No MTP in Hypothyroidism

·         Please don’t kill me . I am an truly Indian, No MTP in Cub clinical Hypo:: Patients with SCH, at any gestation: Treat as per guidelines, with l-thyroxine. Do not consider MTP.

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·         Patients with OH, beyond 20 weeks gestation: Treat as per guidelines, with l-thyroxine. Do not consider MTP.

·         Patient with OH, below 20 weeks gestation: Treat as per guidelines, with l-thyroxine. If conception has occurred without difficulty, and OH is “severe," take a final decision after discussing all aspects with the patient. MTP cannot be recommended at present unless there is a request from the patient.

Conclusion

Maternal hypothyroidism is relatively common and may not be diagnosed (and therefore not treated) during pregnancy. This may even remain undiagnosed for several months after delivery. Currently it seems unclear as to how detrimental this may be for the development of the neonate. The consequences of maternal hypothyroidism on the fetus or neonate are probably the result of interplay of several factors acting, such as decreased availability of maternal thyroid hormones at crucial times in fetal brain development, obstetric events associated with maternal hypothyroidism, and possibly prolonged concealed maternal hypothyroidism during pregnancy. Ethically important but debatable issue is whether clinicians should recommend terminating pregnancy when severe hypothyroidism is diagnosed late in gestation. Present consensus among obstetric care providers and endocrinologists is against recommending abortion, but despite the administration of thyroxine, future parents cannot be fully reassured about potential brain damage as a result of longstanding and severe intrauterine undiagnosed hypothyroidism. Keeping in view the nature of the condition, it seems highly unlikely that any randomized clinical trial will ever be done to assess the TSH level cut-off at which MTP must be the advised.

 Any discussion regarding this will necessarily court controversy, skirting with the gray zones of eugenics, ethics, public health, obstetrics, and endocrinology. Decision making will vary from region to region, depending on the level of iodine intake, and the frequency and severity of OH in pregnancy. It will also vary between clinicians, based on personal clinical experience, and from patient to patient, based on personal attitudes, beliefs, and practices regarding abortion. Often, the decision may be taken because of “non-endocrine” issues or other obstetric-related factors, with OH being just a contributory factor favoring MTP.

This editorial should stimulate constructive debate and meaningful research in this area so that an evidence-based consensus is evolved over a period of time.