The authors respond to “Treatment of subclinical hypothyroidism in pregnant women”
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* Siobhan Deshauer
* Ahraaz Wyne

We thank Dr. Romney1 for his response to our article.2

The guideline from the American Thyroid Association has two separate recommendations for women who test positive for thyroid peroxidase antibodies.3 The recommendations apply to those with a thyroid-stimulating hormone (TSH) level between 2.5 mIU/L and the pregnancy-specific upper limit of normal (typically 2.5–3.0 mIU/L), and those who have a TSH level greater than the reference range. There is a strong recommendation to treat those above the reference range and a weak recommendation to treat those with a level of 2.5–3.0 mIU/L. Our statement in point four combined both of these groups.

## Footnotes

*   **Competing interests:** None declared.

## References

1.  Romney JS. Treatment of subclinical hypothyroidism in pregnant women [letter]. CMAJ 2018; 190:E545.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTkwLzE3L0U1NDUiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTkwLzE3L0U1NDYuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  Deshauer S, Wyne A. Subclinical hypothyroidism in pregnancy. CMAJ 2017;189:E941.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTg5LzI4L0U5NDEiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTkwLzE3L0U1NDYuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

3.  Alexander EK, Pearce EN, Brent GA, et al. 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017;27:315–89.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1089/thy.2016.0457&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=28056690&link_type=MED&atom=%2Fcmaj%2F190%2F17%2FE546.atom)