title: Obstetric Outcomes of an Afro-Caribbean Cohort Following Universal Screening and Treatment of Subclinical Hypothyroidism.
abstract: OBJECTIVE
  Restoration of euthyroidism with l-thyroxine reportedly reduces obstetric complications associated with subclinical hypothyroidism (SCH). The objective was to determine if obstetric outcomes of treated subjects were equivalent to euthyroid subjects.
  
  
  METHODS
  This was a prospective cohort study. Subjects were considered euthyroid if serum thyroidstimulating hormone (TSH) was 0.4-3 mIU/L and free thyroxine (FT4) 10.29-17.05 pmol/L with negative thyroid peroxidase antibodies (TPOAb). Subclinical hypothyroidism was diagnosed if FT4 was 10.29-24.45 pmol/L and TSH 2.5-3 mU/L with positive TPOAb, or TSH > 3.0 mU/L regardless of antibody status. Subclinical hypothyroidism subjects were treated with l-thyroxine until TSH < 2.5 mIU/L. Data were analysed with Stata (StataCorp, USA).
  
  
  RESULTS
  Seven hundred and sixty-nine singleton pregnancies were screened; 96% at 14 weeks gestation. Five hundred and eleven (66%) were euthyroid by study definition. Prevalence of SCH was 1.9% (15/769); 26% (4/15) were TPOAb positive. Eighty-one per cent were treated according to protocol; compliance was 54%. Mean gestational age (GA) at first endocrinologist visit was 22.7 ± 2.7 weeks. Normal TSH was documented in 36% at GA 33 ± 2.94 weeks. Subjects with SCH had significantly greater pre-existing history of preterm premature rupture of membranes (PPROM) and preterm labour, Caesarean sections for non-reassuring fetal heart rate and neonatal necrotizing enterocolitis.
  
  
  CONCLUSIONS
  L-thyroxine appeared to reduce obstetric complications. However, prevalence of SCH was low and compliance was < 50%.
authors.affiliation: Department of Obstetrics and Gynaecology, The University of the West Indies, Kingston 7, Jamaica. E-mail: nadinej@cwjamaica.com.
authors.forename: N
authors.initials: N
authors.lastname: Johnson
authors.affiliation: Department of Obstetrics and Gynaecology, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: A-K
authors.initials: AK
authors.lastname: Taylor-Christmas
authors.affiliation: Department of Obstetrics and Gynaecology, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: V
authors.initials: V
authors.lastname: Chatrani
authors.affiliation: Department of Chemical Pathology, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: E
authors.initials: E
authors.lastname: Choo-Kang
authors.affiliation: Department of Microbiology, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: M
authors.initials: M
authors.lastname: Smikle
authors.affiliation: Department of Medicine, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: R
authors.initials: R
authors.lastname: Wright-Pascoe
authors.affiliation: Department of Medicine, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: K
authors.initials: K
authors.lastname: Phillips
authors.affiliation: Tropical Medicine Research Institute, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: M
authors.initials: M
authors.lastname: Reid
keywords: Hypothyroidism; obstetric outcomes; subclinical