TY  - BOOK
AU  - Burman, Kenneth D
AU  - Downs, Erin
AU  - Jonklaas, Jacqueline
AU  - Popoveniuc, Geanina
AU  - Sullivan, Shannon D
AU  - Zeymo, Alexander
TI  - Randomized Trial Comparing Two Algorithms for Levothyroxine Dose Adjustment in Pregnant Women With Primary Hypothyroidism
SN  - 0021-972X
PY  - 2017///
KW  - IN PROCESS -- NOT YET INDEXED
KW  - MedStar Washington Hospital Center
KW  - Medicine/Endocrinology
KW  - Journal Article
N1  - Available online through MWHC library: 1999- June 2013, Available in print through MWHC library: 1999 - 2006
N2  - Conclusions: We compared two options for LT4 dose adjustment and showed that an ongoing adjustment approach is as effective as empiric dose increase for maintaining goal TSH in hypothyroid women during pregnancy; Context: Regulation of maternal thyroid hormones during pregnancy is crucial for optimal maternal and fetal outcomes. There are no specific guidelines addressing maternal levothyroxine (LT4) dose adjustments throughout pregnancy; Design: Thirty-three women on stable LT4 doses were recruited at <10 weeks gestation during 38 pregnancies and randomized to one of two dose-adjustment groups. Group 1 (G1) used an empiric two-pill/week dose increase followed by subsequent pill-per-week dose adjustments. In group 2 (G2), LT4 dose was adjusted in an ongoing approach in micrograms per day based on current thyroid stimulating hormone (TSH) level and LT4 dose. TSH was monitored every 2 weeks in trimesters 1 and 2 and every 4 weeks in trimester 3; Main Outcome Measure: Proportion of TSH values within trimester-specific goal ranges; Objective: To compare two LT4 dose-adjustment algorithms in hypothyroid pregnant women; Results: Mean gestational age at study entry was 6.4 +/- 2.1 weeks. Seventy-five percent of TSH values were within trimester-specific goal ranges in G1 compared with 81% in G2 (P = 0.09). Similar numbers of LT4 dose adjustments per pregnancy were required in both groups (G1, 3.1 +/- 2.0 vs G2, 4.1 +/- 3.2; P = 0.27). Women in G1 were more likely to have suppressed TSH <0.1 mIU/L in trimester 1 (P = 0.01). Etiology of hypothyroidism, but not thyroid antibody status, was associated with proportion of goal TSH values; Setting: Academic endocrinology clinics in Washington, DC
UR  - https://dx.doi.org/10.1210/jc.2017-01086
ER  -