.2(who)-380.8(were)-381.5(TPOAb)]TJ
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10.4581 0 TD
()Tj
/F6 1 Tf
1.1508 0 TD
[(\(26.8%)-376.6(vs.)-378(8.0%,)]TJ
/F8 1 Tf
7.6001 0 TD
(p)Tj
/F11 1 Tf
.6639 0 TD
(<)Tj
/F6 1 Tf
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[(0.01\).)-377.9(In)-384.9(con-)]TJ
-20.8087 -1.2203 TD
[(trast,)-492.2(Iijima)]TJ
/F8 1 Tf
5.6717 0 TD
[(et)-488(al.)]TJ
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2.643 0 TD
[(\(182\))-486.3(did)-490.1(not)-487.2(nd)-489.9(an)-489.8(increased)-491.1(risk)-484.2(for)]TJ
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[(preterm)-462.2(birth)-461.4(in)-462.2(women)-460.5(positive)-462.5(for)-459.2(seven)-466.8(different)-460.8(auto-)]TJ
0 -1.2266 TD
[(antibodies)-483.4(and)-473.8(thyroid)-479.9(antibodies.)-473.7(This)-479.1(study)-478.5(had)-473.8(an)-470.8(un-)]TJ
0 -1.2203 TD
[(usually)-362.8(low)-355.7(rate)-354.7(of)-357.3(preterm)-354.7(birth)-360.3(in)-354.7(both)-352.5(study)-358.3(and)-353.7(control)]TJ
T*
[(groups)-340.7(\(3%)-336.7(vs.)-340.1(3.1)-337.1(%\).)-340.1(Interestingly,)-340.3(Haddow)]TJ
/F8 1 Tf
20.6696 0 TD
[(et)-336.3(al.)]TJ
/F6 1 Tf
2.3395 0 TD
[(\(216\))-340.9(re-)]TJ
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[(ported)-261.1(a)-252.4(signicant)-255.8(increase)-254.1(in)-259.8(preterm)-253.5(premature)-260.7(rupture)-252.4(of)]TJ
0 -1.2203 TD
[(the)-446.4(membranes)-446.9(in)-443.2(TAb)]TJ
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10.5846 0 TD
()Tj
/F6 1 Tf
1.214 0 TD
[(women)-441.5(but)-442.5(not)-442.9(in)-443.2(preterm)-449.5(birth)]TJ
-11.7986 -1.2203 TD
[(among)-191(women)-182.3(who)-184.8(were)-185.5(positive)-190.7(for)-187.3(TPOAb)-183.9(and)-182.9(TgAb)-184(in)-184(the)]TJ
0 -1.2266 TD
[(rst)-340.6(trimester.)-336.3(Their)-333(data)-331.3(revealed)-336(a)-334.6(positive)-336.1(association)-339.9(be-)]TJ
0 -1.2203 TD
[(tween)-359.4(very)-359.8(preterm)-354.7(delivery)-357.2(\()]TJ
/F11 1 Tf
13.4804 0 TD
(<)Tj
/F6 1 Tf
.7714 0 TD
[(32)-353.1(weeks\))-361.7(and)-353.7(thyroid)-359.7(anti-)]TJ
-14.2518 -1.2203 TD
[(body)-419.3(positivity)-426.8(\(OR)-418.7(1.73,)-421.7(95%)-418(CI)-419.6(1.002.97\).)-416.8(However,)-419.5(the)]TJ
T*
[(adjusted)-437.1(odds)-440(ratio)-436.9(for)-433.9(very)-435.7(preterm)-436.9(delivery)-439.4(and)-429.5(thyroid)]TJ
0 -1.2266 TD
[(antibody)-622.2(positivity)-616.5(failed)-616.9(to)-616.6(reach)-622.4(statistical)-619.9(signicance)]TJ
0 -1.2203 TD
[(\(adjusted)-285.9(OR)-279.2(1.70,)-282.6(95%)-278.9(CI)-280.5(0.982.94\).)]TJ
/F10 1 Tf
0 -2.447 TD
[(Question)-338(57:)-333.4(Should)-333.9(women)-335.1(be)-332.5(screened)-337.6(for)]TJ
0 -1.2203 TD
[(thyroid)-337.5(antibodies)-335.9(before)-332.8(or)-335.1(during)-336.6(pregnancy)]TJ
T*
[(with)-336.8(the)-334.6(goal)-335.4(of)-330.2(treating)-338.4(TAb+)-335.3(euthyroid)-335(women)]TJ
0 -1.2266 TD
[(with)-336.8(LT)]TJ
6.7246 0 0 5.9768 345.0897 417.4298 Tm
(4)Tj
8.9663 0 0 8.9663 351.8361 418.9038 Tm
[(to)-330.2(decrease)-336.4(the)-334.6(rate)-334.1(of)-330.2(preterm)-340.7(delivery?)]TJ
/F6 1 Tf
-3.212 -1.8336 TD
(Negro)Tj
/F8 1 Tf
3.2689 0 TD
[(et)-500.7(al.)]TJ
/F6 1 Tf
2.6683 0 TD
[(\(28\))-499.5(reported)-508.3(an)-496.1(increased)-503.7(risk)-503.1(of)-502.8(preterm)]TJ
-7.05 -1.2203 TD
[(delivery)-793.4(among)-785.4(euthyroid)-790.9(TPOAb)]TJ
/F9 1 Tf
16.6293 0 TD
()Tj
/F6 1 Tf
1.5554 0 TD
[(women)-789.3(compared)]TJ
-18.1847 -1.2203 TD
[(with)-331.5(euthyroid)-329.4(TPOAb)]TJ
/F9 1 Tf
10.2874 0 TD
()Tj
/F6 1 Tf
1.0939 0 TD
[(women)-327.7(in)-323.1(the)-332.5(only)-323.9(published)-325.3(pro-)]TJ
-11.3812 -1.2203 TD
[(spective)-329(interventional)-322.4(trial)-323.9(to)-319.4(date)-325.4(\(22.4%)-319.7(vs.)-321.1(8.2%,)]TJ
/F8 1 Tf
23.243 0 TD
(p)Tj
/F11 1 Tf
.6639 0 TD
(<)Tj
/F6 1 Tf
.9421 0 TD
(.01\).)Tj
-24.849 -1.2266 TD
[(The)-303.5(TPOAb)]TJ
/F9 1 Tf
5.248 0 TD
()Tj
/F6 1 Tf
1.0749 0 TD
[(subjects)-303.9(were)-299.3(then)-304.3(randomized)-303.7(to)-300.4(either)-305.1(treat-)]TJ
-6.3229 -1.2203 TD
[(ment)-304.8(with)-299.9(LT)]TJ
6.7246 0 0 5.9768 367.37 346.2235 Tm
(4)Tj
8.9663 0 0 8.9663 373.4361 347.6975 Tm
[(or)-300.7(no)-303.3(treatment,)-302.5(with)-299.9(the)-300.9(dose)-304.2(based)-299(on)-303.3(TSH)]TJ
-6.7339 -1.2203 TD
[(level.)-491.1(The)-486.8(treated)-490.8(group)-484.8(had)-486.4(a)-486.4(signicantly)-491.4(lower)-482.7(rate)-487.4(of)]TJ
0 -1.2266 TD
[(preterm)-240.9(delivery)-237(than)-240.7(did)-237.2(the)-237.7(untreated)-236.3(group)-238.2(\(7%)-235.6(vs.)-238.9(22.4%,)]TJ
/F8 1 Tf
0 -1.2203 TD
(p)Tj
/F11 1 Tf
.6702 0 TD
(<)Tj
/F6 1 Tf
.9358 0 TD
(.05\).)Tj
/F12 1 Tf
5.9777 0 0 5.9777 312.2645 295.37 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 322.7527 292.8755 Tm
[(RECOMMENDATION)-284.2(45)]TJ
/F6 1 Tf
.0569 -1.2203 TD
[(There)-272.4(is)-276.7(insufcient)-278.9(evidence)-275.2(to)-275.1(recommend)-276(for)-275.8(or)-275.4(against)]TJ
T*
[(screening)-452.1(for)-452.9(thyroid)-448.2(antibodies)-451.8(in)-449.5(the)-452.7(rst)-448.1(trimester)-453.5(of)]TJ
0 -1.2267 TD
[(pregnancy,)-310.1(or)-313.3(treating)-309.6(TAb)]TJ
/F9 1 Tf
12.0704 0 TD
()Tj
/F6 1 Tf
1.0749 0 TD
[(euthyroid)-316.7(women)-308.8(with)-312.5(LT)]TJ
6.7246 0 0 5.9768 546.5762 258.5196 Tm
(4)Tj
8.9663 0 0 8.9663 549.9211 259.9936 Tm
(,)Tj
-25.279 -1.2203 TD
[(to)-281.4(prevent)-284.7(preterm)-278.8(delivery.)]TJ
/F4 1 Tf
12.7091 0 TD
[(Level)-278.8(I-USPSTF)]TJ
/F3 1 Tf
-13.8472 -3.054 TD
[(Thyroid)-341.1(Nodules)-335.6(and)-331.9(Thyroid)-334.7(Cancer)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Thyroid)-507.7(nodules)-514.8(and)-505.4(thyroid)-511.5(cancer)-507.9(discovered)-507.3(during)]TJ
-1.1128 -1.2203 TD
[(pregnancy)-212.4(present)-209.4(unique)-210(challenges)-214.2(to)-205.6(both)-207.1(the)-212.4(clinician)-208.7(and)]TJ
0 -1.2266 TD
[(the)-319.9(mother.)-323.9(A)-317.5(careful)-320.9(balance)-319.4(is)-321(required)-317(between)-325.7(making)-316.3(a)]TJ
0 -1.2203 TD
[(denitive)-226.1(diagnosis)-225.1(and)-220.9(instituting)-221.9(treatment,)-226.6(while)-220.6(avoiding)]TJ
T*
[(interventions)-560.9(that)-553.9(may)-551.6(adversely)-556.8(impact)-551.8(the)-553.8(mother,)-551.5(the)]TJ
0 -1.2266 TD
[(health)-288.4(of)-281.4(the)-282(fetus,)-284.6(or)-275.4(the)-282(maintenance)-288(of)-281.5(the)-282(pregnancy.)]TJ
/F10 1 Tf
0 -2.4406 TD
[(Question)-312.7(58:)-314.4(What)-310.8(is)-311.5(the)-309.4(frequency)-315.6(of)-311.3(thyroid)-312.2(nodules)]TJ
0 -1.2203 TD
[(during)-336.6(pregnancy?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Three)-481.1(studies)-472.5(have)-477.8(evaluated)-475.8(the)-478(prevalence)-482.4(of)-471.1(thyroid)]TJ
-1.1128 -1.2266 TD
[(nodules)-293.5(during)-288.3(pregnancy,)-284.8(the)-288.3(impact)-292.6(of)-287.8(pregnancy)-288.2(on)-284.4(nod-)]TJ
0 -1.2203 TD
[(ular)-308.6(size,)-310.7(and)-303.1(the)-307.3(percentage)-312.3(of)-306.7(women)-308.8(who)-305(have)-307(new)-308.4(nod-)]TJ
T*
[(ules)-651(detected)-650.9(during)-648.7(pregnancy.)-651.6(All)-647.1(three)-649.3(studies)-649.5(were)]TJ
0 -1.2267 TD
[(performed)-335.2(in)-335.7(areas)-329.7(with)-331.5(mild)-330.1(to)-332(moderate)-332.6(iodine)-332.3(deciency)]TJ
/F3 1 Tf
-27.9978 77.2217 TD
(1100)Tj
41.5036 0 TD
[(STAGNARO-GREEN)-337.3(ET)-338.7(AL.)]TJ
ET
endstream
endobj
326 0 obj
<>stream
/GS1 gs
BT
/F6 1 Tf
8.9663 0 0 8.9663 59.7543 725.7825 Tm
0 0 0 1 k
0 Tc
0 Tw
[(\(Brussels,)-401.5(China,)-392.3(and)-397.9(Germany\).)-393.3(The)-398.3(prevalence)-393.9(of)-395.3(thyroid)]TJ
0 -1.2203 TD
[(nodules)-426.3(varied)-418.4(between)-426.9(3%)-418.4(and)-423.2(21%)-418(\(183,217,218\))-419.7(and)-423.2(in-)]TJ
0 -1.2266 TD
[(creased)-427.2(with)-426.3(increasing)-430(parity)-427.3(\(9.4%)-421.3(without)-430.9(a)-423.1(prior)-426.4(preg-)]TJ
0 -1.2203 TD
[(nancy,)-234.2(20.7%)-224.4(with)-230.3(one)-233.7(prior)-230.4(pregnancy,)-234.3(20.7%)-224.4(with)-230.3(two)-232.5(prior)]TJ
T*
[(pregnancies,)-221.9(and)-214.6(33.9%)-218.1(with)-217.7(three)-219.3(or)-218.5(more)-215.9(prior)-217.7(pregnancies\))]TJ
0 -1.2266 TD
[(\(217\).)-211.1(In)-214.2(the)-206.1(Belgian)-213.3(study,)-209.5(60%)-209.3(of)-211.9(the)-212.4(nodules)-211.3(doubled)-207.7(in)-209.3(size)]TJ
0 -1.2203 TD
[(during)-300.9(pregnancy)-300.9(yet)-295.6(remained)-298.3(between)-300.4(5)-296.7(and)-296.8(12)-163.4(mm)-298.6(\(183\).)]TJ
T*
[(No)-401.1(increase)-399.5(throughout)-400.5(pregnancy)-402.1(was)-394.5(noted)-401.5(in)-398.9(the)-395.8(maxi-)]TJ
0 -1.2266 TD
[(mum)-300(diameter)-295.4(of)-300.4(the)-294.6(dominant)-298.2(nodule)-298.5(in)-297.8(the)-300.9(Chinese)-296.1(study)]TJ
0 -1.2203 TD
[(\(mean)-272.7(diameter)-270.1(was)-274.3(5.1,)-270.4(5.1,)-264.1(and)-271.5(5.5)-166.3(mm,)-269.9(in)-272.5(the)-269.3(rst,)-267.6(second,)]TJ
T*
[(and)-379(third)-377.8(trimesters,)-381.8(respectively\).)-378.8(However,)-381.6(an)-375.9(increase)-380.6(in)]TJ
T*
[(nodular)-191.3(volume)-189.2(was)-185.8(reported)-185.8(during)-187.1(pregnancy)-193.4(with)-186.1(a)-182.9(return)]TJ
0 -1.2266 TD
[(to)-471.1(rst)-473.4(trimester)-472.4(volumes)-468.8(by)-470.4(the)-465.3(third)-472.7(postpartum)-474.8(month)]TJ
0 -1.2203 TD
[(\(218\).)-470.3(The)-467.9(studies)-472.5(in)-468.5(Belgium)-468.6(and)-467.5(Germany)-465.8(reported)-470.4(that)]TJ
T*
[(11%20%)-386.5(of)-382.6(women)-384.6(with)-382.1(a)-378.9(nodule)-387(detected)-385.3(in)-380(the)-389.4(rst)-378.5(tri-)]TJ
0 -1.2266 TD
[(mester)-271.7(of)-268.8(pregnancy)-269.3(developed)-267(a)-271.4(second)-268.9(nodule)-266.9(through)-269.4(the)]TJ
0 -1.2203 TD
[(course)-429(of)-420.6(pregnancy)-427.4(\(183,218\).)-421.2(Increasing)-428.5(age)-421.1(is)-422.2(associated)]TJ
T*
[(with)-312.5(an)-312.7(increase)-311(in)-310.4(the)-307.3(percentage)-318.6(of)-306.7(women)-308.8(who)-311.3(have)-313.4(thy-)]TJ
0 -1.2266 TD
[(roid)-281.9(nodules)-287.1(present)-285.2(during)-282(pregnancy)-281.9(\(183,218\).)]TJ
/F10 1 Tf
0 -3.054 TD
[(Question)-338(59:)-333.4(What)-336.1(is)-330.4(the)-334.7(frequency)-334.6(of)-336.6(thyroid)-337.5(cancer)]TJ
0 -1.2203 TD
[(in)-338(women)-335.1(with)-330.5(thyroid)-337.5(nodules)-332.1(discovered)-340.4(during)]TJ
T*
(pregnancy?)Tj
/F6 1 Tf
1.1128 -1.8336 TD
[(Data)-418.2(r)-7(e)-12.5(g)-10.7(a)-12.2(r)-13.3(d)-9.3(i)-9.9(n)-16(g)-421.7(t)-13.1(h)-9.7(e)-429.9(p)-7.7(r)-13.3(e)-12.5(v)-13.4(al)-22(en)-22.3(c)-11.9(e)-423.5(o)-9.1(f)-430.4(th)-22.8(y)-10.7(r)-13.3(o)-9.1(i)-9.9(d)-426.6(c)-11.9(a)-12.2(n)-9.7(c)-11.9(e)-12.5(r)-424.3(d)-9.3(e)-12.5(r)-13.3(i)-9.9(v)-13.4(e)]TJ
