임신 중 TSH가 2.5 mU/L보다 적은 경우

임신 중 TSH가 2.5 mU/L보다 적은 경우....T4 치료는 필요하지 않음

TSH between the trimester-specific lower limit of normal and 2.5 mU/L

– These women are euthyroid and do not require T4 treatment.

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이전에는 치료는 재발성 유산의 과거력이 있고 TPO 항체가 양성인 경우 갑상선 호르몬 치료(T4, 매일 50 mcg)를 한다고 하였으나 변경.

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이전 알고리즘

이전 알고리즘

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TSH between the trimester-specific lower limit of normal and 2.5 mU/L

– These women are euthyroid and do not require T4 treatment.

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Management of pregnant women with or at risk for hypothyroidism

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Refer to UpToDate content on screening for thyroid dysfunction during pregnancy for identification of pregnant women at risk for hypothyroidism.

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TSH: thyroid-stimulating hormone; TPO: thyroid peroxidase antibodies; T4: thyroxine.

* 4 mU/L or population and trimester-specific upper limit of normal, if available.

¶ The presence of TPO antibodies guides management of pregnant women. It informs the extent of autoimmunity, the risk of pregnancy loss, and the risk of postpartum thyroid dysfunction.

Δ Free T4 should be interpreted using assay method and trimester-specific reference ranges.

◊ For women at high risk for developing hypothyroidism (eg, radioiodine treatment, hemithyroidectomy, exposure to high-dose irradiation of the head and neck), monitor TSH at least once more during the first trimester and again mid-pregnancy. Treat with levothyroxine if TSH rises above 4 mU/L.

§ Suggestion is based upon weak evidence. The approach to management varies. If a decision is made not to treat, measure TSH approximately every 4 weeks during the first trimester, then once in each of the second and third trimesters to monitor for the development of hypothyroidism. Treat with levothyroxine if TSH rises above 4 mU/L.

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모니터링은? 임신중 갑상선기능저하증 발생 위험이 높은 군의 경우에 임신 중 TSH 평가는 임신 첫 1분기는 4주마다, 2분기/3분기는 각 분기별로 시행하며 만일 TSH가 약 4 mU/L 이상으로 오르면 T4 치료를 시애합니다.

In pregnant women who are not treated with thyroid hormone and who are at particularly high risk for developing hypothyroidism during pregnancy (TPO antibody-positive, post-radioiodine treatment, post-hemithyroidectomy, history of exposure to high-dose irradiation of the head or neck region), we reassess TSH during pregnancy (eg, approximately every four weeks during the first trimester, and then once during each of the second and third trimesters). If TSH rises above the population and trimester-specific upper limit of normal (approximately 4 mU/L), we begin treatment with T4.

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REF. UpToDate 2019.07.06