Hypothyroidism
20
Flowchart 2. Approach to Increased TSH Levels in Pregnancy
Start
levothyroxine
Consider starting
levothyroxine
Low FT4
TSH <6 mU/L
c
Consider
confirmation test
after 1–3 weeks
TSH ≥6 mU/L
Confirmed overt
hypothyroidism
Overt
hypothyroidism
No additional follow-up,
unless risk factors (Table 1)
Normalized TSH
Green boxes indicate a diagnosis, yellow boxes indicate an action, and orange boxes indicate
recommended follow-up.
a
Women with a high TSH have a higher risk of TPOAb positivity. TPOAb positivity can be used
for counseling on postpartum thyroiditis and guide screening in future pregnancies.
b
Or alternatives as described in the thyroid function testing subsection of this guideline.
