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In addition to an increase level of TSH above 2.5 mU/L during the first trimester, and above 3 mU/L in the second and third trimester, a decrease fT4 concentration (also using reference range for pregnant women) will help clinicians diagnose overt hypothyroidism during pregnancy.
Total thyroxine is rarely measured, having been largely superseded by free thyroxine tests. Total thyroxine (Total T4) is generally elevated in hyperthyroidism and decreased in hypothyroidism. It is usually slightly elevated in pregnancy secondary to increased levels of thyroid binding globulin (TBG).