Preconception Counseling in Patients with Hypothyroidism and/or Thyroid Autoimmunity

Abstract

Preconception counseling is an essential tool for preventing adverse pregnancy outcomes associated with thyroid dysfunction. The high prevalence of thyroid disease among women of reproductive age, and the increased risk of adverse pregnancy outcomes associated with thyroid dysfunction, emphasize the necessity for well-established screening and treatment criteria in the preconception period. We therefore conducted a literature review for relevant information on the screening, diagnosis and treatment of subclinical and overt hypothyroidism in women seeking pregnancy. While screening for thyroid disease is recommended only in the presence of risk factors, iodine supplementation should be recommended in most regions, with higher doses in areas with severe deficiency. Known hypothyroid women should be counseled about increasing their levothyroxine dose by 20-30% in the case of suspected or confirmed pregnancy (missed menstrual cycle or positive pregnancy test). Treating subclinical hypothyroidism appears to be beneficial, especially in the presence of autoimmunity or in patients undergoing artificial reproductive techniques. Regarding the management of TPOAb negative SCH women or euthyroid women with positive TPOAb, further research is necessary in order to make evidence-based recommendations.

Keywords: hypothyroidism; iodine status; preconception; pregnancy; screening; subclinical hypothyroidism (SCH); thyroid autoimmunity.

Figure 1

Risk factors for thyroid disease in the preconception period; Yrs—years; BMI—body mass index; RPL—recurrent pregnancy loss.

Figure 2

SCH approach according to TSH value and the presence of thyroid autoimmunity—filled violet rectangles suggest treatment while grey rectangles suggest no need for treatment; SCH—subclinical hypothyroidism; TSH—thyroid stimulating hormone; TPOAb—thyroid peroxidase antibodies; * —or upper limit of normal for nonpregnant.