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\begin{document}

\title{Thyroid Function Control among Pregnant Women Following a Therapeutic
Thyroidectomy}



\author[1]{Gilad Horowitz}%
\author[2]{Maya  Ish-Shalom}%
\author[2]{Anton Warshavsky}%
\author[2]{Naftali  Stern }%
\author[1]{Dan Fliss}%
\author[3]{Doron  Comaneshter}%
\author[4]{Shlomo  Vinker}%
\affil[1]{Tel Aviv Sourasky Medical Center}%
\affil[2]{Tel Aviv Ichilov-Sourasky Medical Center}%
\affil[3]{Clalit Health Services}%
\affil[4]{Tel Aviv University Sackler Faculty of Medicine}%


\vspace{-1em}



  
  \date{June 18, 2024}


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\begin{abstract}
Background: The total number of thyroidectomies performed worldwide both
for benign and malignant disease has increased dramatically during the
past few decades. Gestational hypothyroidism has deleterious effects on
the fetus. Objective: The aim of this study was to assess the extent of
thyroid function control among pregnant women who had previously
undergone a therapeutic thyroidectomy. Methods: This retrospective
cohort study included all female patients insured in the largest health
maintenance organization in Israel who were pregnant between May, 2001
and September, 2012 and had a medical history of thyroid surgery. The
thyroid-stimulating hormone (TSH) levels throughout the pregnancy were
compared to recommended trimestral values. A multivariate analysis was
performed to determine risk factors for not attaining TSH recommended
range. Results: A total of 477 females with a history of thyroid surgery
had given 701 births during the study period. Forty-three percent (n=
203), had thyroidal malignancy. Nearly half of the women underwent total
thyroidectomy (43.4\% n=207). The women's TSH values were within the
recommended range in only 60\% (n= 350) of the pregnancies during the
first trimester (0.1-2.5 mIU/L), in 61\% (n=335) during the second
trimester (0.2--3 mIU/L), and in 70\% (n=338) during the third trimester
(0.3--3 mIU/L). In multivariate analysis, women that underwent a total
thyroidectomy due to a benign thyroid disease, were at the highest risk
for not attaining target TSH levels. Conclusions: This very large cohort
of pregnant women with a past history of thyroid surgery demonstrated a
significant percentage of pregnancies with TSH values above the
recommended range. Women that underwent a total thyroidectomy due to
benign thyroid disease were at the highest risk for gestational
hypothyroidism.%
\end{abstract}%



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