Subclinical Hypothyroidism during Pregnancy: Controversies
Journal Title: Journal of the Indian Medical Association - Year 2018, Vol 116, Issue 4
Abstract
Hypothyroidism is associated with increased risk of adverse maternal and fetal outcomes, including infertility, miscarriages, preterm deliveries, perinatal death, gestational hypertension, gestational diabetes and impaired neurocognitive development in the offspring. While it is clear that overt hypothyroidism is associated with increased risk and must be treated optimally, the diagnostic thresholds and the significance of subclinical hypothyroidism during pregnancy are debated. The diagnosis of SCH should be based on assay-specific, population-specific and trimester-specific reference ranges. In the absence of such reference ranges, the upper limit of TSH of the non-pregnant population can be reduced by 0.5mIU/l. Treatment with levothyroxine is associated with reduced rates of miscarriage, gestational hypertension, gestational diabetes, preterm deliveries and perinatal death. However, the effect on neurocognitive outcomes has not been demonstrated. Consistent benefits have been demonstrated in women with SCH who are TPO-Ab positive and therefore, assessment of thyroid autoimmunity must be done for clinical decision-making. Levothyroxine is indicated in women with TSH > 10mIU/l or in women with TSH above the upper limit of reference range with TPO-Ab positivity. In others, the decision should be individualized based on assessment of risk.
Authors and Affiliations
Gagan Priya
Keywords
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