Endocrine Abstracts

Introduction: Maternal hypothyroidism is the most common disorder of thyroid function in pregnancy and may influence the outcome of mother and fetus at all stages.

Aim: To evaluate screening and management of all high risk pregnant women for thyroid dysfunction.

Method: A retrospective audit as carried out between January 2005 and December 2006. Our local standards were TSH<3 mIU/l for screening and TSH<2 mIU/l for treatment. Women were identified as high risk if they had known thyroid dysfunction or a family history of diabetes or thyroid disease. Computer based search was performed to extract the data for the study. Women were considered screened if they had thyroid function tests checked any time from date of booking up to delivery.

Results: A total of 8478 women were booked to the antenatal clinic. Of 3673 (43%) high risk pregnant women were identified of whom 57% had a family history of diabetes, 25% thyroid disease, 16% both, and 2% (186) had known thyroid dysfunction. Of 93, 55, 60, and 15% respectively were not screened at all during their entire pregnancy. When screened only 85, 83, 83 and 56% respectively had TSH levels <3 mIU/l.

Only 8% (303) were reviewed in combined medical obstetric clinics and required 689 appointments. Of 43% attended in first trimester, 44% in second trimester, and 13% in third trimester.

Only 38, 43 and 63% referred in 1st, 2nd, and 3rd trimester had an initial TSH level <2 mIU/l on treatment. Of 77, 80 and 72% successfully achieved TSH levels <2 mIU/l before delivery.

Conclusion: Current screening methods are not adequate with not enough women being tested and not enough achieving target TSH in early pregnancy. Increased awareness of the need for screening and management of thyroid disease in early pregnancy is needed amongst health care professionals in primary and secondary care settings.