May 2007 · Vol. 19, No. 05What you need to know about thyroid disorders in pregnancy
Managing overt disorders is straightforward, but even subclinical disease warrants heightened scrutiny
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Fast Track
Levothyroxine should be ingested at least 4 hours before or after the prenatal vitamin
Approximately 5% of women with secondary subclinical hypothyroidism develop overt disease each year
Treat gravidas and women planning to conceive with levothyroxine (starting at 2 μg/kg/day) if they have an elevated TSH or low FT4
Postpartum thyroid dysfunction affects 5% to 9% of women and usually involves psychiatric symptoms
A late evening TSH surge can cause a falsely elevated TSH measurement
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Meena
Khandelwal,
MDAssociate Professor, Department of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine, Cooper University Hospital, University of Medicine and Dentistry of New Jersey, Camden, NJ
Until recently, thyroid dysfunction was thought to have little influence on pregnancy as long as it was treated, and management was straightforward. That was before case-control studies in prominent journals suggested an association between even subclinical hypothyroidism and impaired neonatal neurodevelopment.1-4
The risk associated with hyperthyroidism in pregnancy is less clear. Currently, it is believed to cause no adverse effects; the low thyroid-stimulating hormone (TSH) resolves in most women within 4 to 12 weeks.
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