Subclinical Hypothyroidism and Thyroid Autoimmunity in Pregnancy: To Treat or Not to Treat

Endocrinol Metab Clin North Am. 2024 Sep;53(3):363-376. doi: 10.1016/j.ecl.2024.05.010. Epub 2024 Jun 15.

Abstract

Subclinical hypothyroidism and thyroid autoimmunity in pregnancy are common conditions. They are both associated with adverse maternal and offspring outcomes. Women with thyroid autoimmunity should be monitored with regular thyroid function tests preconception and during gestation to identify women who develop hypothyroidism. The effectiveness of thyroid hormone treatment in reducing adverse outcomes in pregnancy has been studied in a number of randomized controlled trials. Current evidence shows obstetrical benefits of levothyroxine treatment in pregnant women with a thyroid-stimulating hormone level greater than 4 mU/L.

Keywords: Euthyroid; Hypothyroidism; Levothyroxine; Pregnancy; Thyroglobulin antibody; Thyroid hormone replacement; Thyroid peroxidase antibody.

Publication types

  • Review

MeSH terms

  • Autoimmunity / drug effects
  • Female
  • Humans
  • Hypothyroidism* / complications
  • Hypothyroidism* / drug therapy
  • Hypothyroidism* / immunology
  • Pregnancy
  • Pregnancy Complications* / drug therapy
  • Pregnancy Complications* / immunology
  • Thyroiditis, Autoimmune / complications
  • Thyroiditis, Autoimmune / drug therapy
  • Thyroiditis, Autoimmune / immunology
  • Thyroxine / therapeutic use

Substances

  • Thyroxine