ArticleEndocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists2025
Assessing the Quality of Care of Pregnant Patients With Thyrotoxicosis at an Urban Safety Net Hospital.
Article in Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThyrotoxicosis can adversely affect pregnancy. The quality of care (QoC) for thyrotoxicosis in pregnancy at a tertiary care safety net hospital was evaluated based on current guidelines.
methodsPregnant patients with thyrotoxicosis or a history of Graves disease who delivered in 2015-2021 were divided into 3 groups: low thyroid stimulating hormone (TSH), active Graves disease, and past Graves disease. The QoC was assessed using thyroid hormone and thyroid stimulating immunoglobulin (TSI) levels, fetal ultrasound, and endocrine referrals. We assessed potential impacts of race/ethnicity and socioeconomic status (SES).
resultsWe included 147 subjects (mean age 31.5 years, 76% Black, 86% non-Hispanic). Of patients with low TSH (n = 95), 75% had repeat TSH measurements and 33% had TSI measured. Hispanic patients were more likely to have TSI and repeat TSH measured than non-Hispanics (58% vs 29%; P = .04, and 100% vs 71%; P = .03, respectively). In patients with active Graves disease (n = 23, 70% treated with thionamides), 35% had free thyroxine levels at goal and 90% had endocrine care or referral. In patients with past Graves disease (n = 27), 56% had TSI measured, 78% had first-trimester TSH measurements, and 58% had TSH at goal. Black patients were less likely to have TSH checked in the first trimester than other races (85% vs 100%, P = .048).
conclusionThe QoC of thyrotoxicosis in pregnancy at this tertiary care center can be improved. A larger study is needed to assess the potential impacts of race and SES on the care of pregnant patients with thyrotoxicosis.
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