6
Assessment
Î Excessive doses of iodine exposure during pregnancy should be
avoided except in preparation for the surgical treatment of Graves'
disease. Clinicians should carefully weigh the risks and benefits when
ordering medications or diagnostic tests that will result in high iodine
exposure. (S-M)
Î Sustained iodine intake from diet and dietary supplements exceeding
500 μg daily should be avoided during pregnancy due to concerns
about the potential for fetal thyroid dysfunction. (S-M)
Thyroid Auto-Antibodies & Pregnancy Complications
Î Euthyroid, but thyroid peroxidase (TPO) or thyroglobulin (Tg) antibody
positive, pregnant women should have measurement of serum TSH
concentration performed at time of pregnancy confirmation, and every
4 weeks through mid-pregnancy. (S-H)
Î Selenium supplementation is NOT recommended for the treatment of
TPOAb-positive women during pregnancy. (W-M)
Î Intravenous immunoglobulin treatment of euthyroid women with a
history of recurrent pregnancy loss is NOT recommended. (W-L)
Î There is insufficient evidence to conclusively determine whether LT4
therapy decreases pregnancy loss risk in TPOAb-positive, euthyroid
women who are newly pregnant. However, administration of LT4 to
TPOAb-positive, euthyroid pregnant women with a prior history of
loss may be considered given its potential benefits in comparison to
its minimal risk. In such cases, 25–50 mcg of LT4 is a typical starting
dose. (W-L)
Î There is insufficient evidence to recommend for or against treating
euthyroid, thyroid autoantibody positive pregnant women with LT4 to
prevent preterm delivery. (I)
