Long-term hypothyroidism in patients started on levothyroxine during pregnancy
Authors' conclusion
One-third of the patients who started on LT4 during pregnancy had long-term hypothyroidism. The TSH level at treatment initiation and the LT4 dose during pregnancy could guide the decision for continuing long-term LT4.
Study context
- Population
- Pregnant women started on levothyroxine (LT4) per 2014 ETA recommendations, tertiary centre, 2014–2020106 followed long-term
- Participants
- 177 women
- Exposure
- Long-term hypothyroid vs euthyroid women after LT4 started in pregnancy
- Long-term hypothyroidn = 36
- Outcome
- Long-term hypothyroidism and associated factors
- Follow-up
- At least 6 months post partum
Methodological detailssingle tertiary centre, multivariate logistic regression, ROC curve analysis
- Single tertiary centre
- Multivariate logistic regression
- ROC curve analysis
Main finding
As reported in the abstract
Long-term hypothyroidism · 28.5 (9.0-81.9) months
Long-term hypothyroid
34%
36
- Maximal LT4 dose during pregnancy associated with long-term hypothyroidism (MVR), OR
- 1.03, 95% CI: 1.00-1.05, P = 0.003
Observational data: associations, not effects.
Further findings
Gestational week at LT4 initiation
P = 0.077
TSH at LT4 initiation
P = 0.005
Maximal LT4 dose during pregnancy
P = 0.005
- Optimal cutoffs predicting long-term hypothyroidism (ROC): LT4 dose 68.75 µg/day specificity 87% · sensitivity 42% · P P = 0.013
- Optimal cutoffs predicting long-term hypothyroidism (ROC): Thyroid-stimulating hormone (TSH) ≥ 3.8 mU/L specificity 68.5% · sensitivity 77% · P P = 0.019
LT4 could have been stopped in patients continuing it immediately after delivery
- LT4 could have been stopped
- 45%
Original publication
Long-term hypothyroidism in patients started on levothyroxine during pregnancy. Eur Thyroid J. Published 20 June 2024. doi:10.
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