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Endocrine Abstracts (2022) 84 PS3-13-122 | DOI: 10.1530/endoabs.84.PS3-13-122

ETA2022 Poster Presentations Pregnancy & Iodine (9 abstracts)

Preconception tsh levels and early gestation maternal thyroid function in a large cohort of women with hashimoto’s thyroiditis (ht) diagnosed preconceptionally

Mariacarla Moleti 1 , Maria Di Mauro 1 , Giuseppe Paola 1 , Laura Perdichizzi 1 , Marta Ragonese 1 , Roberta Granese 1 , Angela Alibrandi 2 & Francesco Vermiglio 3


1University of Messina, Italy; 2Department of Economy Unit of Statistical and Mathematical Sciences, University of Messina, Italy; 3University of Messina, Messina, Italy


Several lines of evidence indicate an increased risk of adverse gestational outcomes in women with Hashimoto’s thyroiditis (HT) already as of TSH levels at early pregnancy >2.5mU/l, and definitely greater for TSH concentration >4mU/l. The latest guidelines recommend preconception TSH levels (pre-C-TSH) in HT women be maintained below 2.5mU/l, this threshold being expected to prevent hypothyroidism occurrence at early gestation.

Objectives: To perspectively evaluate: i) whether maintaining pre-C-TSH values <2.5mU/l in HT women was effective in preventing the occurrence of early gestation thyroid insufficiency, defined by TSH >2.5mU/l (diagnostic criteria 1) or >4.0mU/l (diagnostic criteria 2) at early gestation; ii) the cut-off values of TSH that would best preconceptionally identify euthyroidism at early gestation in HT women, by means of Receiver-Operating Characteristic (ROC) curves.

Methods: Two-hundred and sixty women preconceptionally diagnosed with HT and pre-C-TSH <2.5 mU/l, whose thyroid function was prospectively monitored from pre-conception up to pregnancy term.

Results: Of the 260 women, 122/260 (46.9%) were on LT4 therapy (Hypo-HT group) and 138/260 (53.1%) were confirmedly euthyroid without LT4 (Eu-HT group) prior to conception. At 1st trimester, 37/122 (30.3%) Hypo-HT women had TSH >2.5mU/l, with almost 2/3 of these women (24/37, 64.9%) displaying TSH values >4.0mU/l. Analogously, at 1st trimester evaluation TSH was >2.5mU/l in 42/138 (30.4%) EU-HT women, but >4.0 mU/l in 14/138 (10.1%) only. The optimal pre-conception TSH cut-offs found were 1.24mU/l and 1.73 mU/l for the diagnostic criteria 1 in Hypo-HT and Eu-HT women, respectively, and 1.74 mU/l and 2.07 mU/l for the diagnostic criteria 2 in Hypo-HT and Eu-HT women, respectively. Applying the above cut-offs, the relative risk reduction (RRR) of early gestational thyroid insufficiency was 82.7% and 94.0% for the diagnostic criteria 1 in Hypo-HT and Eu-HT women, respectively, and 82.5% and 97.9% for the diagnostic criteria 2 in Hypo-HT and Eu-HT women, respectively.

Conclusions: In our series, about one third of HT women whose pre-C TSH were in the range recommended by current guidelines (<2.5mU/l) required to increase or to start LT4 therapy once pregnant because of TSH levels exceeding the advisable TSH threshold at early pregnancy. In contrast, a more than halved rate of HT women whose pre-C serum TSH was below the calculated cut-offs was found to have unsatisfactory thyroid function at their first antenatal visit. The identification of population-specific pre-conception TSH cut-offs is in our view indicated, to optimize maternal thyroid function of HT women prior to conception.

Volume 84

44th Annual Meeting of the European Thyroid Association (ETA) 2022

Brussels, Belgium
10 Sep 2022 - 13 Sep 2022

European Thyroid Association 

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