Optimising levothyroxine treatment for subclinical hypothyroidism during pregnancy

Curr Med Res Opin. 2023 Oct 28:1-12. doi: 10.1080/03007995.2023.2276120. Online ahead of print.ABSTRACTThe onset of pregnancy places additional stress of the thyroid gland, which must produce additional thyroid hormones to support the developing foetus. Hypothyroidism, including subclinical hypothyroidism (SCH) may appear de novo at this time, or existing thyroid disease may become more severe. Accordingly, SCH is a relatively common complication of up to about 3% of pregnancies, with higher rates in some areas. There is strong evidence from systematic reviews and meta-analyses that uncontrolled SCH is associated with an increased risk of adverse pregnancy outcomes, including miscarriage, preeclampsia, gestational diabetes. The evidence base also suggests that treatment with levothyroxine (LT4), optimised to control thyrotropin (TSH) to within it pregnancy-specific reference ranges, reduces these risks. Current management guidelines provide a clear framework of intervention with LT4 in pregnant women with SCH, especially where TSH is high or where thyroperoxidase autoantibodies are present. Sub-optimal adherence to LT4 is common: it is important that patients take their LT4 correctly and that treating physicians and/or healthcare professionals manage these patients according to the latest management guidelines. The titration of LT4 is likely to occur within a range of LT4 daily doses between 25 g and 75 g for the majority of this population. LT4 is a narrow therapeutic index ...
Source: Current Medical Research and Opinion - Category: Research Authors: Source Type: research