QI Project to Improve Thyroid Function Assessment in Early Pregnancy in Women with Known Hypothyroidism

Background
Hypothyroidism possible implications:
-Maternal: period problems, subfertility, miscarriage, pre-eclampsia, hypertension in pregnancy, IUGR, postpartum haemorrhage
- Neonatal: adverse neonatal outcomes, premature birth, low birth weight, neonatal respiratory distress, deafness, three times more likely to have IQ 1 SD below the mean of controls.

Recommendation from British Thyroid Foundation: As soon as woman is pregnant, GP to:
Increase levothyroxine by 25-50mcg (30% increase)
- 25mcg in those on≤100mcg - 50mcg in those on >100mcg
Immediately perform thyroid function tests (TFT) as soon as pregnancy is confirmed
Refer to endocrine antenatal clinic
Aim: Review thyroid function assessment in early pregnancy in women with pre-existing hypothyroidism
Standard: TFT should be performed as soon as women are pregnant (before < 8 weeks gestation) – 75% target