SUMMARY OF THE STUDY
The authors examined a large US medical claims database and identified 7990 pregnant women who were diagnosed with subclinical hypothyroidism between January 2010 and December 2014. They found that only 1214 (15.2%) received treatment with levothyroxine. Treatment was more likely in women who a) had higher TSH levels, b) were obese, c) had recurrent miscarriages, d) had thyroid disease before their pregnancy and e) were cared for by an endocrinologist as opposed to a gynecologist or primary care physician. Moreover, endocrinologists started levothyroxine at lower TSH levels than other specialties.
Women who lived in the Northeast and Western US were more likely to receive levothyroxine treatment compared with other regions. Asian women were more likely, whereas Hispanic women were less likely to receive levothyroxine when compared to white women. Finally, the proportion of women treated with levothyroxine increased over time; levothyroxine treatment was twice as likely in 2014 as in 2010, perhaps because in 2012 the Endocrine Society Published guidelines recommending levothyroxine treatment for all pregnant women with subclinical hypothyroidism.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
There is large variation in the treatment practices for subclinical hypothyroidism during pregnancy among endocrinologists, gynecologists and primary care physicians, especially when the TSH is only mildly elevated. Patient characteristics and geographic location also influence the likelihood of levothyroxine therapy and, taken together, these findings suggest ongoing disparities in health access and quality which merits further research.
— Philip Segal, MD