-1.1128 -1.2266 TD
.0121 Tc
[(from)-301.6(t)12.1(h)-10.7(r)5.1(e)-.4(e)-297.6(r)-1.2(etr)5.1(o)-3.3(s)4.5(p)-1.9(ective)-291.3(studies)-299(p)4.4(erformed)-294.4(at)-298.2(three)-297.6(t)12.1(e)-7.2(r)-1.2(tiary)]TJ
0 -1.2203 TD
.0113 Tc
[(referral)-611.9(centers)-609.7(\()-84(Mayo)-617.4(C)11.3(l)-11.4(inic,)-617.6(G)-.1(eorge)-614.6(W)-.4(a)11.3(s)-8.5(hi)-4.9(ngton)-618.1(U)3.6(n)-4.7(i)1.4(-)]TJ
T*
.0123 Tc
[(vers)4.7(it)12.3(y)-435.2(H)-.3(os)4.7(pital,)-426.9(and)-427(M).9(ount)-430.8(Sinai)-427.5(H)-.3(ospital-Toronto\),)-426.9(o)3.2(ne)]TJ
0 -1.2266 TD
.0115 Tc
[(prosp)3.8(e)-1(ctive)-462.6(s)3.9(tudy,)-459.3(a)-.7(nd)-459.4(a)-462.2(r)-1.8(e)11.5(t)-7.8(rospec)11.5(t)-7.2(ive)-462.6(s)3.9(tudy)-460.8(of)-463.2(the)-462.6(C)-1.3(a)11.5(l)-10.5(i-)]TJ
0 -1.2203 TD
.0129 Tc
[(for)5.9(n)-3.1(ia)-403.9(Cancer)-411.4(Regist)12.9(r)-7.2(y)2.2(.)-407.3(T)3.6(he)-404.3(rese)12.9(arch)-407.8(pe)12.9(r)-6.7(f)-.2(ormed)-407.4(a).7(t)-404.9(t)-.2(he)-404.3(re-)]TJ
T*
.012 Tc
[(ferr)5(al)-257.1(centers)-254.9(r)5(evealed)-256.6(a)-253.1(15)12(%)-267.3(\()12(6)-6.9(/)2.7(40,)-256.5(Mayo)-256.3(C)12(l)-10.7(inic\))-260.4(\()12(2)-6.9(19\),)-256.5(1)12(2)-6(%)]TJ
0 -1.2266 TD
[(\(7/57,)-326.1(George)-323.1(Washingt)11.9(o)-10.3(n)-326.6(Hospit)11.9(a)-7(l)-4.3(\))-323.7(\()-1.2(22)11.9(0)-6.1(\))-1.2(,)-326.1(a)-.3(nd)-326.2(43%)-324.8(\(7)11.9(/)-9.6(1)-.3(6)11.9(,)]TJ
0 -1.2203 TD
0 Tc
[(M)-11.4(o)-15.4(u)-7.7(n)-16(t)-341.9(S)-11.1(i)-9.9(n)-16(ai)-350.8(H)-12.6(o)-9.1(s)-14(p)-7.7(i)-16.2(t)-13.1(al)-22(-T)-22.4(o)-9.1(r)-13.3(o)-9.1(n)-16(to)-22.2(\))-341.9(\()-13.1(22)-18(1)-12.2(\))-341.9(r)-13.3(a)-12.2(t)-13.1(e)-341.3(o)-9.1(f)-341.9(t)-13.1(h)-9.7(y)-10.7(r)-13.3(o)-15.4(i)-9.9(d)-338.1(m)-10.2(a)-12.2(l)-16.2(i)-9.9(g)-10.7(-)]TJ
T*
.011 Tc
[(n)-5(a)-1.2(ncy.)-282.8(All)-283.4(t)-2.1(hre)11(e)-292.3(st)11(u)-9.8(d)1.7(i)-5.2(e)-1.5(s)-281.2(a)-1.2(re)-286.1(lim)-5.5(ited)-282.9(by)-277.9(two)-282.6(m).8(ajor)-286.9(met)11(h)-11.8(odo)-4.4(-)]TJ
T*
.0112 Tc
[(logical)-403.3()1.9(aws.)-402.7(The)-406()1.9(rst,)-402.7(and)-402.8(m)1(os)]TJ
14.9094 0 TD
[(t)-400.3(p)-2.8(roblematic,)-402.7(i)1.3(s)-401.1(s)-2.8(election)]TJ
-14.9094 -1.2266 TD
.0126 Tc
[(bia)12.6(s)-7.2(.)-274.8(T)3.3(he)-271.8(population)-275.3(s)-1.4(tu)4.9(dy)-270(consist)12.6(e)-6.7(d)-274.9(o)-2.8(f)-272.4(w)-1.7(omen)-275.3(refe)12.6(r)-7(r)-.7(ed)-274.9(for)]TJ
0 -1.2203 TD
[(diagnos)5(i)2.7(s)-374.4(a)12.6(n)-9.3(d)-369.8(t)12.6(r)-7.5(eatment)-367.2(a).4(t)-367.2(m)-3.9(a)12.6(j)-4.5(or)-367.5(ref)12.6(e)-6.7(rra)12.6(l)-376.1(c).7(enters)5(.)-369.7(A)-1.4(s)-368.1(s)-1.4(u)4.9(c).7(h)]TJ
T*
0 Tc
[(t)-13.1(h)-16(ey)-434.3(a)-12.2(r)-13.3(e)-423.5(n)-16(o)-9.1(t)-430.4(r)-7(e)-12.5(p)-14(r)-13.3(es)-20.2(e)-12.5(n)-9.7(t)-13.1(a)-12.2(t)-13.1(i)-9.9(v)-13.4(e)-423.5(o)-15.4(f)-424.1(t)-13.1(h)-9.7(e)-429.9(p)-14(o)-9.1(p)-14(u)-7.7(l)-16.2(at)-18.9(i)-16.2(o)-9.1(n)-427(o)-9.1(f)-430.4(p)-14(r)-7(e)-12.5(g)-10.7(n)-16(an)-21.9(t)]TJ
0 -1.2266 TD
.0111 Tc
[(women)-428.6(w)3.2(i)-5.1(t)11.1(h)-435.4(t)-2(hyroid)-428.2(no)-4.3(dul)-5.1(e)-1.4(s)-420.2(d)-4.5(e)11.1(t)-8.2(ected)-421.9(d)1.8(uring)-429.6(p)3.4(regnancy.)]TJ
0 -1.2203 TD
.0121 Tc
[(Instea)12.1(d)-9.4(,)-205.8(they)-207.3(r)5.1(e)-.4(pre)12.1(s)-8.1(ent)-209.7(a)-208.7(select)-209.7(group)-204.2(o)3(f)-209.7(w)-2.2(omen)-206.3(refe)12.1(r)-7.5(r)-1.2(ed)-205.9(to)-205.6(a)]TJ
T*
.0117 Tc
[(tertiar)4.7(y)-315.2(medica)11.7(l)-320.1(c)-.2(enter)-311.5(d)-3.9(u)4(e)-317(to)-313.5(p)4(h)-4.3(ys)4.1(ician)-314.2(c)-.2(oncern)-314.2(of)-317.6(thyroid)]TJ
0 -1.2266 TD
.0121 Tc
[(malignancy.)-458.7(C)-.7(onsequently,)-458.7(they)-460.2(over)5.1(repr)5.1(esent)-456.3(t)-1(he)-455.7(pr)5.1(eva-)]TJ
0 -1.2203 TD
.0106 Tc
[(l)-5.6(e)10.6(n)-11.7(c)-1.3(e)-425.6(o)1.5(f)-432.5(t)10.6(h)-12.2(y)-.1(ro)-4.8(id)-428.7(malign)-5.4(a)10.6(n)-11.3(c)-1.3(y)-423.8(d)1.3(uring)-430.1(p)2.9(regnancy.)-428.6(S)-.5(econ)-5.4(dly,)]TJ
T*
.0127 Tc
[(each)-205.7(s)5.1(t)-.4(udy)-200.4(w)-1.6(as)-203.6(re)12.7(t)-6.6(r)-.6(ospe)12.7(ctive)-202.2(i)-3.5(n)-199.3(n)-3.3(a)12.7(t)-6.2(ure)12.7(;)-211.4(therefore)12.7(,)-211.4(neit)12.7(h)-10.1(e).2(r)-203(t)12.7(h)-10.1(e)]TJ
T*
.0119 Tc
[(accuracy)-561.6(of)-564(the)-563.4(d)-3.7(iagnosis)-564.8(nor)-564.2(t)-1.2(he)-563.4(comple)11.9(t)-7.4(e)-.6(ness)-564.8(of)-564(case)]TJ
0 -1.2266 TD
[(identication)-200.1(w)4(it)11.9(h)-10.9(i)2(n)-200.1(t)-1.2(he)-203(databa)11.9(s)-7.9(e)-203(could)-199.8(b)1.2(e)-203(v)4.8(eried.)-199.7(T)2.6(he)-203(lone)]TJ
0 -1.2203 TD
.0114 Tc
[(prospective)-494.3(s)-2.6(tudy)-492.5(i)-4.8(n)1.7(vestigated)-497.4(the)-494.3(p)-2.6(revalen)-4.6(c)-.5(e)-494.3(o)2.3(f)-501.2(t)-1.7(hyroid)]TJ
T*
.0107 Tc
[(cancer)-280.9(duri)-5.5(ng)-278.2(pregnan)-5.3(c)10.7(y)-283.9(i)-5.5(n)-277.2(2)10.7(1)-7.3(2)-279.7(Chin)-5.3(e)10.7(s)-9.5(e)-280(w)2.8(o)-4.7(m).5(en.)-276.7(T)1.4(h)-5.3(e)-273.7(stud)-5(y)]TJ
0 -1.2267 TD
.0127 Tc
[(found)-199(a)-195.5(15.3%)-197.6(\(34)12.7(/)-8.8(2)12.7(2)-5.3(1\))-202.7(r)5.7(a).5(te)-195.8(of)-196.4(thyr)5.7(oid)-199(n)3(odules)-197.3(and)-199(a)-195.5(0%)-197.6(rate)]TJ
0 -1.2203 TD
.0136 Tc
[(of)-600.2(m)3.4(a)1.4(l)3.7(i)3.7(g)2.9(nan)3.9(c)1.7(y)2.9(.)-602.6(I)5.2(n)-2.4(t)13.6(e)-5.7(rpr)6.6(e)1.1(ti)3.7(ng)-597.8(th)3.9(ese)-599.6(d)4.3(ata)-599.2(i)3.7(s)-601(h)-2.4(am)3.4(p)5.9(e)1.1(red)-602.7(b)2.9(y)]TJ
T*
0 Tc
[(the)-231.4(limited)-220.2(number)-228.6(of)-224.5(women)-226.6(enrolled)-225.4(in)-228.2(the)-225.1(study)-225.5(\(218\).)-223.7(The)]TJ
0 -1.2266 TD
[(nal)-584.8(study)-579.6(consisted)-577.7(of)-584.9(a)-581.2(population-b)6.7(ased)-585.4(retrospecti)8.6(ve)]TJ
0 -1.2203 TD
[(analysis)-516(of)-515.4(all)-518.7(obstetrical)-509.1(deliveries)-515.6(in)-519.1(California)-510.3(between)]TJ
T*
[(the)-395.8(years)-385.2(1991)-390.1(through)-389.5(1999)-383.7(identied)-386.5(by)-394.5(cross-refer)11.5(encing)]TJ
0 -1.2266 TD
[(maternal/ne)8.1(onatal)-338(hospital)-338.3(discharg)10.1(es)-342.6(in)-335.7(California)-333.3(and)-334.7(the)]TJ
0 -1.2203 TD
[(California)-440.8(Cancer)-445.6(Registry)-436.3(\()]TJ
/F8 1 Tf
12.728 0 TD
(n)Tj
/F9 1 Tf
.7208 0 TD
()Tj
/F6 1 Tf
.9358 0 TD
[(4,846,505)-438.7(women\).)-438.6(A)-450.3(prev-)]TJ
-14.3846 -1.2203 TD
[(alence)-416.5(of)-420.6(thyroid)-416.6(cancer)-413.1(in)-417.9(pregnancy)-414.7(of)-420.6(14.4/100,)13.1(000)-422.2(was)]TJ
T*
[(reported,)-606.1(with)-609.7(papillary)-605.5(cancer)-609.1(being)-610(the)-610.8(most)-609.1(frequent)]TJ
0 -1.2266 TD
[(pathological)-403.5(type)-410.8(\(222\).)-407.1(Timing)-407.5(of)-414.2(diagnosi)10.1(s)-412.3(o)0(f)-414.2(the)-408.4(thyroid)]TJ
0 -1.2203 TD
[(malignancy)-587.6(was)-596.8(as)-595.2(follows)9.3(:)-597.3(3.3/100,00)13.5(0)-600.2(cases)-589.3(diagnosed)]TJ
T*
[(before)-507.7(delivery,)-505.5(0.3/100,000)-498.1(at)-512.1(delivery,)-505.5(and)-511.7(10.8/100,)13.1(000)]TJ
0 -1.2267 TD
[(within)-281.5(1)-277.7(year)-276.4(postpartu)9.7(m.)]TJ
/F10 1 Tf
28.0042 74.5598 TD
[(Question)-331.7(60:)-333.4(What)-336.1(is)-336.7(the)-334.6(optimal)-334.9(diagnostic)-335.9(strategy)]TJ
0 -1.2203 TD
[(for)-330.9(thyroid)-337.5(nodules)-338.5(detected)-330.4(during)-336.6(pregnancy?)]TJ
/F1 1 Tf
1.1128 -2.447 TD
[(History)-565.3(and)-563.3(physical)-568.5(examination.)]TJ
/F6 1 Tf
16.8 0 TD
[(The)-512.1(patient)-514.5(with)-514.9(a)]TJ
-17.9128 -1.2203 TD
[(thyroid)-448.2(nodule)-450.2(should)-445.3(be)-446.9(asked)-450.7(about)-444.8(a)-448.4(family)-445.3(history)-452.9(of)]TJ
0 -1.2266 TD
[(benign)-284.6(or)-281.7(malignant)-287.2(thyroid)-290.2(disease,)-283.3(familial)-283.1(medullary)-285.4(thy-)]TJ
0 -1.2203 TD
[(roid)-199.7(carcinoma,)-204.5(multiple)-207.3(endocrine)-205.5(neoplasia)-204.5(type)-202.2(2)-201.8(\()-82.7(MEN)-204.1(2\),)]TJ
T*
[(familial)-352.6(papillary)-358.9(thyroid)-353.4(carcinoma,)-356.2(and)-353.7(familial)-352.6(polyposis)]TJ
0 -1.2266 TD
[(coli)-464.4(\(223,224\).)-465.4(Previous)-466.9(disease)-463.7(or)-465(treatment)-470.3(involving)-468.7(the)]TJ
0 -1.2203 TD
[(neck)-234.6(\(history)-238.4(of)-237.2(head)-233.4(and)-233.5(neck)-234.6(irradiation)-235.6(during)-237.7(childhood\),)]TJ
T*
[(rapidity)-579.3(of)-578.6(onset,)-579.8(and)-575(rate)-582.3(of)-578.6(nodule)-576.7(growth)-582.4(should)-578.1(be)]TJ
T*
[(documented)-326.8(\(225\).)-324.9(A)-317.5(progressive)-326.5(nodule)-330.1(growth)-323.2(warrants)-323.4(a)]TJ
0 -1.2266 TD
[(ne-needle)-319.9(aspiration)-313.3(\(FNA\),)-319.5(while)-315.5(persistent)-315.8(cough)-314.7(or)-313.3(dys-)]TJ
0 -1.2203 TD
[(phonia)-298.5(may)-298.7(suggest)-297.7(a)-296.7(malignant)-299.9(lesion)-305.3(\(224\).)-299.6(Thorough)-300(pal-)]TJ
T*
[(pation)-333.5(of)-325.7(the)-332.6(thyroid)-334.4(and)-328.4(neck)-329.5(inspection)-335.1(for)-332.7(cervical)-329(nodes)]TJ
0 -1.2266 TD
[(are)-278.3(essential)-284.7(\(226\).)]TJ
/F1 1 Tf
1.1128 -2.4406 TD
(Ultrasound.)Tj
/F6 1 Tf
6.2028 0 TD
[(Thyroid)-242.1(ultrasound)-245(is)-245.1(the)-244(most)-242.4(accurate)-240.3(tool)]TJ
-7.3156 -1.2266 TD
[(for)-541.4(detecting)-545.5(thyroid)-549.4(nodules,)-543(determining)-550.9(their)-545.4(features,)]TJ
0 -1.2203 TD
[(monitoring)-623.2(their)-621.3(growth,)-623.3(and)-619.2(evaluating)-617(cervical)-626.1(lymph)]TJ
T*
[(nodes.)-405.3(Nodules)-403.9(smaller)-404.4(than)-411.4(10)-163.4(mm)-399.8(do)-404.1(not)-411.3(require)-402.5(a)-404.2(FNA)]TJ
T*
[(unless)-434.4(suspicious)-440.8(for)-440.2(malignancy)-435.9(on)-436.1(ultrasound)-441(or)-433.4(clinical)]TJ
0 -1.2266 TD
[(grounds)-383.7(\(227\).)-375.4(Ultrasonographic)-388.5(features)-383(suggestive)-384.1(of)-382.6(ma-)]TJ
0 -1.2203 TD
[(lignancy)-514.7(include)-519.8(a)-518(hypoechoic)-519.6(pattern,)-520.9(irregular)-520.2(margins,)]TJ
T*
[(chaotic)-431.9(intranodular)-439.2(vascular)-435.9(spots,)-433.8(nodules)-438.9(that)-433.8(are)-430.1(taller)]TJ
0 -1.2266 TD
[(than)-367.2(they)-374.9(are)-366.8(wide,)-371.4(and)-372.6(microcalcications)-376.4(\(228\).)-369.1(The)-366.7(pres-)]TJ
0 -1.2203 TD
[(ence)-331.3(of)-325.7(two)-333.7(or)-332.3(more)-329.7(suspicious)-333.3(sonographic)-332.3(criteria)-330.1(reliably)]TJ
T*
[(identies)-365.8(mo)18.6(st)-336.9(ne)15.7(op)21.2(l)15.4(a)0(s)18.1(t)12.2(ic)-344.2(le)21.9(si)20.4(on)25.5(s)-355.4(o)0(f)-344.7(t)12.2(he)-344.7(t)12.2(h)0(y)23.8(r)0(o)15.5(i)15.4(d)-357.1(g)14.6(la)22.2(nd)-341.5(\(8)19(7)13.1(%)0()]TJ
