title: Management of thyroid disease in pregnancy - Room for improvement in the first trimester.
abstract: BACKGROUND
  First-trimester care of maternal thyroid dysfunction has previously been shown to be poor. This study evaluates early management of thyroid dysfunction in pregnancy in Australia.
  
  
  METHODS
  Patients reviewed by the Obstetric Medicine team for thyroid dysfunction from 1 January 2012 to 30 June 2013 were included. Data were collected on gestation at referral from the patient's general practitioner to the antenatal clinic, information provided in the referral letter, thyroid function tests and thyroid medications.
  
  
  RESULTS
  Eighty-five women were included in the study. At the time of general practitioner referral to antenatal services, 19% of women with preexisting thyroid disease had no thyroid function tested. Forty-three percent had an abnormal thyroid-stimulating hormone defined as being outside the laboratory-specific pregnancy reference range if available, or outside the level of 0.1-2.5 mIu/L in the first trimester, 0.2-3.0 mIu/L in the second trimester and 0.3-3.0 mIu/L in the third trimester. Only 21% of women increased their thyroxine dose prior to their first antenatal clinic review.
  
  
  CONCLUSIONS
  This study highlights that a significant proportion of women with known thyroid disease either have untested thyroid function in the first trimester or a thyroid-stimulating hormone outside of levels recommended by guidelines.
authors.affiliation: School of Medicine, Faculty of Medicine and Biomedical Sciences, University of Queensland, Queensland, Australia; Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Queensland, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Robinson
authors.affiliation: School of Medicine, Faculty of Medicine and Biomedical Sciences, University of Queensland, Queensland, Australia; Department of Rheumatology, Royal Brisbane and Women's Hospital Queensland, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Robinson
authors.affiliation: School of Medicine, Faculty of Medicine and Biomedical Sciences, University of Queensland, Queensland, Australia; Department of Endocrinology, Royal Brisbane and Women's Hospital, Queensland, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: D'Emden
authors.affiliation: School of Medicine, Faculty of Medicine and Biomedical Sciences, University of Queensland, Queensland, Australia; Department of Obstetrics and Gynaecology, Ipswich Hospital, Queensland, Australia.
authors.forename: Kassam
authors.initials: K
authors.lastname: Mahomed
keywords: Thyroid; first trimester; general practitioner; pregnancy; triage