Hypothyroidism is a common endocrine condition and if untreated can have serious consequences in pregnant women. Generally, TSH receptor antibodies (TRAb) is performed in hyperthyroid pregnant women as high titres can cause foetal hyperthyroidism Neonatal thyrotoxicosis develops in 1% of infants born to thyrotoxic mothers due to placental transfer of TRAb.
As part of management of hypothyroid pregnant women, TRAb are checked routinely in our hospital in keeping with our trust guidelines in order to minimise the remote incidence of neonatal thyrotoxicosis. In literature there is no evidence to support this practice as routine guideline. Therefore a retrospective consecutive audit was carried out on diagnosed hypothyroid patients attending antenatal clinic in Queen Elizabeth Hospital, Kings lynn from 01/01/2013 to 31/12/2014. Two practices were looked at.
Results of TRAb performed in hypothyroid pregnant women. Any cases of neonatal thyrotoxicosis in patients with positive TRAb. Out of 74 patients audited, 56.75%patients had TRAb checked. 6.75% patients were positive for TRAb, 50% were negative and 43.24% did not have them checked. There were no cases of neonatal thyrotoxicosis seen in any patient included in this audit.
As a result of this audit we concluded that it is safe not to perform TRAB routinely in hypothyroid pregnant women. It is not only cost effective (one TRAb costs £39.16) but would reduce unnecessary work load and anxiety for patients.