0 -1.2266 TD
[(9)13.1(3)13.1(%)-412.6(of)-401.6(ca)20.2(se)24.1(s\))-406.5(\()12.2(2)13.1(29)19.9(\))12.2(.)-413.9(Ul)20.4(t)12.2(r)0(a)25.1(s)0(o)21.2(n)0(o)19.1(g)0(r)20.2(a)13.1(ph)20.5(ic)-401.2(f)12.2(e)0(a)19.6(t)12.2(ur)16.9(e)12.8(s)-412.3(su)22.6(gg)22.8(es)17.8(t)12.2(i)0(v)21(e)-410.9(of)]TJ
0 -1.2203 TD
[(m)15.1(a)0(l)22.3(i)0(g)17.3(n)0(a)22.4(n)0(c)22.6(y)-251(or)-237.4(wi)20.1(t)12.2(h)-250(e)12.8(x)0(t)16.3(r)0(a)25.1(c)0(a)20.2(p)0(s)22.6(u)0(l)20.4(a)13.1(r)-253.6(g)14.6(ro)21.8(wt)16.9(h)-250(o)16.2(r)-253.6(m)15.1(et)18.6(a)13.1(s)0(t)17.2(a)13.1(t)12.2(i)0(c)-243.1(l)15.4(ym)17(ph)]TJ
T*
[(no)19.1(d)16(e)0(s)-330(w)0(a)17.8(r)0(r)23.9(a)0(n)22.4(t)-341.9(FN)20.9(A)-342.8(e)12.7(va)18.7(lu)20.4(a)13.1(t)12.2(io)19(n.)-328.8(FN)20.9(A)-342.8(o)0(f)-332(n)0(o)19.1(d)0(u)20.9(l)15.4(es)-336.3(t)12.2(h)0(a)22.4(t)-341.9(a)13.1(p)0(p)16.3(e)12.8(a)13.1(r)]TJ
0 -1.2266 TD
[(b)14.5(e)0(n)15.7(i)15.4(gn)-260.7(on)-259.1(ul)20.4(t)12.2(r)0(a)18.8(s)0(o)21.2(u)0(n)20.5(d)-268.6(c)13.4(a)13.1(n)-269(b)0(e)-263.6(d)16(ef)18.6(e)12.7(r)0(r)17.6(e)12.8(d)-268.6(u)0(n)20.5(t)0(i)21.3(l)-269.1(po)21.2(st)17.2(pa)24.4(rt)17.8(um)26.4(.)]TJ
/F1 1 Tf
1.1128 -2.4406 TD
[(Thyroid)-289.4(function)-293.1(tests.)]TJ
/F6 1 Tf
10.9007 0 TD
[(All)-242.4(women)-239.2(with)-243(a)-239.8(thyroid)-239.6(nodule)]TJ
-12.0135 -1.2203 TD
[(should)-350.5(have)-357.6(a)-353.6(TSH)-349.2(and)-353.7(FT)]TJ
6.7246 0 0 5.9768 419.8109 351.666 Tm
(4)Tj
8.9663 0 0 8.9663 426.3306 353.1967 Tm
[(performed)-354.1(\(6,230,231\).)-354(Thyroid)]TJ
-12.8798 -1.2266 TD
[(function)-495.2(tests)-496.7(are)-493.3(usually)-489.2(normal)-494.3(in)-493.8(women)-492.1(with)-495.9(thyroid)]TJ
0 -1.2203 TD
(cancer.)Tj
/F12 1 Tf
5.9777 0 0 5.9777 310.0535 311.8109 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 320.485 309.3164 Tm
[(RECOMMENDATION)-284.1(46)]TJ
/F6 1 Tf
.0569 -1.2203 TD
[(The)-442.6(optimal)-438.7(diagnostic)-444.9(strategy)-441.2(for)-446.5(thyroid)-441.9(nodules)-445.2(de-)]TJ
T*
[(tected)-281.2(during)-282(pregnancy)-281.9(is)-276.7(based)-280(on)-278(risk)-281.9(stratication.)-280.1(All)]TJ
0 -1.2266 TD
[(women)-258.2(should)-262(have)-262.8(the)-263(following:)-262.9(a)-258.7(complete)-257.7(history)-263.2(and)]TJ
0 -1.2203 TD
[(clinical)-224.3(examination,)-227.3(serum)-222.1(TSH)-229.1(testing,)-225.1(and)-220.9(ultrasound)-232.4(of)]TJ
T*
[(the)-282(neck.)]TJ
/F4 1 Tf
4.2047 0 TD
[(Level)-278.8(A-USPSTF)]TJ
/F6 1 Tf
-4.2237 -2.447 TD
[(As)-312.5(with)-318.8(the)-319.9(general)-321.2(population,)-320.1(the)-319.9(routine)-321.9(measurement)]TJ
-1.1128 -1.2203 TD
[(of)-553.3(calcitonin)-556.1(remains)-556(controversial)-556.1(\(232\).)-558.8(Calcitonin)-557(mea-)]TJ
T*
[(surement)-409.3(should)-413.7(be)-409(performed)-411(in)-411.6(pregnant)-411.5(women)-409.9(with)-407.4(a)]TJ
0 -1.2267 TD
[(family)-445.3(history)-446.6(of)-439.5(medullary)-449.8(thyroid)-441.9(carcinoma)-448.2(or)-446.1(MEN)-444.4(2.)]TJ
0 -1.2203 TD
[(However,)-343.7(the)-338.9(utility)-339.8(of)-344.7(measuring)-340.5(calcitonin)-341.2(in)-342(all)-341.7(pregnant)]TJ
T*
[(women)-346.7(with)-350.5(thyroid)-347.1(nodules)-350.4(has)-345.6(not)-354.4(been)-349(evaluated)-349.4(in)-342(the)]TJ
0 -1.2266 TD
[(literature.)-209(The)-202.3(pentagastrin)-214(stimulation)-207.1(test)-204.5(is)-207.2(contraindicated)]TJ
0 -1.2203 TD
[(in)-278.8(pregnancy)-281.9(\(233\).)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 310.0535 136.4598 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 320.485 133.9653 Tm
[(RECOMMENDATION)-284.1(47)]TJ
/F6 1 Tf
.0569 -1.2203 TD
[(The)-486.8(utility)-491.5(of)-483.8(measuring)-492.2(calcitonin)-486.6(in)-487.5(pregnant)-493.7(women)]TJ
T*
[(with)-280.9(thyroid)-283.8(nodules)-280.8(is)-283.1(unknown.)]TJ
/F4 1 Tf
15.3331 0 TD
[(Level)-285.1(I-USPSTF)]TJ
/F1 1 Tf
-15.352 -2.447 TD
[(Fine-needle)-399.4(aspiration.)]TJ
/F6 1 Tf
11.3559 0 TD
[(FNA)-347.2(is)-352.6(a)-347.3(safe)-355.3(diagnostic)-350(tool)-351(in)]TJ
-12.4688 -1.2203 TD
[(pregnancy)-288.2(and)-284.1(may)-286(be)-288.8(performed)-290.9(in)-285.1(any)-285.5(trimester)-289.1(\(229,234)]TJ
T*
[(242\).)-337(Two)-342.5(retrospective)-346.2(case)-347.8(series)-341.8(of)-338.4(FNAs)-342.2(performed)-347.8(dur-)]TJ
0 -1.2267 TD
[(ing)-435(pregnancy,)-442.9(involving)-443.4(a)-435.8(total)-443(of)-439.5(94)-435.3(patients,)-442.8(have)-439.8(been)]TJ
/F3 1 Tf
-28.0042 77.228 TD
[(PREGNANCY)-339.6(AND)-337.2(POSTPARTUM)-334.3(THYROID)-341(MANAGEMENT)-335.2(GUIDELINES)-17387(1101)]TJ
ET
endstream
endobj
331 0 obj
<>stream
/GS1 gs
BT
/F6 1 Tf
8.9663 0 0 8.9663 62.022 725.7825 Tm
0 0 0 1 k
0 Tc
0 Tw
[(published.)-505.3(In)-498.7(the)-503.3(cases)-500.8(in)-500.1(which)-498.1(surgery)-506(was)-495.6(performed,)]TJ
0 -1.2203 TD
[(pathological)-289.6(examination)-293.9(of)-287.8(the)-294.6(specimens)-292.1(conrmed)-287.8(the)-294.6(di-)]TJ
0 -1.2266 TD
[(agnosis)-269.2(of)-268.8(all)-265.8(FNAs)-266.4(classied)-267.3(by)-268.1(cytology)-268.7(as)-266.4(either)-273.4(benign)-265.6(or)]TJ
0 -1.2203 TD
[(malignant.)-239.5(Six)-238.1(of)-243.5(the)-237.7(16)-239.3(\(37.5%\))-238(cases)-241.6(reported)-242.7(by)-236.5(cytology)-243.4(as)]TJ
T*
[(suspicious)-478.7(for)-471.8(malignancy)-473.8(were)-470(found)-472.6(to)-471.1(be)-472.2(malignant)-470.6(at)]TJ
0 -1.2266 TD
[(pathological)-365.5(examination)-369.8(\(219,220\).)-357.9(Pregnancy)-370.4(does)-361.1(not)-367(ap-)]TJ
0 -1.2203 TD
[(pear)-368.2(to)-363.6(increase)-367.9(the)-364.2(difculty)-366.8(of)-370(making)-360.6(a)-366.2(cytological)-365(diag-)]TJ
T*
[(nosis)-271.6(of)-268.8(thyroid)-277.5(tissue)-267.1(obtained)-276.2(by)-268.1(FNA.)-268(There)-272.4(have)-275.4(been)-266.8(no)]TJ
0 -1.2266 TD
[(prospective)-428.6(studies)-428.2(which)-428.5(have)-427.2(evaluated)-431.6(the)-427.4(reliability)-425.4(of)]TJ
0 -1.2203 TD
[(FNA)-284(in)-278.8(pregnancy.)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 61.2283 603.7227 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 71.6598 601.2282 Tm
[(RECOMMENDATION)-290.5(48)]TJ
/F6 1 Tf
.0569 -1.2203 TD
[(Thyroid)-248.4(or)-243.7(lymph)-244.2(node)-249.3(FNA)-246.1(confers)-248.1(no)-240.1(additional)-249.9(risks)-245.2(to)]TJ
T*
[(a)-284(pregnancy.)]TJ
/F4 1 Tf
5.9435 0 TD
[(Level)-285.1(A-USPSTF)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 61.2283 555.9305 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 71.6598 553.4361 Tm
[(RECOMMENDATION)-290.5(49)]TJ
/F6 1 Tf
.0569 -1.2266 TD
[(Thyroid)-387.5(nodules)-388.3(discovered)-387.2(during)-383.1(pregnancy)-389.4(that)-383.2(have)]TJ
0 -1.2203 TD
[(suspicious)-358.6(ultrasound)-358.8(features,)-354.3(as)-354.9(delineated)-357.6(by)-350.3(the)-351.5(2009)]TJ
T*
[(ATA)-511.6(guidelines,)-513.7(should)-514.9(be)-510.1(considered)-516.3(for)-509.8(FNA.)-514.6(In)-505(in-)]TJ
T*
[(stances)-365.6(in)-367.3(which)-359(nodules)-369.3(are)-360.5(likely)-367.1(benign,)-363.4(FNA)-359.9(may)-361.9(be)]TJ
0 -1.2266 TD
[(deferred)-285.8(until)-277.8(after)-279.3(delivery)-281.3(based)-280(on)-278(patients)-283.7(preference.)]TJ
/F4 1 Tf
0 -1.2203 TD
[(Level)-285.1(I-USPSTF)]TJ
/F1 1 Tf
-.019 -2.447 TD
[(Radionuclide)-296.1(scanning.)]TJ
/F6 1 Tf
11.4065 0 TD
[(The)-240.2(us)16.3(e)-227.5(o)0(f)-224.5(r)0(a)25.1(d)0(i)18.8(o)0(n)19.1(u)0(c)24.7(l)0(i)18.2(d)16(e)-233.8(s)0(c)18.4(a)13.1(nn)18.5(i)15.4(n)0(g)]TJ
-12.5194 -1.2203 TD
[(is)-498(c)13.4(o)0(n)19.1(t)12.2(ra)18.8(i)15.4(n)0(d)18.9(i)0(c)22.5(a)13.1(te)18.6(d)-502.5(d)0(u)20.9(r)0(i)21.1(n)0(g)-494.7(p)0(r)16.9(e)12.8(gn)23.8(an)16.1(c)13.4(y)-503.9(\()12.2(2)0(4)19.9(3)13.1(2)19.9(4)13.1(5)0(\))19(.)-502.4(In)19.8(ad)22.8(ve)18.3(rt)24.1(en)15.7(t)]TJ
T*
[(sc)18.4(a)13.1(n)0(n)18.5(i)15.4(ng)-317.6(pe)24(rf)17.8(o)16.2(r)0(m)20.7(e)0(d)-312.7(p)0(r)16.9(i)15.4(or)-313.3(to)-313.1(12)-315.2(we)23.8(e)12.8(k)0(s)-315.6(g)0(e)21(s)0(t)23.5(a)0(t)19(i)0(o)19(n)-319.5(do)19.5(e)12.8(s)-323.8(no)19.1(t)-322.9(a)13.1(p-)]TJ
0 -1.2266 TD
[(pe)17.7(a)13.1(r)-266.3(to)-262.5(da)22.8(ma)21.9(g)14.6(e)-271.8(t)12.2(h)0(e)-262.5(f)12.2(e)12.8(t)0(a)19(l)-269.1(t)12.2(h)0(y)17.5(r)0(o)21.8(i)0(d)25.1(.)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 61.2283 408.9826 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 71.6598 406.4881 Tm
[(RECOMMENDATION)-290.5(50)]TJ
/F6 1 Tf
.0569 -1.2266 TD
[(The)-335.1(us)22.6(e)-322.4(o)0(f)-313.1(r)0(a)25.1(d)0(i)18.8(o)16.2(io)19(di)18.8(n)15.6(e)-322.4(im)24.2(ag)21.4(in)18.4(g)-320.6(a)13.1(nd)18.9(/)16(o)0(r)-313.3(u)0(p)22.6(t)12.2(ak)21.4(e)-322.4(d)0(e)22.4(t)0(e)18.6(r)0(m)20.7(i)15.4(na)16.1(-)]TJ
0 -1.2203 TD
[(ti)21.3(on)-366.6(or)-363.9(t)12.2(h)0(e)22(r)0(a)18.8(p)0(e)24(u)0(t)17.1(i)15.4(c)-372.3(d)0(o)19.5(s)0(i)20.4(n)0(g)-361.9(i)0(s)-365.2(c)13.4(on)19.1(t)12.2(r)0(a)25.1(i)0(n)18.4(d)0(i)18.8(c)13.4(a)13.1(t)0(e)18.6(d)-369.7(du)20.9(ri)21.1(ng)-361.9(pr)16.9(e)12.7(g)0(-)]TJ
T*
[(na)22.4(nc)16.3(y)14.6(.)-325.4(In)19.8(a)13.1(d)0(v)21.6(e)12.8(rt)17.8(e)12.8(n)0(t)-313.7(u)0(s)22.6(e)-328.7(of)-313.1(ra)25.1(di)18.8(oi)25.3(od)19.5(in)18.4(e)-322.4(p)0(r)23.2(i)0(o)19(r)-323.2(t)12.2(o)-325.2(1)13.1(2)-322(we)17.4(e)12.7(k)0(s)-315.6(o)0(f)]TJ
T*
[(ge)21(st)17.2(a)13.1(t)12.2(io)19(n)-540.8(d)0(o)19.5(e)12.8(s)-538.8(n)0(o)19.1(t)-544.2(a)13.1(p)0(p)22.6(e)0(a)19.6(r)-538.1(to)-534.4(d)16(a)0(m)21.9(a)0(g)21.4(e)-543.7(t)12.2(h)0(e)-534.4(f)12.2(e)12.8(t)0(a)19(l)-541(t)12.2(h)0(y)23.8(r)0(o)15.5(i)15.4(d.)]TJ
/F4 1 Tf
0 -1.2267 TD
[(Le)22.8(ve)21.4(l)-272.4(A)0(-)23.4(U)0(S)20.9(P)0(S)19.3(T)14.7(F)]TJ
/F10 1 Tf
-1.1318 -2.8896 TD
[(Question)-338(61:)-333.4(Does)-333.4(pregnancy)-331.8(impact)-336.5(the)-334.6(prognosis)]TJ
0 -1.2203 TD
[(of)-336.6(thyroid)-331.2(carcinoma?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Seven)-192.1(studies)-194.3(have)-193.2(compared)-187.5(the)-193.4(prognosis)-192.3(of)-192.9(women)-194.9(with)]TJ
-1.1128 -1.2203 TD
[(differentiated)-328.1(thyroid)-321.8(cancer)-324.5(\(DTC\))-321.7(diagnosed)-324.3(either)-324(during)]TJ
0 -1.2266 TD
[(pregnancy)-307.2(or)-307(within)-306.8(the)-307.3(rst)-302.7(postpartum)-310.4(year)-301.7(to)-306.7(women)-308.8(di-)]TJ
0 -1.2203 TD
[(agnosed)-602.3(with)-603.4(thyroid)-606.3(carcinoma)-599.9(at)-600.7(another)-604.5(time)-602.1(period)]TJ
T*
[(\(controls\))-381.9(\(246252\).)-373.5(In)-378.6(six)-373.7(of)-376.3(the)-376.8(studies)-377.6(the)-376.8(prognosis,)-378.6(de-)]TJ
