Last reviewed: November 2017
Last updated: November  2017

Important updates

Updated management parameters for pregnant women with thyroid disease

The 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum clarify the parameters clinicians can use in shared decision making for the management of thyroid disease in pregnant women. The guidelines include areas of uncertainty, for example subclinical hypothyroidism, and examine whether women with subclinical hypothyroidism should be treated in pregnancy.

The American Thyroid Association recommends the following:

  • Maternal hypothyroidism is defined as a thyroid-stimulating hormone (TSH) concentration elevated beyond the upper limit of the pregnancy-specific reference range.

  • Pregnant women with TSH concentrations >2.5 milli-international units/L (mIU/L) should be evaluated for thyroid peroxidase antibody (TPOAb) status.

Levothyroxine therapy is recommended for:

  • Women who are TPOAb-positive with a TSH greater than the pregnancy-specific reference range.

  • Women who are TPOAb-negative who have a TSH greater than 10.0 mIU/L.

See Management: approach

Original source of update



History and exam

Other diagnostic factors

  • weakness
  • lethargy
  • cold sensitivity
  • constipation
  • weight gain
  • depression
  • menstrual irregularity
  • myalgia
  • dry or coarse skin
  • eyelid edema
  • thick tongue
  • facial edema
  • coarse hair
  • bradycardia
  • deep voice
  • diastolic hypertension with or without narrow pulse pressure
  • delayed relaxation of tendon reflexes
  • goiter

Risk factors

  • iodine deficiency
  • female sex
  • middle age
  • FHx of autoimmune thyroiditis
  • autoimmune disorders
  • Graves disease
  • postpartum thyroiditis
  • Turner and Down syndromes
  • type 1 diabetes
  • primary pulmonary hypertension
  • multiple sclerosis
  • radiation therapy
  • infiltrative disease
  • iodine excess
  • amiodarone use
  • lithium use
  • textile workers

Diagnostic investigations

Investigations to consider

  • free serum T4
  • serum cholesterol
  • CBC
  • fasting blood glucose
  • serum CK
  • serum sodium
  • antithyroid peroxidase antibodies
Full details

Treatment algorithm


Authors VIEW ALL

Adjunct Clinical Professor

Department of Family Medicine

University of North Carolina

Chapel Hill



WM declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Medicine

Chair of Family Medicine

University of Chicago Medical Center




BE declares that he has no competing interests.

Consultant Endocrinologist

Queen Elizabeth Hospital




SR declares that he has no competing interests.

Consultant Physician

Caerphilly Miners' Hospital




LP declares that he has no competing interests.

Associated Professor

Consultant Endocrinologist

Herlev Hospital

University of Copenhagen



BN declares that she has no competing interests.

Professor of Internal Medicine

Endocrinology Division Chief

Texas Tech University Health Sciences Center - School of Medicine




JL declares that he has no competing interests.

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