Under and overtreatment with thyroid hormone replacement during pregnancy

Background: Subclinical hypothyroidism (SCH) in pregnancy, defined by elevated thyroid-stimulating hormone (TSH) levels with normal free thyroxine (T4) levels, significantly impacts maternal and neonatal outcomes. Management practices for SCH vary, particularly for borderline TSH levels (2.5–4 mIU/ml). Understanding diverse clinical approaches and the factors influencing these practices is crucial for optimizing treatment guidelines. Methodology: A questionnaire-based survey was conducted among endocrinologists, obstetricians, and physicians managing pregnant women with thyroid dysfunction. Distributed through professional social media groups, the survey addressed various aspects of managing mildly elevated TSH levels, including decision-making factors for treatment, monitoring, and dosing of levothyroxine (LT4), as well as routine screening for antithyroid peroxidase (TPO) antibodies. Responses from 383 doctors were analyzed using appropriate statistical methods to assess differences in clinical practices. Results: Out of 383 respondents, 171 (44.65%) were endocrinologists, 156 (40.73%) were obstetricians, and 56 (14.8%) were physicians. A significant disparity was noted in the perspectives on initiating LT4 treatment. About 82.46% of endocrinologists do not consider it necessary to treat all pregnant women with a TSH level between 2.5 and 4 mIU/ml. On the other hand, 62.82% of obstetricians and 39.29% of general physicians believe that treatment should be initiated even in cases of mildly elevated TSH levels. Positive anti-TPO antibodies, bad obstetric history, history of gestational hypothyroidism in a previous pregnancy, and presence of goiter were considered the most important factors for deciding to initiate LT4 therapy in this specific group of pregnant women. The majority of the participants opined that the first trimester would be the ideal time to initiate LT4 therapy in pregnant women. Out of 171 endocrinologists, about 73% regularly conduct anti-TPO screening of pregnant women with TSH between 2.5 and 4 mIU/ml. Among 156 obstetricians, about 72% do not screen regularly for anti-TPO antibodies, and among 56 physicians, about 52% prefer regular screening, while 48% do not. Conclusions: This survey highlights significant variability in the management of pregnant women with mildly raised TSH levels among different medical specialties. The results underscore the need for more unified, evidence-based guidelines that take into account the complexity of individual cases and the variability of clinical practices. Further research is needed to establish a standardized approach to managing SCH in pregnancy, enhancing both maternal and fetal health outcomes.

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Under and overtreatment with thyroid hormone replacement during pregnancy

Cited by 2 publications

References 61 publications

Isolated Maternal Hypothyroxinemia: Adverse Maternofetal Outcomes but Uncertainty About Treatment Remains

Isolated Maternal Hypothyroxinemia: Adverse Maternofetal Outcomes but Uncertainty About Treatment Remains

Navigating the gray area: A questionnaire-based survey on the clinical practices among endocrinologists, obstetricians, and physicians in managing pregnant women with mildly raised thyroid-stimulating hormone (2.5–4 mIU/ml)

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