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Obstetric Outcomes of an Afro-Caribbean Cohort Following Universal Screening and Treatment of Subclinical Hypothyroidism



Objective: Restoration of euthyroidism with l-thyroxine reportedly reduces obstetric complications associated with subclinical hypothyroidism (SCH). The objective was to determine if obstetric outcomes of treated subjects were equivalent to euthyroid subjects.

Methods: This was a prospective cohort study.  Subjects were considered euthyroid if serum thyroid-stimulating hormone(TSH) was 0.4–3 mIU/L, free thyroxine (FT4) 10.29–17.05 pmol/L with negative TPO antibodies (TPOAb). Subclinical hypothyroidism was diagnosed if FT4 was 10.29–24.45 pmol/L and TSH 2.5–3 mU /L with positive TPOAb, or TSH > 3.0 mU /L regardless of antibody status. Subclinical hypothyroidism subjects were treated with l-thyroxine until TSH < 2.5 mIU /L. Data were analysed with Stata (StataCorp, USA).

Results: Seven hundred and sixty-nine singleton pregnancies were screened; 96% at 14 weeks gestation.  Five hundred and eleven (66%) were euthyroid by study definition. Prevalence of SCH was 1.9% (15/769); 26% (4/15) was TPOAb positive. Eighty-one per cent was treated according to protocol; compliance was 54%. Mean gestational age (GA) at first endocrinologist visit was 22.7 ± 2.7 weeks. Normal TSH was documented in 36% at GA 33 ± 2.94 weeks. Subclinical hypothyroidism subjects had significantly greater pre-existing history of preterm premature rupture of membranes (PPROM) and preterm labour, Caesarean sections for non-reassuring fetal heart rate and neonatal necrotizing enterocolitis. 

Conclusion: L-thyroxine appeared to reduce obstetric complications. However, prevalence of SCH was low and compliance was < 50%.  

31 Oct, 2014
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e-Published: 11 May, 2015
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