Pregnancy outcomes are not altered by variation in thyroid function within the normal range in women free of thyroid disease

Veltri, Flora; Kleynen, Pierre; Grabczan, Lidia; Salajan, Alexandra; Rozenberg, Serge; Pepersack, Thierry; Poppe, Kris

doi:10.1530/eje-17-0628

Cited by 12 publications

(8 citation statements)

References 39 publications

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“…This study confirmed prior findings of a large retrospective study in the United Kingdom showing reduction of miscarriage with levothyroxine in patients with TSH >4 mU/L, but not in those with a TSH of 2.5-4 mU/L (7). Levothyroxine treatment, however, was associated with higher rates of preeclampsia compared with controls (11).…”

Section: Hypothyroidismmentioning

confidence: 74%

“…Nevertheless, whether such a small difference in TSH within the reference range significantly impacts outcomes is in question. In a cross-sectional analysis of a prospective Belgian cohort of 1321 euthyroid pregnant women without thyroid autoimmunity, a TSH ‡2.5 mIU/L (mean TSH 2.98 mIU/L) was not associated with adverse pregnancy outcomes compared with TSH levels <2.5 mIU/L (mean TSH 1.31 mIU/L) (11).…”

Section: Hypothyroidismmentioning

confidence: 96%

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Thyroid and Fertility: Recent Advances

Dosiou

2020

Thyroid

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Background: Thyroid disease is prevalent in women of reproductive age, while infertility is common in women with thyroid dysfunction. In this study, we review the recent advances in the field of thyroid and fertility since the publication of the 2017 American Thyroid Association pregnancy guidelines. Summary: Recent studies have confirmed associations of thyrotropin (TSH) elevation and/or thyroid autoimmunity with infertility and low ovarian reserve in subsets of women, and have led to a better understanding of the pathogenesis linking thyroid autoimmunity with infertility. Even though the benefit of treating patients with TSH >4 mIU/L has been confirmed in a large retrospective cohort study, two large randomized controlled trials have failed to show benefit of thyroid hormone on obstetrical outcomes in euthyroid women with thyroid autoimmunity. New data have emerged regarding the potential gonadal toxicity of radioactive iodine (RAI), based on its impact on ovarian reserve and sperm chromosomal abnormalities. Conclusions: There is continued evidence supporting an important role of thyroid hormone in regulation of reproductive tissues at many levels. Recent randomized trials have failed to identify a benefit of thyroid hormone in euthyroid women with thyroid autoimmunity. Further research in the field is needed to more completely delineate the relevant pathways and identify women who may benefit from levothyroxine treatment. The impact of RAI on fertility also merits further investigation.

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Section: Hypothyroidismmentioning

confidence: 74%

Section: Hypothyroidismmentioning

confidence: 96%

Thyroid and Fertility: Recent Advances

Dosiou

2020

Thyroid

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“…In a recent study in pregnant women without TAI, smoking was associated with higher serum TSH levels [44]. Disparities between study results may reflect variations in populations and the iodine status.…”

Section: Established Variables Contributing To Variation In Thyroid Fmentioning

confidence: 99%

“…In some studies, no impact was observed on serum TSH [9, 10], while in other studies, lower serum TSH levels were observed [29, 44]. Regarding FT4 levels, data are limited to one study in which lower values were noted in pregnant women [9] and another in which no impact was observed [29].…”

Section: Established Variables Contributing To Variation In Thyroid Fmentioning

confidence: 99%

Variables Contributing to Thyroid (Dys)Function in Pregnant Women: More than Thyroid Antibodies?

Veltri

Poppe

2018

Eur Thyroid J

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Variability in thyroid function in pregnant women is the result of 2 main determinants, each accounting for approximately half of it. The first is the genetically determined part of which the knowledge increases fast, but most remains to be discovered. The second determinant is caused by an ensemble of variables of which thyroid autoimmunity is the best known, but also by others such as parity, smoking, age, and BMI. More recently, new candidate variables have been proposed, such as iron, endocrine disruptors, and the ethnicity of the pregnant women. In the future, the diagnosis and treatment of thyroid (dys)function may be optimized by the use of each individual’s pituitary-thyroid set point, corrected with a factor taking into account the impact of nongenetically determined variables.

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“…These data support the current recommendation that euthyroid women without TAI, including those with high-normal TSH levels, may not require intervention with LT4 treatment (see below). A single-centre, cross-sectional analysis of 1321 women without thyroid disease showed that variation of the TSH level within normal range for non-pregnant women did not increase the risk of adverse pregnancy outcomes, including gestational diabetes, pre-eclampsia, postpartum haemorrhage, intra-uterine growth retardation, or low birth weight [35].…”

Section: Lt4 Treatment Of Euthyroid Women With Thyroid Autoimmunitymentioning

confidence: 99%

Levothyroxine in Pregnancy

Poppe

2021

70 Years of Levothyroxine

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Thyroid hormone homeostasis changes markedly during pregnancy, and first trimester-specific reference ranges for thyrotropin (thyroid-stimulating hormone, TSH) are needed to diagnose hypothyroidism. Treatment consists in levothyroxine (LT4) in this setting (triiodothyronine or desiccated thyroid preparations have no role here). Severe hypothyroidism is associated with infertility, and levels of TSH above 4.0 IU/mL signal an increased risk of adverse pregnancy outcomes. All pregnant women (and women planning a pregnancy) with overt hypothyroidism must be managed effectively with oral LT4. Thyroid autoimmunity increases the risk of adverse pregnancy outcomes and is associated with certain causes of infertility. Current European and US guidelines recommend a role for patients with subclinical hypothyroidism and thyroid autoimmunity, not least to guard against progression to overt hypothyroidism during the pregnancy. Women with hypothyroidism undergoing assisted reproduction technology to become pregnant appear to be strong candidates for LT4-based therapy.

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Pregnancy outcomes are not altered by variation in thyroid function within the normal range in women free of thyroid disease

Cited by 12 publications

References 39 publications

Thyroid and Fertility: Recent Advances

Thyroid and Fertility: Recent Advances

Variables Contributing to Thyroid (Dys)Function in Pregnant Women: More than Thyroid Antibodies?

Levothyroxine in Pregnancy

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