Assessing the Quality of Care of Pregnant Patients with Thyrotoxicosis at an Urban Safety Net Hospital.

BACKGROUND

Thyrotoxicosis 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.

METHODS

Pregnant patients with thyrotoxicosis or a history of Graves' disease who delivered in 2015-2021 were divided into three groups: low 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).

RESULTS

We included 147 subjects (mean age 31.5yr, 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=0.04, and 100% vs 71%; p=0.03, respectively). In patients with active Graves' disease (n=23, 70% treated with thionamides), 35% had FT4 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=0.048).

CONCLUSION

The 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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