T*
[(ned)-401.3(as)-405.5(either)-406.2(tumor)-401.2(recurrence)-409.8(or)-401.8(death,)-407.5(of)-401.6(women)-403.6(diag-)]TJ
0 -1.2266 TD
[(nosed)-547.8(during)-541.2(pregnancy/postpartum)-551(did)-540.7(not)-550.4(differ)-545.5(from)]TJ
0 -1.2203 TD
[(controls.)-434.5(The)-436.2(studies)-434.5(ranged)-434.6(in)-430.6(size)-434.2(from)-431.5(9)-435.8(t)0(o)-433.2(595)-428.5(thyroid)]TJ
T*
[(cancer)-413.1(cases)-406(diagnosed)-412.9(during)-408.4(pregnancy/postpartum)-411.9(and)]TJ
0 -1.2267 TD
[(462)-447.5(to)-445.8(2270)-440.7(controls.)-447.1(Prognosis)-451.5(in)-443.2(women)-447.9(diagnosed)-450.8(with)]TJ
0 -1.2203 TD
[(thyroid)-441.9(carcinoma)-441.8(while)-435.6(pregnant)-443.1(did)-439.5(not)-442.9(differ)-438(based)-438.1(on)]TJ
T*
[(whether)-483.6(surgery)-480.7(was)-476.7(performed)-486.9(during)-478(pregnancy)-484.3(or)-477.7(de-)]TJ
0 -1.2266 TD
[(ferred)-232.3(until)-233.6(postpartum.)-237.4(In)-226.8(contrast)-235.5(with)-230.3(these)-232.6(studies,)-235.1(a)-227.1(2010)]TJ
0 -1.2203 TD
[(publication)-193.9(reported)-185.8(that)-193.5(women)-188.6(diagnosed)-185.2(with)-192.4(DTC)-187.9(during)]TJ
T*
[(pregnancy)-256.6(or)-256.4(within)-262.5(1)-252.4(year)-257.4(following)-260(delivery)-256(\()]TJ
/F8 1 Tf
20.7518 0 TD
(n)Tj
/F9 1 Tf
.7208 0 TD
()Tj
/F6 1 Tf
.9358 0 TD
[(15\),)-255.3(had)-258.8(a)]TJ
-22.4084 -1.2266 TD
[(poorer)-602.6(prognosis)-597(in)-601.3(terms)-600.6(of)-597.6(persistence)-599.1(and)-600.3(relapse)-600.6(of)]TJ
0 -1.2203 TD
[(disease)-849.4(compared)-845(with)-843.6(women)-852.5(diagnosed)-842.8(with)-850(well-)]TJ
T*
[(differentiated)-758(thyroid)-751.7(cancer)-748.2(either)-754(prior)-748.8(to)-755.7(pregnancy)]TJ
T*
(\()Tj
/F8 1 Tf
.3225 0 TD
(n)Tj
/F9 1 Tf
.7208 0 TD
()Tj
/F6 1 Tf
.9358 0 TD
[(61\))-334.6(or)-332.3(1)-334.6(year)-333.3(following)-335.9(delivery)-331.9(\()]TJ
/F8 1 Tf
14.783 0 TD
(n)Tj
/F9 1 Tf
.7208 0 TD
()Tj
/F6 1 Tf
.9358 0 TD
[(47\))-334.6(\(252\).)-331.2(Estrogen)]TJ
-18.4186 -1.2266 TD
(receptor)Tj
/F14 1 Tf
3.8001 0 TD
(a)Tj
/F6 1 Tf
.6955 0 TD
[(was)-198.5(present)-203(in)-196.6(the)-199.8(tumors)-200.2(of)-192.9(the)-199.8(majority)-197.3(of)-199.3(women)]TJ
-4.4956 -1.2203 TD
[(diagnosed)-286.4(during)-288.3(pregnancy/postpartum)-291.8(as)-285.4(compared)-288.6(with)]TJ
T*
[(the)-433.7(other)-437.2(two)-434.8(groups,)-432.1(which)-434.9(may)-431.5(indicate)-436.3(that)-433.8(the)-433.7(poorer)]TJ
0 -1.2267 TD
[(prognosis)-287.1(is)-276.7(related)-285.2(to)-281.5(estrogen-mediated)-285.8(growth.)]TJ
29.1107 74.5598 TD
[(In)-403.8(conclusion,)-402.9(the)-402.1(majority)-399.6(of)-401.6(studies)-402.9(indicate)-404.6(that)-402.2(preg-)]TJ
-1.1128 -1.2203 TD
[(nancy)-376.7(does)-380(not)-373.4(worsen)-376.4(the)-376.8(prognosis)-382(in)-373.6(women)-378.3(diagnosed)]TJ
0 -1.2266 TD
[(with)-236.6(DTC.)-235.1(Surgery)-231.3(for)-237.9(DTC)-232.2(diagnosed)-235.8(during)-231.4(pregnancy)-237.7(can)]TJ
0 -1.2203 TD
[(be)-288.8(postponed)-294.5(until)-290.5(postpartum)-291.4(without)-291.8(impacting)-291.3(tumor)-293.7(re-)]TJ
T*
[(currence)-447.1(or)-439.8(mortality.)-439.5(It)-438.9(should)-439(be)-440.6(noted)-439.5(that)-440.1(none)-439.4(of)-439.5(the)]TJ
0 -1.2266 TD
[(studies)-516.7(were)-508(randomized)-512.4(controlled)-512.5(trials,)-511.5(all)-506.1(were)-508(retro-)]TJ
0 -1.2203 TD
[(spective,)-256(and)-246.2(the)-244(size)-250.9(of)-243.5(many)-245.2(of)-249.8(the)-250.3(studies)-244.8(was)-249.1(limited.)-248.4(The)]TJ
T*
[(impact)-235.7(on)-227.5(prognosis)-236.5(of)-230.9(estrogen)-234.2(receptor)]TJ
/F14 1 Tf
18.0013 0 TD
(a)Tj
/F6 1 Tf
.7335 0 TD
[(positivity)-230.8(requires)]TJ
-18.7348 -1.2266 TD
[(further)-278.9(evaluation.)-276.9(The)-271.8(impact)-273.6(of)-275.1(pregnancy)-275.6(on)-271.7(women)-270.8(with)]TJ
0 -1.2203 TD
[(medullary)-285.4(or)-281.7(anaplastic)-283.3(carcinoma)-283.8(is)-276.7(unknown.)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 312.2645 603.7227 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 322.7527 601.2282 Tm
[(RECOMMENDATION)-284.2(51)]TJ
/F6 1 Tf
.0569 -1.2203 TD
[(Because)-352(the)-351.5(prognosis)-356.7(of)-351(women)-353(with)-350.5(well-differentiated)]TJ
T*
[(thyroid)-239.6(cancer)-242.3(identied)-241(but)-233.9(not)-240.6(treated)-244.2(during)-237.7(pregnancy)]TJ
0 -1.2266 TD
[(is)-295.7(similar)-300.5(to)-300.4(that)-301(of)-300.4(nonpregnant)-300.9(patients,)-303.7(surgery)-303.6(may)-298.7(be)]TJ
0 -1.2203 TD
[(generally)-278.5(deferred)-285.8(until)-284.2(postpartum.)]TJ
/F4 1 Tf
16.3321 0 TD
[(Level)-285.1(B-USPSTF)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 312.2645 533.9904 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 322.7527 531.4959 Tm
[(RECOMMENDATION)-284.2(52)]TJ
/F6 1 Tf
.0569 -1.2203 TD
[(The)-347.7(impact)-349.5(of)-344.7(pregnancy)-351.5(on)-347.6(women)-353(with)-350.4(medullary)-348.6(car-)]TJ
T*
[(cinoma)-613.1(is)-618.2(unknown.)-617.6(Surgery)-623.3(is)-611.8(recommended)-620.3(during)]TJ
0 -1.2266 TD
[(pregnancy)-459(in)-455.8(the)-459(presence)-461(of)-452.2(a)-454.8(large)-457(primary)-456.7(tumor)-458.1(or)]TJ
0 -1.2203 TD
[(extensive)-283.2(lymph)-282.1(node)-280.9(metastases.)]TJ
/F4 1 Tf
15.2066 0 TD
[(Level)-285.1(I-USPSTF)]TJ
/F10 1 Tf
-16.3447 -3.0034 TD
[(Question)-338(62:)-333.4(What)-336.1(are)-332(the)-334.6(perioperative)-334.1(risks)]TJ
0 -1.2203 TD
[(to)-336.6(mother)-334.9(and)-331.9(fetus)-334.9(of)-336.6(surgery)-335.8(for)-330.9(thyroid)-337.5(cancer)]TJ
T*
[(during)-336.6(pregnancy?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Surgery)-351.4(is)-327.3(th)21.4(e)-341.3(t)12.2(re)18.4(a)13.1(t)12.2(me)21.5(nt)-332.6(of)-325.7(ch)22.6(oi)19(c)13.4(e)-341.3(f)12.2(o)0(r)-332.3(D)0(T)27.2(C)0(.)-331.9(D)0(e)24(f)12.2(er)18.4(ri)21.1(ng)-324(su)16.3(r-)]TJ
-1.1128 -1.2203 TD
[(ge)21(ry)-359.2(un)20.5(t)12.2(i)0(l)-361.1(p)0(o)21.2(s)0(t)23.5(p)0(a)18.1(r)0(t)24.1(u)0(m)-359.3(h)0(a)22.4(s)-368(no)19.1(t)-367.2(b)0(e)21(e)12.7(n)-370.1(a)13.1(ss)16.3(oc)23.2(ia)22.3(t)12.2(e)0(d)-363.3(w)0(i)26.5(t)0(h)-357.9(a)-372.6(wo)20.9(rs)23.3(e)]TJ
0 -1.2266 TD
[(pr)16.9(og)24.4(no)19.1(si)20.4(s,)-295.1(so)-294.9(it)-294.9(is)-295.7(im)24.2(pe)17.7(ra)25.1(ti)21.3(ve)-297.8(t)12.2(o)-312.6(a)13.1(s)0(s)22.7(e)12.8(ss)-299.8(m)15.1(a)0(t)19(e)12.7(rn)21.2(al)-300.2(a)13.1(n)0(d)-297.2(n)15.6(eo)16.3(na)22.4(t)12.2(a)0(l)]TJ
0 -1.2203 TD
[(co)16.9(m)15.1(p)0(l)20.4(i)0(c)22.5(a)0(t)19(i)0(o)19(n)15.6(s)-241.6(b)0(e)21(f)0(o)15.7(r)0(e)-228.2(a)13.1(dv)21.6(is)20.4(in)18.4(g)-238.4(a)13.1(n)-243.7(o)0(p)21.2(e)12.7(ra)18.8(t)12.2(i)0(o)19(n)-237.3(du)20.9(ri)21.1(ng)-229.1(pr)16.9(e)12.7(g)0(n)23.8(a)0(n)16.1(c)13.4(y)14.6(.)]TJ
T*
-.013 Tc
[(B)-13(e)3.1(tw)-13(e)10.8(e)-13(n)-357.7(1986)-366.6(an)-13(d)-354.5(200)-13(8)-353.5(n)-13(i)5.4(n)2.6(e)-367(s)-13(t)10.5(u)-13(d)7.9(i)-13(e)8.9(s)-362.1(e)-13(v)5.3(al)-13(u)7.4(a).1(t)-13(e)5.6(d)-363.8(t)-.8(h)-13(e)-351.4(i)-13(m)4.9(p)-13(a)11.4(c)-13(t)-354.2(o)-13(f)]TJ
0 -1.2267 TD
0 Tc
[(th)15.1(y)14.6(r)0(o)21.8(i)0(d)18.8(e)12.7(ct)19.2(om)25(y)-453.3(d)0(u)20.9(r)0(i)21.1(n)0(g)-437.8(p)0(r)23.2(e)0(g)21(n)0(a)16.1(n)15.6(cy)-440(on)-442.4(a)-448.4(t)0(o)15.7(t)12.2(a)13.1(l)-452.5(of)-439.5(1)13.1(1)0(3)-441.6(p)0(a)18.1(t)12.2(ie)21.9(nt)21.4(s)]TJ
0 -1.2203 TD
[(\(s)17.2(t)12.2(u)0(d)20.9(y)-402.8(si)20.4(z)13.1(e)-404.6(ra)18.8(n)15.6(g)0(e)21(d)-407.7(f)12.2(r)0(o)21.8(m)-402.2(1)-404.2(t)12.2(o)-401.1(9)0(6)19.9(\))-405.1(\()12.2(2)13.1(19)19.9(,2)22.9(2)13.1(3)0()19.9(2)13.1(27)19.9(,2)22.9(5)13.1(3)0()20(2)13.1(5)13.1(5)0(\))19(.)-401.3(Th)18.9(e)]TJ
T*
[(ma)21.9(jo)17.6(ri)21.1(t)12.2(y)0(,)-298.2(b)0(u)19.5(t)-310.3(no)25.5(t)-310.3(a)0(l)22.2(l)0(,)-303.6(o)0(f)-300.4(t)12.2(he)-300.5(op)21.2(e)12.7(r)0(a)18.8(t)12.2(io)19(n)15.6(s)-311.1(we)17.4(re)-297.8(pe)24(rf)17.8(or)21.8(me)21.5(d)-306.5(i)0(n)-304.1(t)12.2(he)]TJ
0 -1.2266 TD
[(se)17.8(c)13.4(o)0(n)19.1(d)-173.7(t)12.2(r)0(i)21.1(m)0(e)21.5(s)0(t)17.2(e)12.7(r.)-161.7(Th)18.9(e)12.7(r)0(e)-165(w)0(e)23.8(r)0(e)-165(n)15.6(o)-173.5(m)0(a)21.9(t)0(e)18.6(r)0(n)21.2(a)13.1(l)-174.3(o)0(r)-161.5(f)12.2(et)18.6(a)13.1(l)-174.3(co)23.2(mp)20.1(li)18.2(c)13.4(a)13.1(ti)21.3(on)19.1(s)]TJ
0 -1.2203 TD
[(in)-190.3(a)13.1(n)0(y)-184.8(o)0(f)-186.6(t)0(h)21.4(e)-202.2(st)23.5(ud)20.9(ie)21.9(s.)-187.6(R)14.7(e)0(c)19.8(e)12.7(nt)15.1(l)15.4(y)-200.4(\()12.2(2)13.1(00)19.9(9)13.1(\))12.2(,)-198.9(a)-195.5(po)21.2(pu)22.6(la)22.3(ti)21.3(on)19.1(-)12.2(b)0(a)21.4(s)0(e)17.8(d)-192.7(st)17.2(ud)20.9(y)]TJ
T*
[(co)16.9(m)15.1(p)0(a)18.1(r)0(e)24.7(d)-319.1(2)13.1(0)0(1)-308.8(p)0(r)23.2(e)0(g)21(n)0(a)22.4(n)0(t)-307.4(w)0(o)20.9(m)0(e)21.5(n)-319.5(wh)20.3(o)-312.6(u)0(n)20.5(d)0(e)16.1(r)0(w)23(e)12.7(nt)-307.4(t)12.2(h)0(y)17.5(r)0(o)21.8(i)0(d)-303.7(a)0(n)22.4(d)]TJ
T*
[(pa)18.1(ra)25.1(th)15.1(y)14.5(r)0(o)21.8(i)0(d)-379.6(s)0(u)22.6(r)0(g)20.2(e)12.7(ry)-384.5(d)16(u)0(r)16.9(i)15.4(ng)-380.9(pr)23.2(eg)21(na)22.4(nc)16.3(y)-390.1(w)0(i)26.5(t)0(h)-383.2(3)13.1(1)13.1(,)0(1)16.5(5)13.1(5)-391.5(s)0(i)26.8(m)0(i)17.9(l)15.4(ar)18.8(ly)]TJ
0 -1.2266 TD
[(tr)17.8(e)12.8(a)0(t)19(e)12.7(d)-508.8(n)0(o)19.1(n)0(p)20.5(r)0(e)24.7(g)0(n)17.5(a)13.1(nt)-497(wo)20.9(me)21.5(n)-509.2(\()12.2(2)13.1(5)0(6)19.9(\))12.2(.)-508.7(O)0(n)18.9(e)-505.7(hu)20.5(nd)18.9(re)24.7(d)-508.8(s)0(i)20.4(x)0(t)22.7(y)0(-)20.4()0(v)21.5(e)]TJ
0 -1.2203 TD
[(op)14.8(e)12.8(r)0(a)25.1(t)0(i)21.3(o)0(n)19.1(s)-368(we)23.8(re)-361(t)12.2(h)0(y)23.8(r)0(o)21.8(i)0(d)-360.6(r)0(e)24.7(l)0(a)22.2(t)0(e)18.6(d)-369.7(a)13.1(n)0(d)-354.1(4)0(6)19.9(%)-368.4(of)-357.3(t)12.2(h)0(e)-357.4(w)0(o)20.9(m)15.1(en)-357.4(ha)22.4(d)]TJ
T*
[(th)15.1(y)14.6(r)0(o)21.8(i)0(d)-158.3(c)0(a)20.2(n)0(c)22.6(e)0(r)18.4(.)-167.3(Pr)16.9(e)12.7(g)14.5(na)16.1(n)15.6(t)-171.2(pa)18.1(t)12.2(i)0(e)21.9(n)0(t)21.4(s)-172(ha)22.4(d)-167.4(a)-170.2(hi)18.4(g)14.6(h)0(e)15.7(r)-165.1(ra)18.8(t)12.2(e)-170.6(of)-161.3(e)12.8(n)0(d)18.9(o)0(c)23.2(r)0(i)21.1(n)0(e)]TJ
0 -1.2266 TD
[(an)16.1(d)-312.8(g)14.6(en)15.7(e)12.8(r)0(a)25.1(l)-319.7(c)13.4(o)0(m)18.6(p)0(l)26.7(i)0(c)16.2(a)13.1(t)12.2(i)0(o)19(n)0(s)20.6(,)-312.7(lo)19(n)15.6(g)0(e)21(r)-316.8(le)21.9(ng)23.8(th)15.1(s)-311.1(o)0(f)-306.7(s)0(t)23.5(a)0(y)21.4(,)-312.7(an)16.1(d)-312.8(h)0(i)24.7(g)0(h)17.5(e)12.8(r)]TJ
0 -1.2203 TD
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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[(noma)-445.8(discovered)-450.4(early)-444.3(in)-443.2(pregnancy)-452.6(should)-445.3(be)-446.9(monitored)]TJ
