INCREASED NEED FOR THYROXINE DURING PREGNANCY IN WOMEN WITH PRIMARY HYPOTHYROIDISM

Women with hypothyroidism have been thought not to require an increase in thyroxine replacement during pregnancy. To evaluate the effects of pregnancy on thyroxine requirements, we retrospectively reviewed the thyroid function of 12 women receiving treatment for primary hypothyroidism before, during, and after pregnancy. In all patients, the serum thyrotropin level increased during pregnancy. The mean (±SE) serum freethyroxine index decreased from 111.0±5.8 before pregnancy to 86.5±5.2 during pregnancy (normal, 64 to 142; P<0.05), and the mean serum thyrotropin level increased from 2.0±0.5 mU per liter before pregnancy to 13.5±3.3 mU per liter during pregnancy (normal, 0.5 to 5.0 mU per liter; P<0.01). Because of high thyrotropin levels, the thyroxine dose was increased in 9 of the 12 patients. Among the three patients who did not require an increased thyroxine dose were two with low serum thyrotropin levels before pregnancy, suggesting excessive replacement at that time. The mean thyroxine dose before pregnancy was 0.102±0.009 mg per day; it was increased to 0.148±0.015 mg per day during pregnancy (P<0.01). The mean postpartum serum free-thyroxine index was 136.6±11.4 (P<0.05 as compared with values before and during pregnancy), and the mean postpartum serum thyrotropin level was 1.4±0.4 mU per liter (P<0.01 as compared with levels during pregnancy), demonstrating a decrease in the thyroxine requirement. The mean postpartum thyroxine dose was decreased to 0.117±0.011 mg per day (P<0.01 as compared with the dose during pregnancy). Our results indicate that the need for thyroxine increases in many women with primary hypothyroidism when they are pregnant, as reflected by an increase in serum thyrotropin concentrations. Although the effects of this modest level of hypothyroidism are not known, we think it prudent to monitor thyroid function throughout gestation and after delivery and to adjust the thyroxine dose to maintain a normal serum thyrotropin level. (N Engl J Med 1990; 323:91–6.). © 1990, Massachusetts Medical Society. All rights reserved.