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We disagree with three points in the article on unresolved questions in managing hypothyroidism in pregnancy.1
Firstly, the data regarding pregnancy outcome for women with treated hypothyroidism are conflicting, weakened by poor standardisation of important obstetric variables, and at most may indicate an association, but certainly not a causal relation, with thyroid function.2
Thirdly, as there is some evidence4 that excess thyroxine may be harmful, the authors' bold statement that the dosage should normally be incremented by 30-50% is not an evidence based answer to the unresolved question of the article's title, and routine increases in thyroxine should not be recommended until or unless it becomes clear that this will benefit either the mother or the baby.
Competing interests: None declared.