T*
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T*
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T*
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(4)Tj
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[(RECOMMENDATION)-284.2(55)]TJ
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T*
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T*
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T*
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T*
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(&)Tj
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[(RECOMMENDATION)-284.2(57)]TJ
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T*
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T*
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T*
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T*
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(4)Tj
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T*
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T*
[(The)-524.8(appropriate)-529.6(level)-526.1(of)-528(TSH)-526.3(suppression)-530.5(depends)-524(upon)]TJ
T*
[(preconception)-334.2(evidence)-332.1(of)-332(residual)-335.3(or)-332.3(recurrent)-328.9(disease.)-333.9(Ac-)]TJ
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[(and)-182.9(the)-187.1(European)-189(Thyroid)-185.2(Association)-190(\(ETA\))-185.4(consensus)-184.7(\(259\),)]TJ
T*
[(serum)-234.8(TSH)-229.1(should)-236.7(be)-231.9(maintained)-235.1(indenitely)-236.7(below)-233.6(0.1)-166.3(mU/)]TJ
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T*
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T*
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T*
[(have)-250.1(not)-253.2(undergone)-259.1(remnant)-257.8(ablation,)-254(who)-254.4(are)-253(clinically)-251.2(free)]TJ
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T*
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T*
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T*
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T*
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(4)Tj
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T*
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T*
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[(Histor)-30(y and ph)30(ysical e)30(xamination)]TJ
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T*
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[(F)30(ollo)14.9(w-up)]TJ
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T*
[(according to A)120(T)120(A)]TJ
T*
(guidelines)Tj
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[(F)30(ollo)14.9(w-up)]TJ
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T*
[(according to A)120(T)120(A)]TJ
T*
(guidelines)Tj
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[(char)10(acter)-15(istics)]TJ
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(Anaplastic)Tj
0 -1.2 TD
[(immediate Surger)-30(y)]TJ
16.4508 1.0687 TD
(Either second)Tj
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[(tr)-15(imester surger)-30(y or)]TJ
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[(def)30(err)-15(ing surger)-30(y)]TJ
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T*
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[(surger)-30(y f)30(o)0(r)]TJ
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(large)Tj
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[(pr)-15(imar)-30(y or)]TJ
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T*
(lymph)Tj
T*
(nodes)Tj
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[(L)30.1(ymph nodes)]TJ
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(metastases)Tj
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[(Ye)-140(s)]TJ
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[(Ye)-140(s)]TJ
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(No)Tj
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[(Ultr)10(asound)]TJ
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(suspicious)Tj
T*
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[(f)30(or malignancy)]TJ
12.4258 3.1875 TD
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[(tr)10(acheal obstr)-15(uction)]TJ
T*
[(or se)30.1(v)25(ere)]TJ
T*
(compression)Tj
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[(Immediate surger)-30(y)]TJ
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[(Def)30(er w)10(o)0(r)-15(k-up until)]TJ
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[(during)-244(pregnancy,)-240.6(or)-243.7(Tg)-235(level)-241.5(before)-242.1(conception.)-246.7(The)-240.2(authors)]TJ
28.0042 74.5598 TD
[(did,)-195.8(however,)-195.3(nd)-199.1(a)-189.2(positive)-203.3(correlation)-199.9(of)-192.9(cancer)-198.1(progression)]TJ
0 -1.2203 TD
[(with)-280.9(persistence)-282.9(of)-281.5(thyroid)-283.8(cancer)-286.6(before)-280(pregnancy.)]TJ
1.1128 -1.2266 TD
[(Pregnancy)-433.7(does)-430.6(not)-430.3(pose)-435.3(a)-429.5(risk)-427.3(for)-433.9(tumor)-432.8(recurrence)-435.1(in)]TJ
-1.1128 -1.2203 TD
[(women)-523.7(without)-525.8(structural)-527.2(or)-522(biochemical)-522.5(disease)-526.9(present)]TJ
T*
[(prior)-236.7(to)-237.2(the)-237.7(pregnancy.)-240.6(However,)-242.5(pregnancy)-237.7(may)-235.4(represent)-241.6(a)]TJ
0 -1.2266 TD
[(stimulus)-421.4(to)-414.2(thyroid)-422.9(cancer)-419.4(growth)-418(in)-417.9(patients)-420.9(with)-420(known)]TJ
0 -1.2203 TD
[(structural)-615.7(or)-610.5(biochemical)-617.4(disease)-609.1(present)-620.3(at)-607(the)-617.1(time)-614.8(of)]TJ
T*
(conception.)Tj
/F10 1 Tf
0 -2.3331 TD
[(Question)-331.7(69:)-333.4(What)-336.1(type)-332.7(of)-336.6(monitoring)-335.5(should)-334(be)]TJ
0 -1.2267 TD
[(performed)-333(during)-336.7(pregnancy)-338.1(in)-331.7(a)-333.2(patient)-337.7(who)-330.5(has)]TJ
0 -1.2203 TD
[(already)-331.1(been)-336.3(treated)-333.7(for)-337.3(DTC)-333.7(prior)-332.4(to)-336.6(pregnancy?)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 310.0535 586.7715 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 320.485 584.3337 Tm
[(RECOMMENDATION)-284.1(61)]TJ
/F6 1 Tf
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[(Ultrasound)-415.8(and)-416.9(Tg)-412.1(monitoring)-414.6(during)-421.1(pregnancy)-414.7(in)-411.6(pa-)]TJ
0 -1.2203 TD
[(tients)-356.8(with)-363.1(a)-353.6(history)-358(of)-357.3(previously)-361.1(treated)-358(DTC)-358.7(is)-358.9(not)-354.4(re-)]TJ
T*
[(quired)-607.3(for)-610.9(low-risk)-612.7(patients)-610.6(with)-609.7(no)-606.8(Tg)-608.1(or)-610.5(structural)]TJ
0 -1.2266 TD
[(evidence)-281.5(of)-281.5(disease)-286.7(prior)-280.9(to)-281.4(pregnancy.)]TJ
/F4 1 Tf
17.5018 0 TD
[(Level)-278.8(B-USPSTF)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 310.0535 522.0282 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 320.485 519.5337 Tm
[(RECOMMENDATION)-284.1(62)]TJ
/F6 1 Tf
.0569 -1.2203 TD
[(Ultrasound)-175.5(monitoring)-174.3(should)-179.8(be)-181.4(performed)-177.1(each)-172.8(trimester)]TJ
T*
[(during)-250.3(pregnancy)-250.3(in)-253.5(patients)-250.2(with)-255.6(previously)-247.2(treated)-250.5(DTC)]TJ
0 -1.2266 TD
[(and)-347.3(who)-342.9(have)-345(high)-343.5(levels)-344(of)-344.7(Tg)-342.5(or)-351.2(evidence)-338.4(of)-351(persisten)7.1(t)]TJ
0 -1.2203 TD
[(structural)-274.3(disease)-280.4(prior)-274.6(to)-281.4(pregnancy.)]TJ
/F4 1 Tf
16.6988 0 TD
[(Level)-278.8(B-USPSTF)]TJ
/F3 1 Tf
-17.8306 -2.8896 TD
[(Postpartum)-332.3(Thyroiditis)]TJ
/F10 1 Tf
0 -1.8336 TD
[(Question)-331.7(70:)-333.4(What)-336.1(is)-336.7(the)-334.6(denition)-332.7(of)-336.6(PPT)]TJ
0 -1.2203 TD
[(and)-331.9(what)-337.7(are)-332(its)-332.5(clinical)-336.5(implications?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(PPT)-486.3(is)-485.4(t)18.5(h)15.6(e)-467.8(o)16.2(c)13.4(c)19.7(ur)29.6(r)18.3(e)12.7(n)15.6(c)19.7(e)-474.1(o)16.2(f)-468.4(t)18.5(h)15.6(y)14.6(r)18.3(o)16.2(i)15.4(d)-470.9(d)22.3(y)14.6(s)17.7(f)12.2(u)17.6(n)15.6(c)13.4(t)18.5(i)15.4(o)16.2(n)-471.3(i)21.8(n)-471.3(t)12.2(h)15.6(e)-467.8()16(r)18.3(s)17.7(t)]TJ
-1.1128 -1.2203 TD
-.0163 Tc
[(post)-4.1(par)-16.3(t)14.2(um)-589.2(year)-586.1(in)-588.7(women)-588.7(w)1(ho)-588.1(wer)-16.3(e)-573.3(eut)-4.1(h)5.6(yroid)-588.4(p)-16.3(r)13.3(i)-.9(or)-586.1(t)-4.1(o)]TJ
0 -1.2267 TD
-.0177 Tc
[(pre)-5(g)3.2(na)-4.6(ncy)-262.4(\()-5.5(26)-4.6(7\).)-267.2(I)-.8(n)-261.4(i)-2.3(ts)-265.6(clas)-17.7(s)11.3(i)-2.3(ca)-4.6(l)-261.5(f).8(or)-17.7(m)15.7(,)-260.9(t)-5.5(r).6(a)-4.6(n)-2.1(sient)-264.8(t).8(hyrot)-5.5(o)-1.5(xic)-4.3(o)-1.5(sis)-265.6(i)4.1(s)]TJ
0 -1.2203 TD
-.0164 Tc
[(followed)-303.9(b)4.5(y)-305.3(t)-4.2(ransient)-307.7(hy)4.5(p)-16.4(o)11.1(thyroidism)-304.8(with)-310.6(a)-300.4(r)-16.4(e)14.6(t)-4.2(urn)-310.6(t)2.1(o)-303.7(t)-4.2(he)-300.8(eu-)]TJ
T*
-.0177 Tc
[(thyroid)-210.4(s)-17.7(t)12.1(a)1.8(t)-5.5(e)-213.6(by)-211.8(t)-5.5(h)-2.1(e)-213.6(e)1.4(nd)-210.4(of)-214.2(t)-5.5(h)-2.1(e)-207.3(i)-2.3(nitia)-4.6(l)-210.9(post)-5.5(pa)-4.6(rtu)-17.7(m)-200(ye)-5(ar)-214.4(\(1)-4.6(18)-4.6(\).)-210.3(The)]TJ
0 -1.2266 TD
-.0156 Tc
[(clinical)-208.8(cours)-15.6(e)-200.2(of)-205.8(P)-15.6(P)13.3(T)-208.3(v)-15.6(a)15.8(r)2.7(ies,)-208.2(w)-15.6(i)17.2(th)-208.7(25%)-213.2(o).6(f)-212.1(c)4.1(ases)-206.6(p)-15.6(r)14(es)-15.6(e)14.8(n)0(ti)6.2(ng)-209.7(in)-215(the)]TJ
0 -1.2203 TD
-.0166 Tc
[(classical)-311(f)1.9(orm,)-310.4(32%)-309.1(w).7(ith)-310.8(i)-1.2(solat)-4.4(e)]TJ
13.3477 0 TD
-.0144 Tc
[(d)-308.2(t)4.1(hyr)3.9(o)1.8(toxic)5.3(o)1.8(s)3.3(i)1(s)-14.4(,)-290.5(and)-301.9(4)-1.3(3)5.1(%)-306.9(w)2.9(i)1(th)]TJ
-13.3477 -1.2203 TD
-.0172 Tc
[(isolat)-5(ed)-469.1(hypothyroidism)-470(\(2)-4.1(68\))-5(.)-469(T)-1.2(he)-466(t)-5(h)-1.6(yro)-17.2(t)11.2(oxic)-465.4(p)-17.2(h)9.7(ase)-472.3(o)-1(f)-466.6(P).4(P)-17.2(T)]TJ
0 -1.2266 TD
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[(typically)-299.3(occurs)-302.5(betw)-16.7(e)13.4(e)2.4(n)-304.6(2)-294.4(and)-297.9(6)-300.7(months)-296.2(p)-16.7(o)10.8(stp)-16.7(a)14(rt)-4.5(um,)-297.8(b)-2.1(ut)-301.7(epi-)]TJ
0 -1.2203 TD
.3102 Tc
[(s)327.9(o)326.4(d)326.2(e)329.3(sh)325.8(a)323.3(v)328.4(eb)324.8(e)329.3(e)323(nr)328.5(e)322.9(p)327.8(o)326.4(r)310.2(t)340.6(e)329.3(da)329.7(sl)325.6(a)329.7(t)322.4(ea)329.7(s1y)324.8(e)329.3(a)323.3(r)-.3(f)328.7(o)326.4(l)325.6(l)325.6(o)326.4(w)327.5(i)325.6(n)325.8(g)2.3(d)326.2(e)329.3(l)325.6(i)325.6(v)328.4(e)323(r)328.5(y)324.8(.)]TJ
