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  • Title: Weight-based thyroid dosing vs fixed dosing during pregnancy for subclinical hypothyroidism: A retrospective cohort study.
    Author: Bohlega B, Zahedi A, Tomlinson G, Feig DS.
    Journal: Clin Endocrinol (Oxf); 2022 Feb; 96(2):263-269. PubMed ID: 33891710.
    Abstract:
    OBJECTIVE: Thyroid hormones play a crucial role in foetal growth and neurocognitive development. Our aim was to compare a weight-based dosing method of starting thyroxine to a fixed-dose method in newly diagnosed women with subclinical hypothyroidism during pregnancy. DESIGN: We performed a retrospective cohort study of consecutive women with newly diagnosed subclinical hypothyroidism during pregnancy seen at Mount Sinai Hospital and Women's College Hospital, Toronto, Canada 2015-2018. PATIENTS: We identified women that were treated based on pre-pregnancy weight and those that were given a fixed dose of 50 mcg/day. MEASUREMENTS: The percent of women who reached the target TSH of <2.5 mIU/L within 4-8 weeks was compared using a chi-squared test and a logistic regression model, adjusting for age, initial TSH and gestational age treatment was started. RESULTS: 393 women were included: 252 treated using a fixed-dose approach; 141 treated based on pre-pregnancy weight. In the unadjusted analysis, there was no difference between the groups in the percentage of women in the target range within 4-8 weeks (89.6% in the fixed-dose group vs 88.8% in the weight-based group (p = .954)). However, after adjustment for between-group differences in age, initial TSH and gestational age treatment was started, there was a significantly greater odds of achieving the target range using the weight-based dosing (OR 4.26 (1.60-11.7), p = .004). CONCLUSIONS: Treating women with newly diagnosed subclinical hypothyroidism during pregnancy with a weight-based strategy increased the odds of reaching the target TSH range within 4-8 weeks. Clinicians caring for these women should consider this approach when starting treatment during pregnancy.
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