Gestational hypothyroidism Development of mild hypothyroidism in early pregnancy in previously euthyroid women

Capsule:
Previously euthyroid women with infertility or recurrent pregnancy loss and negative thyroid peroxidase antibodies had a 24% incidence of hypothyroidism (TSH  2.5) at the time of pregnancy detection.

Authors:
Karen R. Hammond, D.N.P., C.R.N.P., Nicholas A. Cataldo, M.D., M.P.H., Janice A. Hubbard, Beth A. Malizia, M.D., Michael P. Steinkampf, M.D.

Volume 103, Issue 6, Pages 1532-1536

Abstract:

Objective:
To determine the proportion of euthyroid women attending a fertility practice who develop hypothyroidism in very early pregnancy (gestational hypothyroidism [GHT]), and to examine the association of GHT with exogenous gonadotropin treatment.

Design:
Retrospective cohort study.

Setting:
A private reproductive medicine practice.

Patient(s):
All healthy women (N = 94) with infertility or recurrent pregnancy loss, TSH level

Intervention(s):
Usual fertility care; 30 women who had received exogenous gonadotropins.

Main Outcome Measure(s):
Serum TSH level at the time of pregnancy detection.

Result(s):
Gestational hypothyroidism (TSH ≥ 2.5 mIU/L) developed in 23 of 94 women (24%). The mean increase in serum TSH level from initial evaluation to early pregnancy was 0.45 ± 0.08 [SE] mIU/L. There was a trend toward the association of GHT with use of exogenous gonadotropins. Gestational hypothyroidism was positively associated with initial prepregnancy TSH level.

Conclusion(s):
Euthyroid women may develop mild hypothyroidism in early pregnancy, especially after exogenous gonadotropin treatment. Appropriate vigilance will allow for timely levothyroxine treatment.

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