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To the Editor: The family with resistance to thyroid hormone (RTH) described by Dr Anselmo and colleagues¹ provides a unique opportunity to examine the effects of excess maternal thyroxine on the fetus. We believe that the conclusion that hormone overreplacement in hypothyroidism should be avoided in pregnant women is premature based on the data they provide.

First, in the obstetrics and gynecology literature, fetal loss is established only after confirmation of an intrauterine viable pregnancy. In this study, miscarriage could be defined by bleeding after a positive human chorionic gonadotropin test result. Data were not provided about other risk factors for miscarriage. It is therefore difficult to conclude that there was an increase in fetal loss primarily due to excess thyroid hormone.

Second, the statistically significant differences in birth weight may not be clinically relevant. Birth weights adjusted for gestational age are normal within 2 SDs. Only 3 of . . . [Full Text of this Article]

Alice Y. Chang, MD
alice.chang@utsouthwestern.edu
Division of Endocrinology and Metabolism

Heidi Chamberlain-Shea, MD
Division of Adult and Pediatric Endocrinology and Metabolism
Department of Internal Medicine

Bruce Carr, MD
Division of Reproductive Endocrinology and Infertility
Department of Obstetrics and Gynecology
University of Texas
Southwestern Medical School
Dallas

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