Levothyroxine Treatment in Pregnancy: Indications, Efficacy, and Therapeutic Regimen

Kłubo-Gwieździńska, Joanna; Burman, Kenneth D.; Nostrand, Douglas Van; Wartofsky, Léonard

doi:10.4061/2011/843591

Cited by 23 publications

(22 citation statements)

References 85 publications

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“…Recently, a European survey found similar results, with 42% of responders screening all pregnant women for thyroid dysfunction [37]. Klubo-Gwiezdzinska et al [38] clearly demonstrated the necessity of updating and promulgating new guidelines for L-T4 treatment during pregnancy.…”

Section: Discussionsupporting

confidence: 51%

Reduction of Miscarriages through Universal Screening and Treatment of Thyroid Autoimmune Diseases

Lepoutre¹,

Debiève

Gruson³

et al. 2012

Gynecol Obstet Invest

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Background/Aims: Universal screening for thyroid diseases during pregnancy is controversial. Targeted screening does not identify all women with thyroid dysfunction. Furthermore, antithyroid peroxidase antibodies (TPOAb) are suspected to be associated with an increased risk of fetal loss, premature delivery and hypothyroidism. The aim of our study was to assess the rationale behind universal screening and propose thyroxine treatment in particular cases. Methods: Between January 2008 and May 2009, 537 consecutive iodine-supplemented women with a singleton pregnancy [441 TPOAb– controls and 96 TPOAb+ women (47 nontreated and 49 treated)] were evaluated using thyroid and obstetric parameters. According to our algorithm for thyroid screening in pregnancy, if thyroid-stimulating hormone (TSH) exceeded 1 mU/l in TPOAb+ women, 50 µg of levothyroxine (L-T4) was prescribed. Results: The miscarriage rate was significantly higher in the nontreated TPOAb+ group compared with the treated group (16 vs. 0%; p = 0.02). Compared to the control group, TSH in TPOAb+ patients was higher at the first prenatal visit prior to L-T4 treatment (p < 0.01), while free thyroxine was higher than in the control group after the 20th week (p < 0.05). Conclusions: Our study supports the potential benefit of universal screening and L-T4 treatment for autoimmune thyroid disease during pregnancy. Efforts are still needed to further decrease miscarriage rates.

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Section: Discussionsupporting

confidence: 51%

Reduction of Miscarriages through Universal Screening and Treatment of Thyroid Autoimmune Diseases

Lepoutre¹,

Debiève

Gruson³

et al. 2012

Gynecol Obstet Invest

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“…One is through the interference in the adaptive mechanisms of the high demand on the thyroid, and the other, through the association with an autoimmune environment with direct effects on the placenta and the fetus as a consequence of the generalized activation of the immune system (220,(255)(256)(257) (D,B,D).…”

Section: What Is the Role Of Thyroid Autoimmunity In Fertility And Prmentioning

confidence: 99%

Clinical practice guidelines for the management of hypothyroidism

Brenta

Vaisman

Sgarbi

et al. 2013

Arq Bras Endocrinol Metab

125

123

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Introduction: Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. Objectives: In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. Materials and methods: The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy. Results: Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D. Conclusions: These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given. Arq Bras Endocrinol Metab. 2013;57(4):265-99

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“…8 Untreated maternal overt hypothyroidism is connected with adverse neonatal outcomes including premature birth, low birth weight, and neonatal respiratory distress. 9 Complications in the pregnancies associated with hypothyroidism are complex and serious, with an important increase of the maternal morbidity, and perinatal morbidity and mortality. 10 Targeted thyroid function testing of only the high-risk group would miss about one third of pregnant women with overt/subclinical hypothyroidism.…”

Section: Discussionmentioning

confidence: 99%

To study and compare the obstetric and neonatal outcome of pregnancies complicated with hypothyroidism amongst antenatally detected and treated hypothyroid patients and patients found to be hypothyroid at the time of labor

Shah

Chaudhari

Mathias

2016

Int J Reprod Contracept Obstet Gynecol

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Levothyroxine Treatment in Pregnancy: Indications, Efficacy, and Therapeutic Regimen

Cited by 23 publications

References 85 publications

Reduction of Miscarriages through Universal Screening and Treatment of Thyroid Autoimmune Diseases

Reduction of Miscarriages through Universal Screening and Treatment of Thyroid Autoimmune Diseases

Clinical practice guidelines for the management of hypothyroidism

To study and compare the obstetric and neonatal outcome of pregnancies complicated with hypothyroidism amongst antenatally detected and treated hypothyroid patients and patients found to be hypothyroid at the time of labor

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