# Women with Autoimmune Thyroiditis Taking Levothyroxine During Pregnancy: Is Iodine Supplementation Needed?

## TL;DR

This study finds that women with autoimmune thyroiditis taking levothyroxine during pregnancy may still need iodine supplements to maintain proper iodine levels for fetal development.

## Contribution

The study provides evidence that iodine supplementation remains necessary for L-T4-treated pregnant women with autoimmune thyroiditis.

## Key findings

- ICS users had significantly higher UI/Creat levels compared to non-users.
- ICS use was the only independent predictor of UI/Creat ≥ 150 μg/g.
- Newborns of ICS users had higher neonatal TSH levels.

## Abstract

Background: Iodine is fundamental for the synthesis of thyroid hormones, which play a central role in foetal neurological development. The need for an iodine-containing supplement (ICS) in L-T4-treated women during pregnancy is still a subject of debate. Aim of the Study: The aim of the study is to investigate the iodine status in women with autoimmune thyroiditis (AT) who have or have not been treated with L-T4. Methods: This was a cross-sectional, observational study involving pregnant women with AT, treated with/without L-T4. Upon enrolment, women provided a urine sample (to measure the urinary iodine concentration (UIC), which was normalised to urinary creatinine values (UI/Creat)), and completed a questionnaire. TSH, FT4, and neonatal TSH were also obtained. Results: Among women taking an ICS, 74.1% had a UI/Creat level ≥ 150 μg/g, compared with only 46.2% of those not taking an ICS (p = 0.03). Among L-T4 users only, a UI/Creat level ≥ 150 μg/g was more frequent in ICS users than in non-ICS users (72.8% vs. 41.7%) (p = 0.03). In the multivariate analysis, ICS use was the only independent variable for UI/Creat ≥ 150 μg/g (OR: 3.4; CI: 1.1–10.9) (p = 0.04). There was a tendency towards higher UI/Creat levels as the L-T4 (µg/Kg) dosage increased, although no correlation was found. Newborns of women taking an ICS were found to have elevated neonatal TSH (2.8 mIU/L vs. 1.7 mIU/L) (p = 0.04). All newborns with a TSH >5 mUI/L were those of women taking supplements. Conclusions: Women with AT taking L-T4 still need iodine supplementation, although the amount should be regulated on the basis of their L-T4 dosage.