T*
-.0166 Tc
[(All)-367.9(e)-3.9(pisodes)-372(o)-.4(f)-371.2(t)1.9(hyrotoxicosis)-372(r)1.7(esolve)-370.6(sp)-16.6(o)10.9(n)-1(taneous)-16.6(l)16.5(y.)-373.6(The)-376.9(h)-1(y-)]TJ
T*
0 Tc
[(p)17.6(o)16.2(t)18.5(h)15.6(y)14.6(r)18.3(o)16.2(i)15.4(d)-199(p)17.6(h)15.6(a)13.1(s)17.7(e)-195.9(o)16.2(f)-196.5(P)17.6(P)0(T)-181.4(o)16.2(c)13.4(c)19.7(ur)29.6(s)-197.3(f)18.5(ro)28.1(m)-193.6(3)-195.5(t)12.2(o)-198.8(1)19.5(2)-195.5(m)15.1(o)16.2(n)15.6(t)18.5(h)15.6(s)-197.3(po)27.5(s)17.7(t)18.5(pa)30.8(r)18.3(t)12.2(u)17.6(m)]TJ
0 -1.2266 TD
-.0166 Tc
[(with)-203.4(10%20%)-201.6(o)-.4(f)-200.4(c)-3.2(as)-16.6(e)13.8(s)-207.6(res)-16.6(u)12.3(lting)-204.4(i)-1.2(n)-203.4(p)1(ermanent)-206.8(hypothyroidism.)]TJ
0 -1.2203 TD
-.0159 Tc
[(It)-364.1(should)-360.3(be)-357.2(noted,)-360.3(however,)-360.3(that)-364.1(a)-356.8(r)2.4(ecently)-361.8(p)1.7(u)-15.9(b)16.3(lished)-360.3(a)3.6(r)-15.9(t)14.5(icle)]TJ
T*
-.0146 Tc
[(r)3.7(e)-1.8(por)3.7(t)-2.4(e)4.5(d)-188.3(t)3.9(h)1(at)-185.8(50)4.9(%)-186.9(o)1.6(f)-192.1(w)2.7(om)6.8(en)-188.7(wit)3.9(h)-188.7(P)-14.6(P)14.3(T)-188.3(r)3.7(e)4.5(m).5(ai)7.2(ned)-188.3(h)1(y)6.3(p)-14.6(o)12.9(t)3.9(hyr)3.7(o)1.6(id)-188.3(a)4.9(t)]TJ
0 -1.2266 TD
-.0144 Tc
[(t)4.1(h)1.2(e)-279.9(e)4.7(nd)-283(of)-274.1(the)-273.5()1.6(r)-14.4(s)15.2(t)-280.4(p)3.2(os)3.3(tp)3.2(a)5.1(r)3.9(tu)3.2(m)-277.5(y).1(e)4.7(a)-1.3(r)-274.3(\()-2.2(2)5.1(6)-1.3(9)5.1(\))4.1(.)]TJ
/F10 1 Tf
0 -2.3332 TD
0 Tc
[(Question)-331.7(71:)-333.4(What)-336.1(is)-336.7(the)-334.6(etiology)-332.1(of)-336.6(PPT?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(PPT)-328.2(is)-327.3(an)-331.7(autoimmune)-329.9(disorder)-337.4(associated)-333.1(with)-331.5(the)-326.2(pres-)]TJ
-1.1128 -1.2203 TD
[(ence)-470.4(of)-477.5(thyroid)-473.5(antibodies)-477.1(\(TPO)-469.4(and)-473.8(Tg)-475.3(antibodies\),)-474.2(lym-)]TJ
T*
[(phocyte)-707.1(abnormalities,)-705.9(complement)-701.3(activation,)-705.3(increased)]TJ
0 -1.2266 TD
[(levels)-325.1(of)-332(IgG1,)-323.9(increased)-326.7(natural)-330.9(killer)-325.4(cell)-328.7(activity,)-331(and)-322.1(spe-)]TJ
0 -1.2203 TD
[(cic)-283.3(HLA)-276.3(haplotypes)-289.9(\(270272\).)-278.7(The)-284.5(occurrence)-284.8(of)-281.4(PPT)-283.9(post-)]TJ
T*
[(partum)-355(reects)-352.3(the)-357.8(immune)-351.1(suppression)-359.7(that)-351.6(occurs)-358.8(during)]TJ
T*
[(pregnancy)-244(followed)-245.2(by)-242.8(the)-244(rebound)-243.2(of)-243.5(the)-244(immune)-237.3(system)-245.2(in)]TJ
0 -1.2266 TD
[(the)-282(postpartum)-285.1(period.)]TJ
/F10 1 Tf
0 -2.3332 TD
[(Question)-331.7(72:)-333.4(Are)-336.7(there)-333.4(predictors)-334.4(of)-336.6(PPT?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(PPT)-246(will)-246.2(develop)-245.2(in)-247.2(33%50%)-247.4(of)-243.5(women)-245.5(who)-248.1(present)-247.3(with)]TJ
-1.1128 -1.2203 TD
[(thyroid)-309.1(antibodies)-306.4(in)-310.4(the)-307.3(rst)-309(trimester,)-311(conferring)-315.7(a)-303(relative)]TJ
T*
[(risk)-446.2(of)-445.9(PPT)-442(of)-445.8(between)-445.9(10)-447.9(and)-442.2(59)-448(compared)-446.7(with)-445.3(women)]TJ
0 -1.2267 TD
[(who)-222.8(are)-227.7(negative)-233.2(for)-225.2(thyroid)-226.9(antibodies)-230.5(\(273\).)-223.7(The)-227.6(risk)-231.3(of)-224.5(PPT)]TJ
/F3 1 Tf
-28.0042 77.228 TD
[(PREGNANCY)-339.6(AND)-337.2(POSTPARTUM)-334.3(THYROID)-341(MANAGEMENT)-335.2(GUIDELINES)-17387(1105)]TJ
ET
endstream
endobj
352 0 obj
<>stream
/GS1 gs
BT
/F6 1 Tf
8.9663 0 0 8.9663 62.022 725.7825 Tm
0 0 0 1 k
0 Tc
0 Tw
[(increases)-217.5(as)-209.5(the)-218.7(titer)-213.7(of)-211.9(thyroid)-214.3(antibodies)-217.8(in)-209.3(the)-218.7(rst)-214.1(trimester)]TJ
0 -1.2203 TD
[(increases.)-391.1(Although)-393.8(thyroid)-391.3(hypoechogenecity)-399.3(predates)-391.8(the)]TJ
0 -1.2266 TD
[(hormonal)-367.7(changes)-371.6(of)-370(PPT,)-369(it)-364.4(is)-371.6(not)-367(of)-370(clinical)-369.7(utility)-365.1(in)-373.6(pre-)]TJ
0 -1.2203 TD
[(dicting)-283.2(or)-281.7(diagnosing)-282.2(PPT)-283.9(\(274\).)]TJ
/F10 1 Tf
0 -2.7758 TD
[(Question)-338(73:)-333.4(What)-329.8(is)-336.7(the)-334.7(prevalence)-332.9(of)-336.6(PPT?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
-.03 Tc
[(T)-30(h)-30(e)-554.8(p)-6.1(r).9(e)-4.6(v)-5.4(ale)-4.6(n)-1.8(c)-4(e)-529.4(of)-530(PP)-6.1(T)-526.2(i)-1.9(s)-530.8(a)-4.2(pp)-6.1(rox)-6.9(i)-1.9(mat)-5.2(e)-4.6(ly)-527.6(8)-4.2(.)-1.3(1%)-531.1(a)-4.2(n)-1.8(d)-526.2(v)-5.4(ar)-5.4(ie)-4.6(s)]TJ
-1.1128 -1.2266 TD
-.0269 Tc
[(mar)4(k).3(edly)-423.3(in)-428.6(dif)4.2(f)-2.1(er)4(ent)-425.7(s)-2.9(t)4.2(u)-3(dies)-420.2(\(the)-425.1(r)4(ange)-425.1(is)-426.6(be)4.8(tween)-422.3(1.1%)-420.5(and)]TJ
0 -1.2203 TD
-.0263 Tc
[(16)5.8(.7)5.8(%\))-260.7(\()4.8(275)5.8(\).)-256.8(Women)-263.6(w)3.7(ith)-257.3(o)-3.8(t)4.8(h)-4.4(e)5.4(r)-260.9(autoimmune)-260.1(disorde)5.4(r)-1.7(s)-261.6(h)1.9(av)4.6(e)-260.1(a)-.5(n)]TJ
T*
-.0274 Tc
[(increased)-296(r)-2.8(isk)-291.1(o)-4.9(f)-293.4(P)-3.5(PT.)-295.9(S)-.6(peci)-5.1(c)4.9(a)]TJ
12.9556 0 TD
[(lly,)-295.9(t)-2.6(he)-299.2(pre)4.3(v)-2.8(ale)4.3(n)-5.5(c)4.9(e)-299.2(of)-299.8(PPT)-296(i).7(s)-294.3(25%)]TJ
-12.9556 -1.2203 TD
-.0279 Tc
[(wi)-6.1(th)-341.1(Type)-337.6(1)-337.2(d).7(iabetes)-339(m)-.2(ellitus)-339(\(276)]TJ
14.5743 0 TD
-.0276 Tc
[(,277\),)-340.3(25%)-339(w)2.4(ith)-340.8(c)-1.6(hro)-5.1(n).6(ic)-336.7(viral)]TJ
-14.5743 -1.2266 TD
-.0265 Tc
[(hepa)5.6(titis)-179.6(\()-1.7(27)5.6(8\),)-181.2(1)5.6(4%)-179.9(with)-181.6(syst)4.6(emic)-183.9(lupus)-185.9(e)-1.1(r)4.4(y).7(thema)5.6(t)-1.7(osus)-185.9(\()4.6(279)5.6(\),)-181.2(and)]TJ
0 -1.2203 TD
[(44)5.5(%)-186.3(w)3.4(ith)-181.7(a)-184.2(prior)-185.4(h)1.6(ist)4.5(o)-4.1(r)4.3(y)-182.8(of)-185.1(Gr)4.3(ave)5.1(s)-2.6()-180.2(d)2(isea)5.5(se)-184.6(\()4.5(280)5.5(\).)-181.3(Indiv)4.3(i)-4.8(duals)-179.7(w)-2.9(ho)]TJ
T*
-.0276 Tc
[(had)-327.8(P)-3.7(PT)-334.1(in)-334.5(a)-330.6(p)2.7(rior)-331.8(episode)-331(a)-1.8(nd)-327.8(who)-333.9(r)3.3(eturned)-334.1(t)-2.8(o)-327.5(t)-2.8(he)-331(euthyroid)]TJ
0 -1.2266 TD
-.0264 Tc
[(st)4.7(ate)-456.3(h)1.8(av)4.5(e)-462.6(a)-455.9(70)5.7(%)-464.3(c)5.9(ha)5.7(nce)-462.6(o)2.4(f)-456.8(d)2.2(eve)5.3(l)1.7(oping)-460.8(P)-2.5(PT)-459.4(in)-459.7(a)-455.9(s)-2.4(ubseque)5.3(n)-4.5(t)]TJ
0 -1.2203 TD
-.0273 Tc
[(pregnancy)-537.5(\()-2.5(281\).)-542.4(W)-1(omen)-542.8(on)-542.8(LT)]TJ
6.7246 0 0 5.9768 190.3747 551.4518 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 198.3684 552.9258 Tm
-.0262 Tc
[(thera)5.9(p)-2.3(y)-542.8(s)4.1(econdar)4.7(y)-542.8(to)-541.1(Ha-)]TJ
-15.2066 -1.2203 TD
-.0273 Tc
[(shimotos)-370(t)3.8(hyroiditis)-363.7(predatin)]TJ
12.4814 0 TD
.3395 Tc
[(gp)369.8(r)364.1(e)371.2(g)366.7(n)367.7(a)365.3(n)367.7(c)365.5(y)0(m)367.2(a)371.6(yd)368.1(e)364.9(v)370.4(e)364.9(l)367.6(o)368.3(p)-3.3(P)369.8(P)363.4(T)7.7(i)361.3(f)]TJ
-12.4814 -1.2266 TD
-.0274 Tc
[(their)-224.1(t)3.7(h)-5.5(y)-.2(roid)-226.4(gland)-220.1(i)-5.6(s)-218.4(n)-5.5(ot)-223.9(completely)-221.5(atrophic)-222.7(\(282\).)-220(Cases)-224.7(o)1.4(f)-223.9(P)-3.5(PT)]TJ
0 -1.2203 TD
-.0258 Tc
[(have)-278.6(be)5.9(en)-282.1(re)5.9(port)5.3(ed)-281.7(f)5.3(o)-3.3(llowing)-276.8(misc)6.5(arr)5.1(i)2.3(age,)-275.3(but)-279.2(t)-1(he)-278.6(pr)5.1(eva)6.3(l)2.3(ence)-278.6(of)]TJ
T*
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[(thyro)-5.1(i).5(d)-264.5(d)1(ysfunctio)-5.1(n)-264.9(fo)-5.1(llowing)-266(pregn)-5.7(a)4.5(ncy)-266(l).5(o)-5.1(s)2.7(s)-269.2(i).5(s)-262.9(u)-3.7(nknown)-264.9(\(283\).)]TJ
/F10 1 Tf
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0 Tc
[(Question)-224.2(74:)-225.9(What)-228.6(symptoms)-223.1(are)-224.5(associated)-226.8(with)-223(PPT?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
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[(phase)-346.9(of)-338.4(PPT.)-343.7(This)-340(reects)-346(the)-345.2(degree)-342.9(of)-344.7(increase)-342.6(in)-342(thyroid)]TJ
T*
[(hormone,)-354.8(which)-352.7(is)-352.6(typically)-348.8(mild.)-352(Nevertheless,)-355.4(in)-354.7(prospec-)]TJ
T*
[(tive)-346.1(studies)-339.7(symptoms)-341.9(more)-342.4(common)-344.8(in)-342(women)-340.4(during)-345.2(the)]TJ
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[(hyperthyroid)-356.8(phase)-346.9(of)-351(PPT,)-350.1(compared)-351.9(with)-350.5(euthyroid)-354.7(post-)]TJ
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[(partum)-253.9(controls,)-251.1(include)-254.3(irritability,)-252.6(heat)-249.9(intolerance,)-253.2(fatigue,)]TJ
T*
[(and)-208.2(palpitations)-204.1(\(267,284286\).)-204.2(It)-204.9(is)-207.2(more)-203.3(common)-205.7(for)-206.3(women)]TJ
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[(in)-335.7(the)-338.9(hypothyroid)-333.7(phase)-340.6(of)-332(PPT)-334.5(to)-338.4(be)-333.1(symptomatic.)-340(Symp-)]TJ
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[(toms)-432.1(experienced)-436.6(more)-437.2(frequently)-435.9(during)-433.7(the)-433.7(hypothyroid)]TJ
T*
[(phase)-226.8(of)-230.9(PPT,)-223.6(compared)-231.7(with)-224(euthyroid)-228.2(postpartum)-234.5(controls,)]TJ
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[(include)-380.7(cold)-375.3(intolerance,)-379.7(dry)-374.8(skin,)-376(lack)-373.5(of)-376.3(energy,)-376(impaired)]TJ
0 -1.2203 TD
[(concentration,)-287.3(and)-284.1(aches)-281.6(and)-277.8(pains)-281(\(267,284286\).)]TJ
/F10 1 Tf
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[(Question)-338(75:)-333.4(Is)-330.4(PPT)-336.6(associated)-334.3(with)-336.8(depression?)]TJ
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T*
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(&)Tj
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[(RECOMMENDATION)-290.5(63)]TJ
/F6 1 Tf
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[(Women)-483.2(with)-476.9(postpartum)-481.1(depression)-478.7(should)-483.3(have)-477.8(TSH,)]TJ
T*
(FT)Tj
6.7246 0 0 5.9768 82.5448 159.874 Tm
(4)Tj
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[(,)-274.8(and)-284.1(TPOAb)-278.8(tests)-288(performed.)]TJ
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13.4678 0 TD
[(Level)-278.8(B-USPSTF)]TJ
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[(phase)-334.4(of)-336.6(PPT?)]TJ
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[(There)-361(have)-363.9(been)-361.7(no)-360.2(prospective)-365.4(studies)-365(evaluating)-364.1(when)]TJ
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T*
[(a)-315.7(destructive)-320.5(thyroiditis.)-320.9(Clinical)-313.7(symptoms)-316.6(increased)-320.4(in)-316.7(the)]TJ
