Original Article

To Treat or Not to Treat Euthyroid Autoimmune Disorder during Pregnancy?
F. Debiève^a, S. Dulière^a, P. Bernard^a, C. Hubinont^a, P. De Nayer^b, C. Daumerie^c

Departments of
^aObstetrics ,
^bBiochemistry and
^cEndocrinology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium

Address of Corresponding Author

Gynecol Obstet Invest 2009;67:178-182 (DOI: 10.1159/000185689)

  Key Words

• Hypothyroidism
• Pregnancy
• Antiperoxydase antibodies
• Screening

  Abstract

Background: Subclinical autoimmune hypothyroidism during pregnancy is associated with an increased risk of miscarriage and has a deleterious effect on fetal development. The aim of this study was to evaluate a screening and treatment strategy of subclinical hypothyroidism, and to establish normal ranges of thyroid-stimulating hormone (TSH) and thyroxine (T₄) during pregnancy. Methods: A retrospective study was carried out on 784 consecutive files of pregnant women; the files were systematically searched for thyroid function and antithyroid antibodies in order to determine the effect and the prevalence of anti-thyroid peroxidase antibodies (TPO-Ab) during pregnancy, and to evaluate treatment with levothyroxin (LT₄) in TPO-Ab carriers. Results: Among the 75 TPO-Ab-positive patients, 42 received LT₄ treatment during pregnancy. Although the range of TSH serum levels was wide, the mean TSH level was significantly higher in TPO-Ab-positive women (3 vs. 1 mIU/l, p < 0.01). No significant difference in the obstetrical complications rate was observed between TPO-Ab-positive and TPO-Ab-negative populations. Conclusions: Our study provides information on normal ranges of serum TSH and free T₄ for Belgian pregnant women receiving iodide supplementation. Based on our results, we suggest supplementation of TPO-Ab-positive pregnant women with 50 µg/day of LT₄, unless their TSH levels are lower than 1 mIU/l, to avoid the risk of hypothyroidism during pregnancy.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

Frédéric Debiève
Service d'Obstétrique
Avenue Hippocrate, 10
BE-1200 Bruxelles (Belgium)
Tel. +32 2 764 1014, Fax +32 2 764 8913, E-Mail debieve@obst.ucl.ac.be

  Article Information

Received: February 6, 2008
Accepted after revision: October 10, 2008
Published online: December 18, 2008
Number of Print Pages : 5
Number of Figures : 4, Number of Tables : 0, Number of References : 16