SFEBES2025 Oral Communications Thyroid (6 abstracts)
Pre-gestational and gestational care of hypothyroid women at cambridge university hospital nhs foundation trust (CUH)
Wut Yee Win 1 , Htet Htet Aung 2 , Nyan Tun Lin 1 , Shazia Bhatti 1 , Katarzyna Gajewska-knapik 1 , Isra Ahmedmohamed 1 & Nadia Schoenmakers 3
1Cambridge University Hospital, Cambridge, United Kingdom; 2Watford General Hospital, Watford, United Kingdom; 3Queen Elizabeth Hospital, Birmingham, United Kingdom
Introduction: Inadequate hypothyroidism management during pregnancy can jeopardize obstetric outcomes, therefore optimal pre-conceptual and antenatal care are mandatory. This audit compares care at CUH with standards specified in local guidelines based on the American Thyroid Association recommendations (2017).
Aims and Objectives: • Evaluate pre-conceptual and antenatal management of hypothyroidism at CUH• Assess the reasons for deviation from local standards.• Develop a plan to improve future care in this area.
Method: A retrospective review of notes was conducted for 272 women with hypothyroidism or a need for levothyroxine during pregnancy at CUH. The study assessed adherence to local guidelines and categorized non-compliance based on whether the patient was in primary care or receiving care at CUH.
Results: The following results were observed against the established standards.
| Standard | Result(met) | CUH(non-compliant) | Primary-care(non-compliant) |
| TSH<2.5 mU/l at conception | 49% | 19% | 81% |
| TFT checked following positive pregnancy test | 75% | 39% | 61% |
| Levothyroxine increased appropriately | 70% | 26% | 74% |
| TFT and TSI checked at first contact | 83% | 7% | 93% |
| TFT checked at advised frequency | 83% | 21% | 79% |
| Mean TSH<3 mu/l | 78% | Not applicable | |
| TSI checked at 28 weeks | 70% checked at/after 28 weeks, 36% checked before 28 weeks. | ||
| Appropriate foetal and neonatal monitoring if TSI positive at 28 weeks | 5% were positive (66% referred to neonatology, 22% moved centre, 11% not referred to neonatology) | ||
| TFT checked 6 weeks postpartum | <50% (limited data, recommended post-discharge in primary care) | ||
| Aim:100% for all but >80% for 6 weeks post-partum TFT checks. TFT-Thyroid function testTSI-Thyroid stimulating immunoglobulinTSH-Thyroid stimulating hormone | |||
Conclusion: Although adherence to local standards was excellent in some domains, this audit highlighted inadequacies, especially in achieving a pre-conceptual TSH of <2.5mU/l. To address this, a card has been designed for patients with hypothyroidism to summarize the key management requirements in preconceptual and antenatal care.
Volume 109
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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