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[(thyrotoxic)-222.3(phase,)-217(as)-215.8(compared)-219.1(with)-211.3(controls,)-219.5(are)-221.4(palpitations,)]TJ
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[(heat)-407.9(intolerance,)-411.3(and)-410.6(nervousness)-408.1(\(284,286\).)-408.5(Symptoms)-408.6(are)]TJ
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[(de)-284.7(novo)]TJ
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(&)Tj
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[(RECOMMENDATION)-284.2(64)]TJ
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[(During)-299.3(the)-300.9(thyrotoxic)-298.2(phase)-302.6(of)-294.1(PPT,)-299.5(symptomatic)-305.4(women)]TJ
T*
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[(lowest)-211.9(possible)-207.8(dose)-209.3(to)-211.9(alleviate)-206.6(symptoms)-215.4(is)-207.2(the)-212.4(treatment)]TJ
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[(of)-313.1(choice.)-320.9(Therapy)-315.8(is)-321(typically)-317.2(required)-317(for)-313.8(a)-315.7(few)-318.1(months.)]TJ
/F4 1 Tf
T*
[(Level)-278.8(B-USPSTF)]TJ
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(&)Tj
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[(RECOMMENDATION)-284.2(65)]TJ
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[(ATDs)-291.6(are)-297.3(not)-297.5(recommended)-297.8(for)-294.8(the)-294.6(treatment)-299.5(of)-294.1(the)-294.6(thyr-)]TJ
T*
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9.2125 0 TD
[(Level)-278.8(D-USPSTF)]TJ
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[(Question)-338(77:)-333.4(Once)-333.7(the)-334.6(thyrotoxic)-335.8(phase)-334.4(of)-336.5(PPT)]TJ
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[(resolves,)-244.2(how)-235.6(often)-241.2(should)-239.2(TSH)-240.3(be)-237.7(measured)-238.5(to)-235.4(screen)]TJ
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(&)Tj
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[(RECOMMENDATION)-284.2(66)]TJ
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[(Following)-396.7(the)-402.1(resolution)-399.1(of)-401.6(the)-395.8(thyrotoxic)-399.3(phase)-403.8(of)-395.3(PPT,)]TJ
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[(TSH)-292.3(should)-293.6(be)-288.8(tested)-295.9(every)-296.5(2)-290.4(months)-293.4(\(or)-294.8(if)-288.5(symptoms)-297.6(are)]TJ
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[(present\))-399.5(until)-398(1)-397.9(year)-396.5(postpartum)-405.2(to)-395.3(screen)-402.8(for)-396(the)-402.1(hypo-)]TJ
T*
[(thyroid)-283.8(phase.)]TJ
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6.6201 0 TD
[(Level)-278.8(B-USPSTF)]TJ
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[(Question)-287.4(78:)-289.2(What)-285.5(is)-279.8(the)-290.4(treatment)-285.4(for)-286.7(the)-284.1(hypothyroid)]TJ
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[(phase)-334.4(of)-336.6(PPT?)]TJ
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[(The)-233.9(hypothyroid)-238.9(phase)-233.1(of)-230.9(PPT)-233.3(is)-232.5(associated)-238.2(with)-230.3(increased)]TJ
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[(symptoms)-556.9(including)-556.6(impaired)-552.9(concentration,)-552.9(carelessness,)]TJ
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[(and)-486.4(an)-489.8(increase)-488.1(in)-487.5(total)-487.3(complaints)-486.9(when)-488.8(compared)-484.6(with)]TJ
T*
[(postpartum)-285.1(euthyroid)-285.1(women)-283.5(\(285\).)]TJ
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5.9777 0 0 5.9777 312.2645 361.1338 Tm
(&)Tj
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[(RECOMMENDATION)-284.2(67)]TJ
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[(Wo)17.2(men)-215.8(wh)14(o)-224.1(a)0(r)18.8(e)-227.5(sy)13.2(mp)13.7(tom)18.2(at)12.7(ic)-217.8(wi)13.8(th)-218.8(hy)17.5(pot)14.4(hy)17.5(roi)18.3(di)12.4(sm)-220.2(in)-215.6(PP)16.3(T)]TJ
T*
[(sh)14.3(oul)17.6(d)-262.2(eit)15.1(her)-256.9(ha)16.1(ve)-259.9(the)15.2(ir)-257.1(TSH)-254.4(le)15.5(ve)12(l)-269.1(r)0(e)12(t)0(e)12.3(ste)17.3(d)-262.2(i)0(n)-259.8(4)0()13.6(8)-265.1(wee)17.5(ks)-258.6(or)]TJ
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[(be)-301.5(sta)17.7(rt)11.5(ed)-300.1(on)-303.3(LT)]TJ
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(4)Tj
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T*
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[(Lev)18.4(el)-170.7(B-)14.3(US)14.6(PS)13(TF)]TJ
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[(RECOMMENDATION)-284.2(68)]TJ
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[(Question)-338(79:)-333.4(How)-334(long)-336.6(should)-334(LT)]TJ
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(4)Tj
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[(The)-316.1(length)-312.3(of)-313.1(time)-317.6(that)-313.7(LT)]TJ
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(4)Tj
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T*
[(ciples)-432.5(are)-423.7(to)-426.9(maintain)-428.2(a)-429.5(euthyroid)-424.2(state)-431.6(while)-429.3(a)-423.1(woman)-428.5(is)]TJ
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[(attempting)-801.4(pregnancy,)-803.3(pregnant,)-800.1(or)-800.2(breastfeeding,)-801.5(and)]TJ
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[(transitory)-289.2(or)-281.7(permanent.)]TJ
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(&)Tj
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[(RECOMMENDATION)-284.2(69)]TJ
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[(If)-211.2(LT)]TJ
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(4)Tj
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[(is)-213.5(initiated)-207(for)-212.6(PPT,)-211(future)-212.9(discontinuation)-215.1(of)-211.9(therapy)]TJ
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[(612)-510.2(months)-521.1(after)-513.2(the)-522.2(initiation)-517.3(of)-515.4(treatment.)-517.4(Tapering)]TJ
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6.7246 0 0 5.9768 346.9038 77.726 Tm
(4)Tj
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[(should)-571.8(be)-567.1(avoided)-575.2(when)-571(a)-568.6(woman)-567.6(is)-567.6(actively)]TJ
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[(attempting)-523.2(pregnancy,)-525.1(is)-523.3(breastfeeding,)-529.7(or)-521.9(is)-523.3(pregnant.)]TJ
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[(Level)-278.8(C-USPSTF)]TJ
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(1106)Tj
41.5036 0 TD
[(STAGNARO-GREEN)-337.3(ET)-338.7(AL.)]TJ
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0 Tc
0 Tw
[(Question)-281.1(80)22.8(:)-267.7(H)0(o)16.8(w)-262.3(of)17.5(te)25.1(n)-271.2(s)14.6(ho)20.3(u)13.3(l)0(d)-262.1(s)14.6(cr)20.2(e)14.6(e)0(n)21.6(i)0(n)22.4(g)-271.2(b)13.3(e)-270(p)13.3(e)0(r)20.2(f)0(o)23.8(r)0(m)18.1(e)14.6(d)]TJ
0 -1.2203 TD
[(af)18.8(te)25.1(r)-323.2(t)0(h)17.5(e)-320.6(h)13.3(y)0(p)21.6(o)0(t)17.5(h)13.3(yr)20.2(o)13.3(i)0(d)-312.7(p)0(h)20.3(a)0(s)22.8(e)-320.6(of)-311.3(PP)16.8(T)-321.8(r)0(e)20.2(s)14.6(ol)22.4(ve)22.8(s?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(The)-265.5(impact)-261(of)-262.5(PPT)-265(on)-259.1(long-term)-266.1(thyroid)-264.9(function)-267.6(has)-263.5(been)]TJ
-1.1128 -1.2266 TD
[(evaluated)-292.5(in)-285.1(six)-291.5(studies)-289.1(\(284,293297\).)-286.4(The)-284.5(data)-287(demonstrate)]TJ
0 -1.2203 TD
[(that)-301(within)-300.5(1)-303(year,)-298.3(10%20%)-298(of)-294.1(women)-302.4(who)-298.6(were)-299.3(euthyroid)]TJ
T*
[(following)-531.9(their)-520.1(initial)-529.7(hypothyroid)-523.4(phase)-530.3(of)-521.7(PPT)-524.2(develop)]TJ
0 -1.2266 TD
[(permanent)-417.2(hypothyroidism.)-414.9(Recent)-418.2(data)-407.2(from)-412.5(a)-410.5(large-scale)]TJ
0 -1.2203 TD
[(prospective)-238.9(study)-231.9(of)-237.2(169)-226.2(women)-232.9(with)-236.6(PPT)-233.3(demonstrated)-233.3(that)]TJ
T*
[(82%)-367.4(of)-363.6(the)-364.2(women)-365.7(had)-360(a)-366.2(hypothyroid)-365.3(phase)-365.9(at)-366.7(some)-362(point)]TJ
T*
[(during)-199.8(the)-199.8(rst)-195.2(year)-200.5(and,)-192.2(at)-202.3(the)-193.4(end)-202.3(of)-192.9(the)-199.8(rst)-201.5(year,)-197.1(54%)-190.3(of)-199.3(the)]TJ
0 -1.2266 TD
[(169)-333.6(women)-334(were)-337.2(persistently)-336.4(hypothyroid)-340(\(269\).)-331.2(Factors)-337.3(as-)]TJ
0 -1.2203 TD
[(sociated)-534.6(with)-527.5(an)-527.7(increased)-529(risk)-528.4(of)-534.4(developing)-528.4(permanent)]TJ
T*
[(hypothyroidism)-310.8(are)-309.9(mulitparity,)-310.2(hypoechogenecity)-310.8(on)-303.3(ultra-)]TJ
0 -1.2266 TD
[(sound,)-356.2(the)-351.5(severity)-352.4(of)-351(the)-351.5(initial)-352.6(hypothyroidism,)-351.7(TPO)-355.2(anti-)]TJ
0 -1.2203 TD
[(body)-280.2(titer,)-286.2(maternal)-282.8(age,)-278.6(and)-284.1(a)-277.7(history)-282.2(of)-281.5(miscarriage.)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 58.9606 549.4109 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 69.4488 546.9731 Tm
[(RECOMMENDATION)-284.2(70)]TJ
/F6 1 Tf
.0569 -1.2266 TD
[(Women)-242.9(with)-249.3(a)-239.8(prior)-249.3(history)-250.5(of)-243.5(PPT)-246(should)-249.3(have)-243.8(an)-243.2(annual)]TJ
0 -1.2203 TD
[(TSH)-399.8(test)-406.8(performed)-404.7(to)-401.6(evaluate)-403.3(for)-402.3(permanent)-404.5(hypothy-)]TJ
T*
(roidism.)Tj
/F4 1 Tf
3.9139 0 TD
[(Level)-278.8(A-USPSTF)]TJ
/F6 1 Tf
-3.9392 -2.2257 TD
[(Figure)-583.4(2)-587.5(presents)-583.7(an)-584.6(algorithm)-585(for)-585.6(the)-585.5(treatment)-590.4(and)]TJ
-1.1128 -1.2203 TD
[(monitoring)-288.1(of)-281.4(PPT.)]TJ
/F10 1 Tf
0 -2.2257 TD
[(Question)-338(81:)-333.4(Does)-333.4(treatment)-336(of)-336.6(TAb+)-335.3(euthyroid)]TJ
0 -1.2203 TD
[(women)-335.1(with)-336.8(LT)]TJ
6.7246 0 0 5.9768 125.6881 450.8219 Tm
(4)Tj
8.9663 0 0 8.9663 132.4346 452.296 Tm
[(or)-328.8(iodine)-338.2(during)-336.6(pregnancy)]TJ
-8.106 -1.2203 TD
[(prevent)-337.2(PPT?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(Two)-791.4(prospective)-795.4(randomized)-796.9(placebo-controlled)-795.7(con-)]TJ
-1.1128 -1.2203 TD
[(trolled)-494.4(trials)-483.3(have)-490.4(evaluated)-488.5(the)-490.6(efcacy)-486.4(of)-490.1(iodine)-490.3(or)-484(LT)]TJ
6.7246 0 0 5.9768 295.4834 412.4408 Tm
(4)Tj
8.9663 0 0 8.9663 59.7543 402.9731 Tm
[(treatment)-375.4(during)-370.5(pregnancy)-370.4(to)-370(prevent)-373.2(the)-370.5(development)-372.9(of)]TJ
T*
[(PPT)-486.3(in)-487.5(TAb)]TJ
/F9 1 Tf
5.5452 0 TD
()Tj
