Document Detail

Pregnant women on thyroxine substitution are often dysregulated in early pregnancy.
MedLine Citation:
PMID:  19207005     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Thyroid hormones are important for normal fetal development. Maternal hypothyroidism during early pregnancy is associated with impaired neuropsychological development of children and other adverse outcomes. The primary aim of this prospective study was to determine whether thyroxine-treated pregnant women with hypothyroidism are adequately thyroxine substituted in early pregnancy. A secondary aim was to determine if fetal loss differed between females with thyrotropin (TSH) values within and outside the reference range at their first TSH test, scheduled for 1-2 weeks after verification of pregnancy. METHODS: This was a prospective open-labeled study. During the years 1997-2002, 119 consecutive pregnancies in 101 females with thyroid diseases were followed at the Department of Endocrinology, Malmö University Hospital. At the first visit, 63 patients, median age 30 years (range 17-45 years), were on thyroxine substitution therapy for hypothyroidism. In these patients 83% were in their first trimester at the time of the initial test. RESULTS: Of the 63 patients on thyroxine substitution for hypothyroidism 32 (51%; Group A) patients had serum TSH values within the reference range at their initial test and 31 (49%; Group B) had serum TSH values outside the reference range. Twelve (19%) had TSH values of <0.40 mIU=L and 19 (30%) had TSH values of >4.0 mIU=l. The fetal loss was 2 of 32 (6%) in Group A compared to 9 of 31 (29%) in Group B ( p < 0.05). CONCLUSIONS: In 49% of pregnant women on thyroxine substitution, serum TSH values were outside the reference range when first tested, generally in the first trimester. Fetal loss was significantly greater in pregnant women with abnormal TSH values compared to those with normal TSH values. Thyroid function in pregnant women on thyroxine substitution should be monitored early in pregnancy and carefully followed during pregnancy. The thyroxine dose should be increased as needed early in pregnancy to avoid hypothyroidism.
Bengt Hallengren; Mikael Lantz; Bengt Andreasson; Lars Grennert
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Thyroid : official journal of the American Thyroid Association     Volume:  19     ISSN:  1557-9077     ISO Abbreviation:  Thyroid     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-13     Completed Date:  2009-07-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9104317     Medline TA:  Thyroid     Country:  United States    
Other Details:
Languages:  eng     Pagination:  391-4     Citation Subset:  IM    
Department of Endocrinology, Malmö University Hospital, Malmö, Sweden.
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MeSH Terms
Fetal Development
Hypothyroidism / drug therapy*,  prevention & control
Pregnancy Complications / blood,  drug therapy*
Pregnancy Trimester, First / blood
Prospective Studies
Thyrotropin / blood
Thyroxine / blood,  therapeutic use*
Reg. No./Substance:
7488-70-2/Thyroxine; 9002-71-5/Thyrotropin
Comment In:
Thyroid. 2009 Apr;19(4):323-6   [PMID:  19355821 ]

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