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Intern Med J. 2018 Dec 18. doi: 10.1111/imj.14210. [Epub ahead of print]

Subclinical Hypothyroidism During Pregnancy: The Melbourne Public Hospitals Consensus.

Author information

1
Department of Endocrinology & Diabetes, Western Health, Sunshine Hospital, 176 Furlong Road, St Albans 3021 and Department of Medicine - Western Precinct, The University of Melbourne, St Albans, VIC, 3021.
2
Pregnancy Research Centre, Royal Women's Hospital, 20 Flemington Road, Parkville 3052 and University of Melbourne Department of Obstetrics & Gynaecology, Royal Women's Hospital, 20 Flemington Rd, Parkville, 3052.
3
Endocrine Services in Pregnancy, Monash Health, 264 Clayton Road, Clayton 3168 and Hudson Institute of Medical Research Clayton, 3168.
4
Mercy Hospital for Women, 163 Studley Road, Heidelberg 3084 and Austin Health, 145 Studley Road Heidelberg, 3084.
5
Department of Chemical Pathology, Melbourne Pathology, 103 Victoria Parade, Collingwood 3066 and Department of Medicine, Monash University, Clayton, 3168.
6
Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, 3052.
7
Department of Endocrinology & Diabetes, The Alfred, Commercial Road, Melbourne 3004 and Department of Medicine, Central Clinical School, Monash University, The Alfred, Commercial Road Melbourne 3004.
8
Department of Endocrinology & Diabetes, Eastern Health, Box Hill 3128 and Department of Medicine, Eastern Clinical School, Monash University, Box Hill, 3128.
9
Werribee Mercy Hospital, 300 Princes Highway, Werribee 3030 and St Vincents Institute of Medical Research, St Vincent's Hospital Melbourne, Fitzroy, 3065.
10
Department of Endocrinology & Diabetes, Peninsula Health, Frankston 3199 and Peninsula Clinical School, Monash University, Frankston, 3199.
11
Department of Endocrinology & Diabetes, Northern Health, 185 Cooper Street Epping, 3076.

Abstract

BACKGROUND:

Interest in potential adverse outcomes associated with maternal subclinical hypothyroidism (normal Free T4, elevated TSH) has increased significantly over recent years. In turn, the frequency of maternal thyroid function testing has risen, despite universal thyroid function screening not being recommended, leading to a marked increase in referrals to obstetric endocrinology clinics. In 2017 the American Thyroid Association (ATA) revised their diagnostic and management guidelines. While welcome, these new guidelines contain recommendations which may cause confusion in clinical practice.

AIMS:

To ensure uniform practice in the diagnosis and management of subclinical hypothyroidism in pregnancy across all Melbourne Public Hospitals.

RESULTS:

Consensus was achieved and the guidelines were endorsed by the Council of the Endocrine Society of Australia. Trimester and assay specific TSH reference intervals derived from healthy local populations should be used, where available. When unavailable, a TSH cut-off of 4 mU/L (replacing the previously recommended 2.5 mU/L) should be used to initiate treatment, irrespective of thyroid autoantibody status. The recommended starting dose of levothyroxine is 50 ug daily, with a therapeutic TSH target of 0.1 mU/L to 2.5 mU/L. Levothyroxine should generally be ceased after delivery, with some exceptions. Hospitals will ensure smooth transfer of care back to the woman's general practitioner with clear documentation of pregnancy thyroid management and a recommended plan for follow-up.

CONCLUSIONS:

Fewer women will be classified as having subclinical hypothyroidism during pregnancy, which is likely to lead to reductions in emotional stress, hospital visits, repeated blood tests and financial costs. Uniform clinical practice will occur across Melbourne. This article is protected by copyright. All rights reserved.

KEYWORDS:

Hypothyroidism; Pregnancy; Subclinical hypothyroidism

PMID:
30561039
DOI:
10.1111/imj.14210

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