•ATA recommend diagnosis of hypothryoidism in all pregnant women with; - a TSH > reference interval and a low FT4
- All with TSH > 10mU/L irrespective of FT4
•In women with subclinical hypothryoidism who are not initially treated; ATA recommends monitoring FT4 and TSH every 4 weeks until 16-20/40 and once between 26/40 - 32/40 weeks gestation
•Dosage of levothyroxine will go up during pregnancy ( 30-50%)
•Aim for TSH 1.0 – 2.5 mU/L, monitor TSH as above
•Post partum revert back to original dosage and check TFT’s 6 weeks post partum
•Grave’s disease occurs in 0.1-1% of all pregnancies
•Transient gestational hyperthyroidism can occur in the 1st trimester (prevalence 2-3 %)
•In patients with Grave’s:
üMonitor TFT’s every 4-6 weeks
üTRAb at 24 weeks – can cross the placenta and cause foetal and neontal hyperthryoidism (<1%)
•Uncontrolled Grave’s:
oFoetal loss
oPET
oMiscarriage
oPremature labour
oCCF
Thyroid storm