Women with first trimester pregnancies attending the antenatal clinic for their first antenatal checkup were recruited between January 2019 and June 2020 in a consecutive sample of cases. This prospective study was conducted in an academic tertiary care center in Bhubaneswar, India. Therefore, the present study was carried out to evaluate the effect of levothyroxine treatment on pregnancy outcomes in women with subclinical hypothyroidism in the Indian population. Moreover, there is a paucity of data on the Indian population. Some studies reported a beneficial effect of levothyroxine on adverse pregnancy outcomes, whereas others reported no benefit or inconclusive results. Although several studies on poor outcomes in pregnant women with SCH were conducted and reported in the last decade, data regarding the risk and benefit of levothyroxine treatment in such women are limited and, too, controversial. Therefore, it is imperative to initiate an effective treatment early in pregnancy to reduce these complications. Several observational studies and meta-analyses reported the risk of miscarriage, gestational hypertension, placental abruption, pre-eclampsia, gestational diabetes, intrauterine growth restriction (IUGR), preterm birth, and low birth weight (LBW). SCH in pregnancy has rising clinical importance because of its significant negative impact on pregnancy outcomes. The 2017 American Thyroid Association (ATA) guidelines recommend using a population-based trimester-specific TSH reference range and, if it is not available, 4.0 mIU/L as the upper reference limit of TSH should be used to define thyroid dysfunction for the first trimester of pregnancy. Environmental factors, ethnicity, iodine intake, and genetic susceptibility influence thyroid function, and therefore, it may vary between different populations.
#Hypothyroidism medication free#
An elevated serum thyrotropin (TSH) with a normal free thyroxine (FT4) level on thyroid function tests defines SCH. In pregnancy, the most common thyroid dysfunction is subclinical hypothyroidism (SCH), and its prevalence rate ranges from 3.5% to 14%. In fact, pregnancy is a challenging state for thyroid gland function as any failure to adapt to the physiological changes and to the increased hormonal requirements during gestation results in thyroid dysfunction.
Levothyroxine therapy initiated in the first trimester of pregnancy has possible beneficial effects in subclinical hypothyroidism but with a higher risk for gestational diabetes.Īdequate maternal thyroid hormone is crucial for normal fetal growth in view of the fact that the fetal thyroid gland is not active before 18-20 weeks of gestation and the fetus largely depends on the supply of maternal thyroxine during the critical period of development in the first trimester of pregnancy. However, the risk of gestational diabetes mellitus was significantly higher in women with SCH (OR: 3.432, 95% confidence interval (95% CI): 1.115-10.562). The risks for miscarriage (odds ratio (OR): 1.284, p=0.811), gestational hypertension (OR: 1.993, p=0.365), intra-uterine growth restriction (OR: 1.688, p=0.488), low birth weight (OR: 1.591, p=0.392), and preterm birth (OR: 1.606, p=0.529) were not significantly higher in women with subclinical hypothyroidism as compared to euthyroid women. The median gestational age at the initiation of levothyroxine treatment was nine weeks. ResultsĪ total of 1058 women were screened and 5.1% (n=54) were found to have subclinical hypothyroidism, out of which 57.4% (n=31) were thyroid peroxidase antibody positive.
Pregnancy outcomes were compared with those of healthy pregnant women with normal thyroid function. All the participants were followed up with thyroid function tests and ultrasonography till delivery. They were treated with an initial dose of 50 mcg of levothyroxine and the dose was adjusted at six-week intervals to achieve a normal thyrotropin level.
Healthy women with a singleton pregnancy were screened before 12 weeks of gestation for subclinical hypothyroidism using 2017 American Thyroid Association guidelines. Our study aimed to evaluate the effects of levothyroxine treatment on pregnancy outcomes in these women. Adverse pregnancy outcomes in women with subclinical hypothyroidism (SCH) are well documented, whereas data regarding the risk and benefit of levothyroxine treatment in such cases are insufficient and inconsistent.
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