Hypothyroidism in pregnancy

Hypothyroidism is the most common pregnancy-related thyroid disorder, affecting 3-5% of all pregnant women. Subclinical hypothyroidism is more common than is overt hypothyroidism, and is usually defined as a serum thyroid-stimulating hormone (TSH) concentration greater than the pregnancy-specific reference range for each laboratory value, or by serum TSH concentrations greater than 2·5 mIU/L in the first trimester and greater than 3 mIU/L in the second and third trimesters. Some authors have defined subclinical hypothyroidism as a serum TSH between 5 and 10 mIU/L, and overt hypothyroidism as a serum TSH greater than 10 mIU/L, but this is not the commonly accepted definition. Once overt hypothyroidism is diagnosed, treatment with levothyroxine should be started to achieve serum TSH concentrations within the reference ranges for pregnancy as soon as possible. For patients with subclinical hypothyroidism, recommendations for therapy differ between various professional groups as a result of inconsistent data from both observational studies and clinical trials regarding the benefits for the mother or the child. Similarly, because benefits of therapy are still uncertain, universal screening of all pregnant women for subclinical hypothyroidism or thyroid autoimmunity is not recommended by most professional groups. During gestation, an increase in levothyroxine dose is required in more than 50% of women with previously diagnosed hypothyroidism, and can be managed by increasing the levothyroxine dose by 30% when pregnancy is confirmed.