Endocrine Abstracts

Thyroid dysfunction is associated with well-recognised maternal and fetal complications. There is an increase in thyroxine requirement during pregnancy by 25–50% hence close monitoring of thyroid function and dose augmentation is vital in attaining euthyroid status. In our combined antenatal-endocrine clinic we aim to test thyroid function tests (TFTs) at booking, in the second and third trimesters. In order to reduce the need for patients to re-attend the clinic purely for TFTs we devised a Spread Sheet recording their follow-up results. In this study we evaluated the data using the Endocrine Society clinical practice guidelines (2012) as a standard. We examined data over a 9-year period with a total of 678 patients. Six hundred and five (605) were known hypothyroid, 13 hyperthyroid and 61 with varied diagnosis. A total of 1,114 TFTs were requested out of which 722 (64.8%) were performed and 392 (35.2%) were not done. Two hundred and forty three (243) patients required a dose adjustment of their thyroid replacement with a further three patients initiated on treatment. Out of 243 patients, 109 had both second and third trimester TSH values available. Ninety six (96) showed improvement with 66 having TSH within the reference range for pregnancy (0.4–2.0 mU/l) and 13 showed no improvement or worsened.

In summary two-thirds of patients had been compliant with our novel system of outpatient TFTs monitoring and one third non-compliant. Around one-third had active intervention with nearly half showing improvement in their thyroid status of which two-thirds had results within the target TSH range for pregnancy.

In conclusion overall 552 clinic appointments were saved over a 9-year period, however there is still a need for further improvement in compliance with TFTs monitoring. This could be improved by use of mobile texting and close collaboration with maternity services to remind patients of when their investigations are due.