Pregnancy is a period that places great physiological stress on both the mother and the fetus. When pregnancy is compounded by endocrine disorders such as hypothyroidism, the potential for maternal and fetal adverse outcomes can be immense. While a lot of attention has been focused on the adverse fetal outcomes consequent to hypothyroidism, attention is also being gradually directed towards the adverse maternal outcomes of this disorder. Role of antibody positivity in influencing outcomes in a euthyroid woman, also needs further clarification. Prompt diagnosis and treatment of hypothyroidism in pregnancy is very essential. Subclinical hypothyroidism also needs to be detected and treated to prevent adverse outcomes, especially maternal. Since women with hypothyroidism during pregnancy, especially of the autoimmune variety might have a flare up of the disorder post-partum, or might continue to require thyroxine replacement post-partum, adequate follow-up is mandatory. While targeted case finding is generally practised, recent evidence seems to indicate that universal screening might be a better option. In conclusion, routine screening, early confirmation of diagnosis and prompt treatment. Allied with regular post-partum follow up, is required to ensure favourable maternal and fetal outcomes.

1. Deficiency of thyroid hormone in pregnancy can lead to:
• Miscarriage
• Hypertension or fits during pregnancy
• LBW baby
• Intra Uterine Death
• Preterm birth
• Respiratory distress and consequent hospitalisation
• Possibility of a birth defect or low IQ baby
• Excessive bleeding during delivery

2. TSH level (mU/L)
milliunits per liter
Not on Drug
On Drug
Additional dose
Management in Post Partum Period
I
Trimester
II/ III
Trimester
Not on Drug On Drug
Up to 2.5 Up to 3 No Drug
25mcg
No Drug
Pre-pregnant Dose
to be Resumed
Between
2.6 to10
Between
3 to10
25mcg
More than 10 50 mcg
Same dose to be
Continued
Less than 0.1 No Drug Reduce dose by 25 mcg, If on 25 mcg reduce by 12.5 mcg.
TSH level to be repeated 6 weeks postpartum,
Further treatment as required.
Management of Hypothyroidism during Pregnancy
Source: National Guidelines for Screening of Hypothyroidism during Pregnancy