Screening for autoimmune thyroid disorders after spontaneous abortion is cost-saving and it improves the subsequent pregnancy rate

Abstract

BackgroundHypothyroidism and/or autoimmune thyroid disorders (AITD) may contribute to spontaneous abortions (SpA). Cost-effectiveness analyses of thyroid screening in women after SpA are lacking. Our aim was to evaluate the cost-effectiveness of screening for AITD and/or hypothyroidism and their treatment in women after SpA with regard to their reproductive health.MethodsWe performed a cross-sectional non-randomized study with follow-up in 2008–2011 in the settings of Departments of Endocrinology and Obstetrics/Gynecology of a university hospital. We enrolled 258 women after SpA before the 12th gestational week and followed them for a median of 3 years. At enrollment, serum concentrations of thyroid stimulatory hormone (TSH), antibodies to thyroid peroxidase (TPOAb) and free thyroxine (FT4) were measured and thyroid ultrasound performed. Women with overt hypothyroidism were treated with levothyroxine (n = 45; 61.6%) and women with subclinical hypothyroidism or euthyroid AITD were treated (n = 28; 38.4%) or left untreated (n = 38; 14.7%). Euthyroid women without signs of AITD served as controls (n = 147; 57.0%).ResultsOf the 38 untreated women with AITD and/or subclinical hypothyroidism, 8 (21.1%) reported secondary infertility as compared to 16/147 (10.9%) controls and 3/73 (4.1%) treated women (p = 0.021). Treatment was associated with an increased rate of successfully completed subsequent pregnancies (increment of 6 newborns/100 women) and a savings of €19,539/100 women. Total costs per successfully completed pregnancy were €1,189 in controls, €1,564 in the treated, and €2,488 in the untreated women.ConclusionsScreening for thyroid disorders in women after SpA and treatment with levothyroxine is cost-saving and it improves the subsequent pregnancy rate.

Optimal management of hypothyroidism, hypothyroxinaemia and euthyroid TPO antibody positivity preconception and in pregnancy

“…22,57,58 A prospective nonrandomized Polish study of women (n = 258) who had just suffered a first trimester miscarriage found that it was costeffective to screen and treat women with overt and subclinical hypothyroidism with improvements in the livebirth rate. 59 However, a US study of 286 women with a history of recurrent miscarriage showed no difference in the live birth rate when comparing subclinically hypothyroid and euthyroid women, and when comparing treated and untreated women with subclinical hypothyroidism. 60 In the CATS (Controlled Antenatal Thyroid Screening) study, the largest prospective randomized control trial of screening and levothyroxine treatment (starting from mean gestation of 13 weeks and 3 days) of maternal subclinical hypothyroidism and isolated hypothyroxinaemia (n = 1050 totally), there was no difference in the mean gestational age at delivery nor in infant birthweight with levothyroxine treatment.…”

“…Outside the context of assisted conception, there are suggestions from small nonrandomized prospective and retrospective studies that levothyroxine treatment starting preconception or in early pregnancy could reduce the risk of miscarriage (total n = 393, pooled OR 0·15, 95% CI: 0·03–0·74) and preterm delivery (total n = 298, pooled OR 0·3, 95% CI: 0·10–0·90) . A prospective nonrandomized Polish study of women ( n = 258) who had just suffered a first trimester miscarriage found that it was cost‐effective to screen and treat women with overt and subclinical hypothyroidism with improvements in the livebirth rate . However, a US study of 286 women with a history of recurrent miscarriage showed no difference in the live birth rate when comparing subclinically hypothyroid and euthyroid women, and when comparing treated and untreated women with subclinical hypothyroidism .…”

Identifying and treating subclinical thyroid dysfunction in pregnancy: emerging controversies

“…When the interventional studies with levothyroxine performed so far are reviewed (Table 3) (61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76), they seem to be more effective in preventing adverse obstetric events (mainly miscarriage and preterm delivery) in cases where AITD was present. All these studies have provided us with a more precise understanding of how to identify women at risk of developing pregnancy complications and will probably lead to better indications for therapy and consequently, more effective treatments.…”

Controversies around QALYs

“…Tento článek si klade za cíl shromáždit a přehledně představit argumenty kritiků QALY a poskytnout českým lékařům, kteří se s HTA stále častěji setkávají [13][14][15][16][17][18][19][20][21][22], reprezentativní výběr z relevantních kritických článků. Za tím účelem autoři vyhledali teoretické články o QALY z databází Web of Science, Scopus, PubMed, Science Direct, SpringerLink a ISPOR za celou dobu používání veličiny QALY (od konce 60. let 20. století dodnes).…”