Thyroid and Pregnancy#3
2-17% of pregnant have thyroid TPO antibodies.Most common in Caucasian and Asian but not African Americans. Eythyroid females with positive TPO antibodies need TSH testing every 4 weeks during the mid-pregnancy. Stay away from Selenium during pregnacy. It is not recommended even though this is weak on data. There is an association with TPO and fetal loss but no evidence it is the cause.In recurrent pregnancy loss is not recommended to use IV immunoglobulins with weak evidence. Small doses of T4 25-50 mcgs in females with recurrent fetal loss is recommended but wit weak evidence. Antibody positive pregnancy is associated with increased pre-term delivery.No evidence that treatment with T4 in TPO positive pregnancy reduces early delivery. TSH and TPO testing in all seeking care for infertility. T4 treatment for all infertile with hypothyroidism. Subclinical hypothyroidism in infertile females needs T4 treatment to decrease TSH to <2.5 mU/L.Pregnant females with TSH>2.5 mU/L should be tested for TPO antibodies. TPO negative females should be treated when TSH is >10mU/L.