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Guideline 4. Thyroid Testing of Pregnant Patients

Mounting evidence suggests that hypothyroidism during early pregnancy has a detrimental effect on fetal outcome (fetal wastage and lower infant IQ).

- Pre-pregnancy or first trimester screening for thyroid dysfunction using serum TSH and thyroperoxidase autoantibodies (TPOAb) measurements is important both for detecting mild thyroid insufficiency (TSH >4.0 mIU/L) and for assessing risk for post-partum thyroiditis (elevated TPOAb).

- Initiation of levothyroxine (L-T4) therapy should be considered if the serum TSH level is >4.0 mIU/L in the first trimester of pregnancy.

- A high serum TPOAb concentration during the first trimester is a risk factor for post-partum thyroiditis.

- Serum TSH should be used to assess thyroid status during each trimester when pregnant patients are taking L-T4 therapy, with more frequent measurement if L-T4 dosage is changed.

- Trimester-specific reference intervals should be used when reporting thyroid test values for pregnant patients.

- Total thyroxine (TT4) and triiodothyronine (TT3) measurements may be useful during pregnancy if reliable FT4 measurements are not available, as long as the reference ranges are increased by 1.5-fold relative to non-pregnant ranges.

- Free triiodothyronine (FT3) and free thyroxine (FT4) reference ranges in pregnancy are method-dependent and should be established independently for each method.

- Measurement of serum thyroglobulin (Tg) in differentiated thyroid cancer (DTC) patients during pregnancy should be avoided. Serum Tg rises during normal pregnancy and returns to baseline levels post-partum. This rise is also seen in pregnant DTC patients with remnant normal thyroid or tumor tissue present and is not necessarily a cause for alarm.