Levothyroxine dose adjustment in hypothyroid women achieving pregnancy through IVF

Abstract

Objective: About one out of two women with primary hypothyroidism has to increase the dosage of exogenous levothyroxine (L-T4) during pregnancy. Considering the detrimental impact of IVF on thyroid function, it has been claimed but not demonstrated that L-T4 dose adjustment may be more significant in hypothyroid women who become pregnant after IVF. Design: Retrospective cohort study. Methods: Hypothyroid-treated women who achieved a live birth through IVF were reviewed. Women could be included if thyroid function was well compensated with L-T4 before the IVF cycle (i.e., serum TSH < 2.5 mIU/l and serum free T4 within the normal range). Serum TSH and dose adjustment were evaluated at five time points during pregnancy. The trimester ranges for serum TSH considered as reference to adjust L-T4 therapy were 0.1-2.5 mIU/l for the first trimester, 0.2-3.0 mIU/l for the second trimester, and 0.3-3.0 mIU/l for the third trimester. Results: Thirty-eight women were selected. During the whole pregnancy 32 women (84%; 95% CI: 72-96%) required an increase in the dose of L-T4. In most cases (nZ28), this occured within the first 5-7 weeks of gestation (74%, 95% CI: 58-85%). At 5-7 weeks of gestation, the median (interquartile range) increase of L-T4 dose for the whole cohort was 26% (0-50%). At 30-32 weeks, it was 33% (14-68%). In order to identify predictive factors of dose adjustment, we compared women who did (nZ28) and did not (nZ10) adjust L-T4 dosage at 5-7 weeks' gestation. Significant differences emerged for thyroid autoimmunity prevalence and for the distribution of hypothyroidism aetiology. Conclusions: The vast majority of hypothyroid-treated women who achieve pregnancy through IVF need an increase in the L-T4 dose during gestation. This requirement tends to occur very early during gestation.