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Throughout pregnancy, women undergo a lot of change and a variety of tests. Based on results, treatment may, or may not, be initiated while the pregnancy is ongoing.  For those with subclinical hypothyroidism, a new study finds pregnant women may be overdiagnosed and overtreated.

The small, butterfly-shaped thyroid gland that resides in the front of your neck has a big job. Throughout life, the gland produces hormones that impact most of the organs of your body and strongly influence how your body uses energy.

Disorders of the thyroid are relatively common.  About 20 million people in the US have some form of thyroid disorder and women are affected more often than men.  Men and women are often unaware that they have a thyroid disorder until they suffer symptoms and seek medical advice, or learn of it after a routine blood test.

Thyroid function can impact the ability of a woman to become pregnant and carry the baby to term leading to potential birth injuries. Thyroid dysfunction is linked to increased risk of miscarriage, fetal growth restriction, placental abruption, and hypertension.  Appropriate levels of thyroid hormone are important to the healthy neurological development of a baby. A test for thyroid-stimulating hormone (TSH) is among the common tests of pregnancy.

Because of the known pregnancy complications associated with low TSH, clinicians often prescribe medication for women identified as having subclinical hypothyroidism.  Hypothyroidism occurs when your thyroid gland does not make enough thyroid hormone.  Hyperthyroidism is the term used to describe the condition when your thyroid makes too much thyroid hormone.

Subclinical hypothyroidism—to treat or not?

It is common for women to be diagnosed with a mild decline in thyroid hormone—termed subclinical hypothyroidism—during pregnancy.  A new study published in the Canadian Medical Association Journal (CMAJ) suggests testing for and treating subclinical hypothyroidism early in pregnancy may be subjecting women and their babies to overscreening and overtreatment.

Looking at data from 188,000 Canadian pregnancies, more than half of women who did not have thyroid disease prior to pregnancy were tested during their first trimester and not again while pregnant. In about 5,050 of those pregnancies, women with subclinical TSH results were prescribed medication for the condition, although TSH levels often stabilize as a pregnancy progresses.

Further, 44 percent of those diagnosed continued to take the medication after giving birth, and about one-third continued taking the substitute thyroid hormone during the postpartum year.  As noted by researchers, “Current patterns of practice for TSH testing and management may contribute to overdiagnosis and overtreatment of women during pregnancy and post-partum.”

Appropriate medication practices can be a lifesaver. Inappropriate medication practices can unnecessarily expose pregnant women and their babies to medications they do not need.

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