Controversies in the Management of Hypothyroidism During Pregnancy

Patton, Phillip E.; Samuels, Mary H.; Trinidad, Rosen; Caughey, Aaron B.

doi:10.1097/ogx.0000000000000075

Cited by 6 publications

(8 citation statements)

References 98 publications

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“…Our hospital guidelines follow those of the AES which recommend treatment for all pregnant women, thyroid antibody positive or not, with thyroxine [ 2 ]. We do note that the ATA recommends treatment for only those patients who have a raised TSH and positive thyroid antibodies [ 1 ]. Other authoritative sources also recommend universal treatment of patients with SCH in pregnancy [ 1 ].…”

Section: Methodsmentioning

confidence: 99%

“…Thyroid disorders are among the most common endocrine disorders in pregnancy. The prevalence of hypothyroidism in pregnancy varies from 0.4% to 11% worldwide [ 1 ]. The definitions of subclinical and overt hypothyroidism vary and this may account for some of the different reports of prevalence.…”

Section: Introductionmentioning

confidence: 99%

“…Current American Endocrine Society (AES) Guidelines define overt hypothyroidism during the first trimester of pregnancy as a patient with a serum TSH level > 10 mIU/L with or without a subnormal serum free thyroxine (FT4) level and subclinical hypothyroidism (SCH) as a patient with a serum TSH level > 2.5 mIU/L with a normal free T4 level [ 2 ]. The American Thyroid Association (ATA) defines SCH as a TSH between 2.5 and 10 mIU/L with a normal FT4 concentration [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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Beneficial Effects on Pregnancy Outcomes of Thyroid Hormone Replacement for Subclinical Hypothyroidism

Blumenthal

Eastman

2017

Journal of Thyroid Research

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Background. Hypothyroidism and raised thyroid antibody levels have been associated with adverse obstetrical outcomes. Several studies have investigated causal associations, but results have been inconsistent and few studies have reported the effects of thyroxine replacement therapy on pregnancy outcomes in hypothyroid patients. Objective. The primary study objective was to determine the outcome of pregnancies in women diagnosed with overt and subclinical hypothyroidism (SCH) (serum TSH > 2.5 mIU/L) and those with elevated circulating thyroid autoantibody levels in the first trimester of pregnancy and after the institution of appropriate thyroxine replacement therapy to maintain the serum TSH ≤ 2.5 mIU/L. Study Design. This prospective observational study was undertaken between 2013 and 2016. Blood samples were taken from 1025 women at presentation for thyroid stimulating hormone (TSH), anti-thyroglobulin antibodies (TGAb), and thyroid peroxidase antibodies (TPOAb). Those with a TSH > 2.5 mIU/L were treated with thyroxine and managed appropriately to ensure that the TSH was maintained ≤2.5 mIU/L. Outcomes in these patients were compared to those in euthyroid patients. Maternal antenatal complications and perinatal outcomes were recorded. Results. There were a total of 1025 patients of whom 382 (37.5%) were nulliparous. 10.1% had a TSH level > 2.5 mIU/L and 18.2% had at least one raised thyroid antibody level. No differences in adverse outcomes of pregnancy were evident in women treated for SCH or overt hypothyroidism compared to the euthyroid group. There was also no association between raised thyroid antibodies and adverse pregnancy outcomes in either group. Conclusion. There were no adverse outcomes of pregnancy found in pregnant women who had been diagnosed and treated with thyroxine for SCH at the time of presentation when compared to euthyroid patients. There was also no relationship with thyroid antibodies and adverse pregnancy outcomes in the two groups. It is not possible to unequivocally advocate for thyroxine replacement in pregnant women with subclinical and overt hypothyroidism until large scale randomized controlled trials are performed.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Beneficial Effects on Pregnancy Outcomes of Thyroid Hormone Replacement for Subclinical Hypothyroidism

Blumenthal

Eastman

2017

Journal of Thyroid Research

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“…30,31 TSH values mirror changes in T4, with the lowest levels seen at the peak in hCG levels. 14 As TSH values change during pregnancy, trimester-specific normative values are provided. TSH rarely exceeds 2.5 mIU/L in the first trimester or 3.0 mIU/L in the second or third trimester.…”

Section: Physiologic Thyroid Function Changes In Pregnancymentioning

confidence: 99%

“…TSH rarely exceeds 2.5 mIU/L in the first trimester or 3.0 mIU/L in the second or third trimester. 13,14,16 Studies of thyroid function during the transition from preconception to early conception in women without preexisting thyroid disease have been limited. Poppe et al compared prepregnancy and early pregnancy thyroid function in women undergoing in vitro fertilization (IVF) without history of thyroid disease (n ¼ 77).…”

Section: Physiologic Thyroid Function Changes In Pregnancymentioning

confidence: 99%

Thyroid Autoimmunity and Reproductive Function

Crawford

Steiner

2016

Semin Reprod Med

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Thyroid hormones are important for normal reproductive function, and maternal thyroid dysfunction has been associated with infertility, miscarriage, preterm birth, and poor neurodevelopment in the offspring. Thyroid autoimmunity is the leading cause of thyroid dysfunction in women of reproductive age. Women with thyroid autoimmunity, even with normal thyroid function, appear to be at a higher risk for poor reproductive outcomes, including miscarriage and preterm birth. Thyroxine replacement in women with thyroid autoimmunity with or without appreciable thyroid dysfunction may improve pregnancy outcomes. Thus, identification and treatment of women with thyroid autoimmunity may optimize reproductive success.

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