- \n
- T4 therapy is recommended for TPO Ab-positive women with a TSH greater than the pregnancy-specific reference range and for TPO Ab-negative women with a TSH greater than 10.0 mU\/L.<\/strong> A starting dose of 25-50mcg levothyroxine is recommended. If advice is needed, an \u2018advice only\u2019 request can be sent via SCI Gateway<\/li>\n\n\n\n
- T4 therapy should be considered for TPO Ab-negative women with TSH concentrations greater than the pregnancy-specific reference range and below 10.0 mU\/L, aiming to bring the TSH down to 2.5 mU\/l or below. <\/strong> After pregnancy, levothyroxine could be withdrawn. A starting dose of 25-50mcg of levothyroxine is reasonable. If advice is required, cases can be discussed with a consultant endocrinologist by sending an \u2018advice only\u2019 referral on SCI Gateway.<\/li>\n\n\n\n
- TPO Ab-positive women with TSH concentrations >2.5 mU\/L and below the upper limit of the pregnancy-specific reference range: although the 2017 ATA guidance suggested that T4 therapy may <\/em>be considered for these women, the more recent TABLET trial suggests that use of Levothyroxine in euthyroid women with positive anti-thyroid antibodies DOES NOT improve obstetric outcomes.[10] Therefore, we no longer recommend Levothyroxine therapy in this group.<\/li>\n\n\n\n
- T4 therapy is not recommended for TPO Ab-negative women with a normal TSH (TSH within the pregnancy-specific reference range).<\/li>\n<\/ul>\n\n\n
\n![\"Sub](\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Sub-clinical-hypothyroidism-1024x718.png\")
NHS Lothian<\/span> flowchart copyright NHS Lothian<\/figcaption><\/figure>\n<\/div>\n\n\n REFERENCES – please see the Resources and Links section of the main Thyroid Conditions and Pregnancy<\/a> page. <\/p>\n\n\n\n
C.M. & N.Z. 08-07-24<\/strong><\/p>\n\n\n\n
- <\/ul>\n
Referral Guidelines<\/span><\/a><\/span><\/div>\n<\/p>\n<\/div><\/div>\n\n\n\n
Primary Care Management<\/span><\/a><\/span><\/div>\n<\/p>\n<\/div><\/div>\n\n\n\n
Resources and Links<\/span><\/a><\/span><\/div>\n<\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"
The 2017 American Thyroid Association (ATA) guidelines [9] advise that there is no strong evidence that treating maternal sub-clinical hypothyroidism improves neurocognitive outcomes in children, but there is some evidence that sub-clinical hypothyroidism is associated with increased risks of pregnancy loss or preterm delivery. There is also no evidence to support universal screening of women<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":20032,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1091],"class_list":["post-18717","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-subclinical-hypothyroidism-and-pregnancy"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" Subclinical Hypothyroidism and Pregnancy<\/a>","rttpg_excerpt":"The 2017 American Thyroid Association (ATA) guidelines [9] advise that there is no strong evidence that treating maternal sub-clinical hypothyroidism improves neurocognitive outcomes in children, but there is some evidence that sub-clinical hypothyroidism is associated with increased risks of pregnancy loss or preterm delivery. There is also no evidence to support universal screening of women","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/18717","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=18717"}],"version-history":[{"count":8,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/18717\/revisions"}],"predecessor-version":[{"id":22069,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/18717\/revisions\/22069"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/20032"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=18717"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=18717"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
- T4 therapy should be considered for TPO Ab-negative women with TSH concentrations greater than the pregnancy-specific reference range and below 10.0 mU\/L, aiming to bring the TSH down to 2.5 mU\/l or below. <\/strong> After pregnancy, levothyroxine could be withdrawn. A starting dose of 25-50mcg of levothyroxine is reasonable. If advice is required, cases can be discussed with a consultant endocrinologist by sending an \u2018advice only\u2019 referral on SCI Gateway.<\/li>\n\n\n\n