Preconception Management of Hyperthyroidism and Thyroid Status in Subsequent Pregnancy: A Population-Based Cohort Study
Main finding · Suboptimal thyroid status in pregnancyResult — go to the resultOdds ratio 4.72 95% CI 3.50–6.36Authors' conclusion
The management of women with hyperthyroidism who become pregnant is suboptimal, particularly in those with preconception definitive treatment, and needs urgent improvement. Better thyroid monitoring and prenatal counseling are needed to optimize thyroid status, reduce teratogenic drug exposure, and ultimately reduce the risk of adverse pregnancy outcomes.
Study context
- Population
- Females aged 15–45 years with a clinical diagnosis of hyperthyroidism and a subsequent pregnancy (January 2000 to December 2017), Clinical Practice Research Datalink
- Participants
- 4,712 pregnancies
- Exposure
- Preconception treatment strategies for hyperthyroidism: antithyroid drugs vs definitive treatment vs no treatment
- Outcome
- Suboptimal thyroid status in pregnancy (TSH >4.0 mU/L or TSH <0.1 mU/L plus FT4 >reference range)
Main finding
Suboptimal thyroid status in pregnancy
Odds ratio
4.72
95% CI 3.50–6.36
Definitive treatmentvs Antithyroid drugs
OR 4.72 (95% CI 3.50–6.36)
As reported in the abstract
- TSH measured in pregnancies
- 53.1%
- Suboptimal thyroid status among pregnancies with TSH measured
- 28.1%
Observational data: associations, not effects.
Further findings
Trends in definitive treatment before pregnancy · 2000 to 2017
- Steady decline in use of definitive treatment before pregnancy
Antithyroid drug switching in pregnancy · first trimester
- Carbimazole-exposed pregnancies switched to propylthiouracil
- 32.6%
- Propylthiouracil-exposed pregnancies switched to carbimazole
- 6.0%
Original publication
Preconception Management of Hyperthyroidism and Thyroid Status in Subsequent Pregnancy: A Population-Based Cohort Study. J Clin Endocrinol Metab. Published 18 May 2023. doi:10.
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