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Your current dose will need to be increased before conception to reduce the potential fetal complications.
40%
2/5
Your current dose will only need to be increased during pregnancy, not before.
60%
3/5
Your current dose will only need to be increased before pregnancy, not during.
0%
0/5
Your current dose will be sufficient for her and the fetus during pregnancy.
Your pregnancy is at increased risk of complications because of hypothyroidism regardless of the dose.
Select Answer to see Preferred Response
In hypothyroidism during pregnancy, the levothyroxine dose will only need to be increased during pregnancy, not before. The levothyroxine dose needs to be increased during pregnancy to maintain a euthyroid state as a result of the increase of thyroglobulin binding hormone in pregnancy which decreases the amount of circulating free T3/T4. Thyroid disease, if untreated during pregnancy, increases the risk of miscarriage, placental abruption, hypertensive disorders, and growth restriction. While this patient was well-informed, it is important for obstetricians to screen women at high risk, including those with a history of thyroid disease, type 1 diabetes mellitus, other autoimmune diseases, current or past use of thyroid therapy, or a family history of autoimmune thyroid disease. Carney et al. discuss thyroid disease in pregnancy. They report that in women with hypothyroidism, levothyroxine is titrated to a goal serum thyroid-stimulating hormone (TSH) level less than 2.5 mIU/L. Casey et al. expand on thyroid screening as it relates to pregnancy. A controversy among endocrinologists and obstetricians is whether screening for subclinical thyroid disorders during pregnancy should be standard. In the Controlled Antenatal Thyroid Screening trial, this issue was examined. Twenty-two thousand pregnant women were screened for either isolated high TSH or isolated low free thyroxine level. The authors concluded that antenatal screening and maternal treatment for women with subclinical thyroid dysfunction did not result in improved cognitive function of their children. Incorrect Answers: Answers 1,3,4: These are not appropriate responses. Answer 5: While this patient would be at increased risk if untreated, treating hypothyroidism adequately with thyroid replacement therapy reduces the risk dramatically.
5.0
(5)
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