/F6 1 Tf
1.2519 0 TD
[(women.)-488.7(Neither)-488.4(intervention)-490.1(decreased)-487(the)]TJ
-6.7971 -1.2203 TD
[(prevalence)-412.9(of)-401.6(PPT)-404.1(\(298,299\).)-408.5(Levothyroxine)-406.5(diminished)-407.9(the)]TJ
0 -1.2266 TD
[(degree)-355.6(of)-357.3(hypothyroidism)-361.4(during)-351.5(the)-357.8(hypothyroid)-359(phase)-353.2(of)]TJ
0 -1.2203 TD
[(PPT)-283.9(and)-277.8(iodine)-288(appeared)-277.1(to)-281.4(enhance)-287(thyroid)-283.8(dysfunction.)]TJ
/F12 1 Tf
5.9777 0 0 5.9777 58.9606 341.6881 Tm
(&)Tj
/F3 1 Tf
8.9663 0 0 8.9663 69.4488 339.2503 Tm
[(RECOMMENDATION)-284.2(71)]TJ
/F6 1 Tf
.0569 -1.2266 TD
[(Treatment)-194.6(of)-186.6(TAb)]TJ
/F9 1 Tf
7.6887 0 TD
()Tj
/F6 1 Tf
.9611 0 TD
[(euthyroid)-196.6(pregnant)-190.2(woman)-194.5(with)-192.4(either)]TJ
-8.6497 -1.2203 TD
(LT)Tj
6.7246 0 0 5.9768 80.7874 315.8362 Tm
(4)Tj
8.9663 0 0 8.9663 87.4204 317.3102 Tm
[(or)-370.2(iodine)-370.2(to)-370(prevent)-373.2(PPT)-366.1(is)-371.6(ineffective)-372(and)-372.6(is)-365.2(not)-373.4(re-)]TJ
-1.9475 -1.2203 TD
(commended.)Tj
/F4 1 Tf
5.9752 0 TD
[(Level)-278.8(D-USPSTF)]TJ
/F10 1 Tf
-7.1133 -2.2257 TD
[(Question)-255.8(82:)-251.2(Does)-251.2(treatment)-253.8(of)-248(TAb+)-253.1(euthyroid)-252.8(women)]TJ
0 -1.2203 TD
[(with)-336.8(selenium)-335.3(during)-336.6(pregnancy)-331.8(prevent)-337.2(PPT?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(In)-309(2007)-307.9(Negro)]TJ
/F8 1 Tf
6.5948 0 TD
[(et)-311(al.)]TJ
/F6 1 Tf
2.2826 0 TD
[(\(65\))-309.8(evaluated)-311.4(the)-307.3(impact)-311.5(of)-306.7(selenium)]TJ
-9.9902 -1.2203 TD
[(administration)-307.2(in)-304.1(preventing)-302.3(PPT)-302.9(in)-297.8(151)-302(Italian)-302.9(women)-302.4(who)]TJ
0 -1.2266 TD
[(were)-406.8(positive)-405.6(for)-402.3(thyroid)-404(antibodies)-401.2(during)-402.1(pregnancy.)-405(Se-)]TJ
0 -1.2203 TD
[(venty-seven)-267.5(women)-264.5(received)-266.2(200)]TJ
/F14 1 Tf
14.7134 0 TD
(m)Tj
/F6 1 Tf
.5501 0 TD
[(g/day)-261(of)-262.5(selenium)-263.4(during)]TJ
-15.2635 -1.2203 TD
[(pregnancy)-484.3(and)-480.1(the)-478(postpartum)-487.4(period)-479.2(and)-480.1(74)-479.6(women)-479.5(re-)]TJ
0 -1.2266 TD
[(ceived)-449(a)-442.1(placebo.)-450(The)-448.9(prevalence)-444.5(of)-445.8(PPT)-448.3(was)-445.1(signicantly)]TJ
0 -1.2203 TD
[(decreased)-417.5(in)-411.6(women)-409.9(receiving)-413.7(selenium)-415.1(as)-405.5(compared)-415.1(with)]TJ
T*
[(women)-346.7(in)-342(the)-345.2(placebo)-345.9(group)-339.4(\(28.6%)-345(vs.)-346.4(48.6%)]TJ
/F8 1 Tf
21.0047 0 TD
(p)Tj
/F11 1 Tf
.6702 0 TD
(<)Tj
/F6 1 Tf
.9358 0 TD
[(0.01\).)-340(Be-)]TJ
-22.6107 -1.2266 TD
[(cause)-222.7(only)-216.4(a)-220.8(single)-218.4(trial)-216.4(has)-219.2(documented)-219.3(a)-220.8(benet)-219.7(of)-218.2(selenium)]TJ
0 -1.2203 TD
[(supplementation)-196.9(to)-192.9(prevent)-196.1(PPT,)-192(there)-194(is)-188.2(insufcient)-196.7(evidence)]TJ
T*
[(to)-319.4(recommend)-320.2(selenium)-326.6(supplementation)-323.3(during)-319.9(pregnancy)]TJ
T*
[(in)-285.1(TAb)]TJ
/F9 1 Tf
3.0603 0 TD
()Tj
/F6 1 Tf
1.0559 0 TD
[(women)-277.1(\(see)-286.1(Recommendation)-282.8(21\).)]TJ
/F3 1 Tf
-4.1162 -2.9465 TD
[(Thyroid)-341.1(Function)-335.5(Screening)-335.8(in)-331.6(Pregnancy)]TJ
/F10 1 Tf
0 -1.8336 TD
[(Question)-338(83:)-333.4(Should)-333.9(all)-333.9(pregnant)-337.7(women)-335.1(be)-332.5(screened)]TJ
0 -1.2203 TD
[(for)-261.4(serum)-255.7(TSH)-259.3(level)-254.3(in)-255.8(the)-258.8(rst)-259.5(trimester)-256.6(of)-254.4(pregnancy?)]TJ
/F6 1 Tf
1.1128 -1.8336 TD
[(The)-417.3(question)-421.8(of)-414.2(whether)-420.4(all)-411.2(pregnant)-424.1(women)-416.2(should)-413.7(be)]TJ
-1.1128 -1.2267 TD
[(screened)-197.1(in)-184(order)-190.4(to)-192.9(identify)-189.4(and)-189.3(treat)-190.7(thyroid)-189(dysfunction)-194.1(has)]TJ
28.0042 74.5598 TD
[(been)-570.3(extremely)-577.6(controversial.)-578(In)-574.6(order)-569.8(for)-579.3(any)-570.1(screening)]TJ
0 -1.2203 TD
[(program)-304.2(to)-306.7(be)-307.8(worthwhile,)-314.7(the)-307.3(condition)-306.7(of)-313.1(interest)-306.9(must)-310.5(be)]TJ
0 -1.2266 TD
[(prevalent)-319.3(in)-316.7(asymptomatic)-317.6(individuals,)-320.2(there)-320.5(must)-316.8(be)-314.1(a)-315.7(reli-)]TJ
0 -1.2203 TD
[(able)-576.4(and)-581.3(readily)-577.3(available)-576.9(test)-577.5(to)-584.9(identify)-575.1(the)-585.5(condition,)]TJ
T*
[(and)-290.4(identication)-297.7(of)-294.1(the)-288.3(condition)-300.4(must)-291.6(result)-291.8(in)-291.5(a)-290.4(benecial)]TJ
0 -1.2266 TD
[(intervention.)-290.7(Finally,)-290.8(the)-288.3(screening)-294(and)-284.1(intervention)-300.4(strategy)]TJ
0 -1.2203 TD
[(must)-278.9(be)-282.5(shown)-284.4(to)-281.4(be)-276.2(cost-effective.)]TJ
1.1128 -1.2203 TD
[(U.)14.7(S.)-368.1(dat)16(a)-372.6(sug)18.2(ges)13.3(t)-373.5(tha)15.6(t)-373.5(app)16.7(rox)13.3(imat)17.9(ely)-361.9(2%)18.3(3%)-367.9(of)-363.6(preg)18.9(nan)12.7(t)]TJ
-1.1128 -1.2266 TD
[(wom)17(en)-294.1(will)-284.1(hav)15.3(e)-297.1(a)0(n)-293.7(elev)14.9(at)12.7(ed)-293.8(seru)15.7(m)-294.7(TSH)-292.3(lev)14.8(el)-294.3(at)-290.8(the)-294.6(tim)17.4(e)-297.1(o)0(f)]TJ
0 -1.2203 TD
[(rou)14.1(tin)11.6(e)-442.5(scr)11.3(een)15.8(ing)14(.)-451.8(O)0(f)-439.8(the)-440(sc)12.1(ree)12.1(ned)-442.6(wo)14.6(men)11.8(,)-445.5(0.3%)21.7(0.5)17.5(%)-444.2(will)]TJ
T*
[(hav)15.3(e)-189.6(O)0(H)-186.4(and)-176.6(2%2)18.8(.5%)-181.1(wi)13.8(ll)-184.1(have)-180.6(SC)14(H)-189.7(\(36)13.2(,30)17(0\).)-179.9(The)-183.3(prev)16.3(ale)16(nce)]TJ
T*
[(of)-357.3(bot)11.3(h)-363.8(O)0(H)-357.1(and)-353.7(SCH)-359(in)12.1(cre)12.8(ase)11.9(s)-361.7(wit)13.3(h)-363.8(pat)11.3(ien)12.1(t)-360.9(age)-351.6(and)-360(is)-358.9(als)14.6(o)]TJ
0 -1.2266 TD
[(lik)13.8(ely)-305(to)-306.7(be)-314.1(hi)12(ghe)11.3(r)-316.8(i)0(n)-310.4(i)0(o)12.7(dine)15.5(-de)15.6(ci)13.1(ent)-307.3(re)12.1(gion)17.5(s.)-314.1(Hyp)13.2(er)12(thyr)16.3(oi)12.7(d-)]TJ
0 -1.2203 TD
[(ism)-236.4(is)-238.8(les)14.2(s)-241.6(com)13(mon)15.2(,)-249.5(occ)17.6(urri)19(ng)-241.7(in)-240.9(app)16.7(rox)13.3(imat)17.9(ely)-235.5(0.1)17(%0.)15.4(4%)-235.1(of)]TJ
T*
[(pre)17(gna)11.7(nt)-282.1(wom)17(en)-287.8(\(9)12.7(6\).)-274.8(The)-278.2(prev)16.3(ale)16(nce)-280.8(of)-281.5(thyr)16.3(oi)12.7(d)-287.5(dys)16.6(fun)13.8(ctio)12.9(n)]TJ
0 -1.2266 TD
[(in)-323.1(preg)18.9(nan)12.7(t)-329.3(wom)17(en)-325.8(is)-327.3(si)14.1(mil)14.3(ar)-329(to)-319.4(the)-319.9(prev)16.3(ale)16(nce)-325(of)-325.7(oth)18.7(er)-329.4(di)12.4(s-)]TJ
0 -1.2203 TD
[(ord)12.5(er)12.1(s)-273.2(for)-269.5(whi)16.7(ch)-274.6(uni)17(ver)11.3(sal)-263.6(scr)11.3(eeni)18.6(ng)-273.4(has)-263.5(bee)14.7(n)-281.6(adv)15.7(oca)17.4(ted.)]TJ
1.1128 -1.2203 TD
[(Serum)-548.1(TSH)-557.9(testing)-550.9(is)-554.9(relatively)-553.7(inexpensive,)-559.5(is)-554.9(widely)]TJ
-1.1128 -1.2266 TD
[(available,)-358.5(and)-353.7(is)-358.9(a)-353.6(reliable)-356.5(test)-362.6(in)-354.7(pregnancy,)-360.7(assuming)-353.8(that)]TJ
0 -1.2203 TD
[(trimester-specic)-284.6(reference)-288.7(ranges)-281.1(are)-278.3(applied.)]TJ
1.1128 -1.2203 TD
[(The)-284.5(adverse)-283.3(maternal)-289.1(and)-284.1(fetal)-288.4(effects)-292.7(associated)-288.8(with)-287.2(un-)]TJ
-1.1128 -1.2203 TD
[(diagnosed)-526.7(and)-524.4(untreated)-527.2(overt)-523.1(thyroid)-530.4(dysfunction)-529.2(\(both)]TJ
0 -1.2266 TD
[(ov)21.8(er)18.4(t)-209.1(h)0(y)17.5(p)0(o)21.2(t)0(h)15.1(y)14.6(ro)15.5(id)18.8(is)20.4(m)-206.2(a)0(n)16.1(d)-205.3(ov)21.8(er)18.4(t)-209.1(h)0(y)17.5(p)0(e)17.7(r)0(t)17.8(h)0(y)23.8(r)0(o)15.5(i)0(d)18.8(i)15.4(sm)13.8(\))-202.8(i)0(n)-202.9(p)0(r)23.2(e)0(g)14.7(n)0(a)22.4(n)0(t)]TJ
0 -1.2203 TD
[(wo)20.9(me)21.5(n)-294.2(h)0(a)22.4(v)0(e)-285.2(b)14.6(ee)19.2(n)-294.2(c)0(l)22.5(e)0(a)19.6(r)0(l)14.7(y)-288.9(de)22.4(li)18.2(ne)15.7(a)13.1(t)0(e)18.6(d)-293.9(a)13.1(s)-292.2(de)22.4(sc)18.4(ri)14.7(b)14.6(e)0(d)-281.1(i)0(n)-285.1(p)0(r)23.2(e)0(v)18.3(i)0(o)19(u)0(s)]TJ
T*
[(se)17.8(c)13.4(t)0(i)15(o)0(n)19.1(s)0(.)-383.6(S)0(u)19.1(b)0(c)15.3(l)0(i)24.6(n)0(i)18.4(c)0(a)20.2(l)-401.9(m)15.1(a)0(t)19(e)0(r)18.4(n)0(a)16.1(l)-395.5(hy)17.5(pe)17.7(rt)24.1(hy)17.5(ro)15.5(id)18.8(i)15.4(s)0(m)-390.9(h)0(a)22.4(s)-399.7(no)19.1(t)-398.8(b)0(e)21(e)0(n)]TJ
0 -1.2266 TD
[(a)13.1(s)0(s)16.3(o)0(c)16.9(i)15.4(at)19(ed)-262.1(wi)20.1(th)-263.1(ad)22.8(ve)18.3(rs)17(e)-271.8(m)0(a)21.9(t)0(e)18.6(r)0(n)14.9(a)13.1(l)-269.1(o)0(r)-262.7(f)12.2(et)18.6(al)-262.3(ou)21.2(tc)12.9(om)25(es)-260.4(\(2)19(5\))19(.)]TJ
1.1128 -1.2203 TD
[(The)-259.2(maternal)-263.8(and)-258.8(fetal)-263.1(consequences)-269.1(of)-256.2(SCH)-264.2(in)-259.8(pregnancy)]TJ
-1.1128 -1.2203 TD
[(are)-291(less)-296.9(well)-293.1(dened,)-299.6(although)-297(the)-294.6(majority)-292.1(of)-294.1(studies)-301.7(report)]TJ
0 -1.2266 TD
[(an)-508.7(association)-510.6(between)-509.1(SCH)-504.5(and)-511.7(adverse)-510.9(pregnancy)-509.5(out-)]TJ
0 -1.2203 TD
[(comes.)-263(A)-260.6(retrospective)-270.3(study)-263.5(by)-255.4(Casey)]TJ
/F8 1 Tf
17.2173 0 TD
[(et)-260.4(al.)]TJ
/F6 1 Tf
2.1877 0 TD
[(described)-261.6(a)-265.1(two-)]TJ
-19.405 -1.2203 TD
[(to)-218.2(threefold)-216.5(increased)-219.2(risk)-218.6(of)-218.2(placental)-219.1(abruption)-219.8(and)-214.6(preterm)]TJ
0 -1.2266 TD
[(delivery)-521.5(before)-520.3(34)-517.5(weeks)-519.3(in)-512.8(untreated)-527.2(women)-517.4(with)-521.2(SCH)]TJ
0 -1.2203 TD
[(compared)-339.2(with)-344.1(euthyroid)-342(controls)-349.3(\(35\).)-338(Abalovich)]TJ
/F8 1 Tf
22.674 0 TD
[(et)-342.6(al.)]TJ
/F6 1 Tf
2.3458 0 TD
(\(38\))Tj
-25.0198 -1.2203 TD
[(reported)-230.1(that)-231.5(inadequate)-236.3(LT)]TJ
6.7246 0 0 5.9768 420.6613 362.6645 Tm
(4)Tj
8.9663 0 0 8.9663 426.1038 364.1385 Tm
[(treatment)-236.3(in)-228.2(women)-232.9(with)-230.3(either)]TJ
-12.8545 -1.2203 TD
[(OH)-344.5(or)-351.2(SCH)-346.4(was)-350.2(associated)-352.1(with)-350.5(signicant)-350.6(increases)-350.3(in)-348.4(the)]TJ
0 -1.2266 TD
[(risks)-390.7(for)-396(miscarriage)-395.7(and)-391.6(preterm)-398.9(delivery.)-398(Allan)]TJ
/F8 1 Tf
22.5665 0 TD
[(et)-393.2(al.)]TJ
/F6 1 Tf
2.4533 0 TD
(\(36\))Tj
-25.0198 -1.2203 TD
[(described)-318.5(a)-322(fourfold)-324.9(increased)-326.7(rate)-316.7(of)-325.7(fetal)-320(death)-322.4(in)-323.1(mothers)]TJ
T*
[(with)-540.1(hypothyroidism)-544.8(compared)-547.9(with)-540.1(a)-543.3(euthyroid)-544.3(control)]TJ
0 -1.2266 TD
[(population.)-541.4(Negro)]TJ
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1112
derived
converted from application/vnd.adobe.photoshop to image/tiff
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