Endocrine Abstracts

Introduction: Hypothyroidism in pregnancy may be associated with neurodevelopmental delay of the unborn baby. Timely management of abnormal thyroid function tests (TFTs) in pregnancy is important. In our centre, some patients attend an Endocrinology-led dedicated antenatal thyroid clinic, whilst others attend an Obstetrician-led general antenatal clinic.

Objectives: The management of hypothyroid pregnant patients attending our centre was audited against The American Endocrine Society clinical practice guidelines which recommend targeted case finding at the first ante-natal clinic visit and thyroxine adjustment to maintain TSH≤2.5 μU/ml.

Methods: Pregnant patients with hypothyroidism attending both clinics between 2007 and 2008 were identified from the biochemistry database. Data was recorded from case-notes including whether targeted case finding was done and gestation at 1st general antenatal clinic visit, 1st TSH measurement and referral to thyroid antenatal clinic. TSH values were recorded together with action following abnormal results.

Results: Fifty-three patients were identified. Targeted case finding was done only in 11 patients (20.7%). Fifty-two patients were seen in the general antenatal clinic in the 1st trimester (98%). Thirty patients (56.6%) were referred to the dedicated antenatal thyroid clinic (11 in the 1st trimester, 10 in the 2nd trimester and 9 in the 3rd trimester).

Thirteen, 25 and 15 patients had TFTs first checked in 1st, 2nd trimester and 3rd trimesters respectively. Nineteen patients had an abnormal TSH at any time (range 2.6–97 μU/ml), with only 11 followed up appropriately (10 seen in the dedicated thyroid clinic, 1 seen only in the general antenatal clinic). All patients with an abnormal TSH that was not acted upon appropriately were seen only in the general antenatal clinic.

Conclusions: Management of hypothyroid patients attending the general antenatal clinic alone was suboptimal suggesting endocrinology involvement in these patients’ care is required. The results of this audit have implications both for education and service provision.