HYPOTHYROID ACTION POINTS (PREGNANCY)
PLEASE SEE THE PRIMARY CARE MANAGEMENT SECTION ON OBSTETRIC THYROID PAGE FOR FULL DETAILS
Hypothyroidism – Action points
Assess thyroid status: Preferably prior to conception or at booking in the following situations
Known hypothyroidism – Type 1, Type 2 diabetes
Previous history of thyroid disorder – Family history of thyroid disease
Features of thyroid disease – Other autoimmune thyroid disorder
Hypothyroid patients should be offered an appointment with consultant obstetrician
Measure TRAbs in all patients with history of Graves’ disease (irrespective of thyroid status)
Patients with detectable TRAbs require special management. Inform Endocrinologist/Obstetrician as soon as possible.
Patients with established hypothyroidism should have T4 dose increased by 25 micrograms as soon as a positive pregnancy test is found. Further monitoring after 2 weeks and possible further changes in T4 dose may be required to ensure FT4 is 16-28 pmol/L; TSH <2.5 mU/L as quickly as possible.
Further checks on thyroid function test should be made at least once in each trimester
If TFTs are not stable contact consultant obstetrician, as a growth scan may be required.
Cut back T4 dose to pre-pregnancy dose 2-6 weeks post-partum.
Hypothyroidism in Pregnancy
* It is important to produce this test profile (especially a FT4 of 16 -28 pmol/L) as soon as possible in the pregnancy and preferably before conception
