The exploration of Hashimoto's Thyroiditis related miscarriage for better treatment modalities

Abstract

Hashimoto's thyroiditis (HT) is the most prevalent autoimmune thyroid disease (ATD) worldwide and is strongly associated with miscarriage and even recurrent miscarriage (RM). Moreover, with a deepening understanding, emerging evidence has shown that immune dysfunctions caused by HT conditions, including imbalanced subsets of CD4+ T-helper cells, B regulatory (Breg) cells, high expression levels of CD56dim natural killer (NK) cells, and cytokines, possibly play an important role in impairing maternal tolerance to the fetus. In recent years, unprecedented progress has been made in recognizing the specific changes in immune cells and molecules in patients with HT, which will be helpful in exploring the mechanism of HT-related miscarriage. Based on these findings, research investigating some potentially more effective treatments, such as selenium (Se), vitamin D3, and intravenous immunoglobulin (IVIG), has been well developed over the past few years. In this review, we highlight some of the latest advances in the possible immunological pathogenesis of HT-related miscarriage and focus on the efficacies of treatments that have been widely introduced to clinical trials or practice described in the most recent literature.

Impact of thyroid cancer treatment on assisted reproductive technology outcomes in women with infertility

“…Our previous study demonstrated that treatment with levothyroxine did not reduce the miscarriage rates or increase the clinical pregnancy and live birth rates of women undergoing IVF-ET who had normal thyroid function and tested positive for thyroid autoantibodies [ 26 ]. Dysfunctions in immunological regulation may be involved in the mechanism and should be explored further [ 27 ].…”

A Nomogram Predicting Central Lymph Node Metastasis for Patients with Papillary Thyroid Cancer

“…Currently, a range of works 13,21,30,31 , especially retrospective study, have determined a high concurrence rate of HT and PTC from surgical specimens but the relationship between these two diseases, as well as HT and CLNM, has been controversial. Immunologically, emerging evidence has shown that an abnormal in ammatory response, especially the imbalanced subsets of T cells, NK cells, and cytokines were presenting in HT condition 12,32 , which could potentially affect the tumor microenvironment and subsequent prognosis. For instance, in vitro experiment, Lubin et al 33 conducted that the presence of background HT was contributed to a higher risk of CLNM via increased programmed death ligand-1(PD-L1).…”

Thyroid diseases in pregnancy: guidelines of the Polish Society of Endocrinology [Choroby tarczycy w ciąży: zalecenia postępowania Polskiego Towarzystwa Endokrynologicznego]

“…Maternal AITD may also be an independent risk factor for newborn hospitalisation in the intensive care unit [124]. The reasons for the increased risk of obstetric failure in euthyroid women are still not clearly understood, and they include direct adverse effects of aTPO antibodies (including cross-reactions between aTPO antibodies and hCG in accessing the hCG receptor), decreased thyroid and ovarian reserve, older age of patients with Hashimoto's disease, coexistence of other autoimmune diseases, and immunological disturbances in the course of autoimmune diseases (including increased concentrations of endometrial cytokines) [125,126].…”

“…Przyczyn wzrostu ryzyka niepowodzeń położniczych u kobiet z AITD w okresie eutyreozy wciąż jednoznacznie nie poznano. Postuluje się między innymi bezpośredni, niekorzystny wpływ przeciwciał aTPO (w tym reakcje krzyżowe pomiędzy przeciwciałami aTPO i hCG, w dostępie do receptora dla hCG), zmniejszoną rezerwę tarczycową oraz jajnikową, starszy wiek pacjentek z chorobą Hashimoto, współwystępowanie innych chorób autoimmunizacyjnych oraz zaburzenia immunologiczne w przebiegu chorób z autoagresji (w tym zwiększony poziom cytokin endometrialnych) [125,126].…”