Thyroid autoimmunity and pregnancy in euthyroid women

Kyrilli, Aglaia; Unuane, David; Poppe, Kris

doi:10.1016/j.beem.2022.101632

Cited by 13 publications

(6 citation statements)

References 90 publications

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“…The median (IQR range) gestational age at which LT4 was started was 13 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) weeks, of whom 30.2% started treatment after 20 weeks of gestation. The starting dose of LT4 was 45.3 ± 16.3 ug / day.…”

Section: Resultsmentioning

confidence: 99%

“…However, it is not always clear if outcomes were corrected for TAI. Another reason why few studies are published in pregnant women with SCH without TPOAb is because the latter is the most frequent cause of SCH [16,17]. For many years, pregnant women with TSH levels >2.5 mIU/L in the rst trimester of pregnancy were systematically treated with LT4, independently of TAI, and therefore, few studies are available on the impact of TSH levels >4.0 mIU/L without TAI.…”

Section: Discussionmentioning

confidence: 99%

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Impact of thyroid hormone treatment on maternal pregnancy outcomes in women with subclinical hypothyroidism without TPOAb

Sitoris

Veltri

Jelloul

et al. 2022

Preprint

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Purpose: To investigate the impact of thyroid hormone treatment (LT4) on maternal pregnancy outcomes in women with subclinical hypothyroidism (SCH) without thyroid peroxidase antibodies (TPOAb) positivity. Design/Methods: Single centre, cross-sectional study in 1460 women screened for TSH, free T4 and TPOAb at median 13 (11-17) weeks of gestation during the period 2013-2014. Exclusion criteria were twin- and assisted reproduction pregnancies, TPO positivity, overt hyperthyroidism, and treatment with LT4 before screening. The impact of LT4 on maternal pregnancy outcomes was investigated in a group of 53 women with SCH (TSH >3.74 mIU/L) in which LT4 was initiated at median 13 (10-22) weeks (treated group). The control group included 18 women with SCH (TSH >3.74 mIU/L; untreated group). The prevalence of pregnancy complications in these two groups was compared with that in a reference group of 1389 women (TSH £3.74 mIU/L and no TPOAb; REF group). Results: The prevalence of pre-eclampsia and gestational diabetes (GDM) was higher in the control group vs that in the REF group (16.7% vs 5.0% and 27.8% vs 18.9%; p=0.017 and p=0.016, respectively), but comparable in the LT4 treated SCH group vs the REF group (7.6% vs 5.0% and 22.6% vs 18.9%; p=0.918 and 0.676, respectively). The prevalence of iron-deficiency anaemia was lower in the LT4 treated vs the REF group (17.0% vs 32.5%; p=0.017). Conclusions: Pregnant women with SCH and without TPOAb positivity who were LT4 untreated had a higher prevalence of pre-eclampsia and GDM compared with euthyroid women, while this was not the case when SCH women were treated with LT4, even when it was initiated after the first trimester.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of thyroid hormone treatment on maternal pregnancy outcomes in women with subclinical hypothyroidism without TPOAb

Sitoris

Veltri

Jelloul

et al. 2022

Preprint

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show abstract

“…Corrections for FT4 should be made because the inverse log/linear relationship between TSH and FT4 has been challenged during pregnancy and since FT4 levels will be high/increased in women with GTT and in GD ( 16 , 18 ). Adjusting for thyroid autoimmune parameters should be considered for several reasons; it may impede a normal hCG stimulation effect during the first trimester, and it is associated with impaired pregnancy outcomes as such ( 19 , 20 ). Since in our study, only two women with sTSH had TAI, we were not able to notice a particular pattern in them compared with the 34 women with sTSH and no TAI.…”

Section: Discussionmentioning

confidence: 99%

Gestation-suppressed serum TSH levels during early pregnancy are not associated with altered maternal and neonatal outcomes

Jelloul,

Sitoris,

Veltri

et al. 2023

European Thyroid Journal

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Objective: To investigate the impact of suppressed serum TSH levels (sTSH) during early pregnancy on maternal and neonatal outcomes. Methods: Single centre, retrospective cohort study in 1081 women screened at 11.8 ± 2.4 weeks of pregnancy for TSH, free T4 (FT4) and TPOAb. Exclusion criteria were twin- and assisted reproduction pregnancies, women with TSH levels >3.74 mIU/L, severe hyperthyroidism, treated for thyroid dysfunction before or after screening and gestational blood sampling <6 or >16 weeks of pregnancy. The prevalence of adverse pregnancy outcomes was compared between the study group sTSH (TSH<0.06 mIU/L; n=36) and euthyroid controls (TSH: 0.06-3.74 mIU/L; n=1045), and the impact of sTSH on pregnancy outcomes verified in logistic regression analyses. Results: Median (IQR range) serum TSH level in women with sTSH was 0.03 (0.03-0.03) vs 1.25 (0.81-1.82) mIU/L in controls and FT4 levels 18.0 (14.4-20.3) vs 14.2 (12.9-15.4) pmol/L; both p<0.001. None of the women with sTSH had thyrotropin receptor antibodies. Compared with controls, the prevalence of TPOAb positivity (TAI) was comparable between groups (5.6% vs 6.6%); p=0.803. The prevalence of maternal and neonatal pregnancy outcomes was comparable between the study and control group. The logistic regression analyses with corrections for TAI, FT4 and demographic parameters confirmed the absence of an association between sTSH, and the following outcomes: iron deficient anaemia (aORs (95% CI)); 1.41 (0.64-2.99); p=0.385, gestational diabetes 1.19 (0.44-2.88); p=0.713, preterm birth 1.57 (0.23-6.22); p=0.574 and low Apgar-1’ score 0.71 (0.11-2.67); p=0.657. Conclusions: Suppressed serum TSH levels during the first to early second trimester of pregnancy were not associated with altered maternal or neonatal outcomes.

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“…The authors found an increased risk of GDM in TAI pregnant women with TSH <4.0 mIU/L, while there was no such risk in controls with TSH <4.0 mIU/L and negative thyroid antibodies (OR: 2.04, 95% CI: 1.32–3.137, p < 0.001). The plausible link between TAI and GDM is an elevated concentration of inflammatory cytokines, which leads to insulin resistance ( 63 ).…”

Section: Thyroid Autoimmunity and The Risk Of Maternal Obstetric Comp...mentioning

confidence: 99%

Thyroid autoimmunity and its negative impact on female fertility and maternal pregnancy outcomes

et al. 2023

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Thyroid autoimmunity (TAI) is commonly defined as the presence of thyroperoxidase antibodies (TPOAbs) and/or thyroglobulin antibodies (TgAbs), which predisposes an individual to hypothyroidism. TAI affects nearly 10% of women of reproductive age and evokes great interest from clinicians because of its potentially negative impact on female fertility and pregnancy course. In this mini-review, we review the current literature concerning the influence of TPOAb or TPOAb/TgAb positivity without thyroid dysfunction on reproduction. TAI may negatively affect female fertility; several studies have found an increased prevalence of TAI in infertile women, especially in those with unexplained infertility and polycystic ovary syndrome. According to some observations, TAI might also be connected with premature ovarian insufficiency and endometriosis. The relationship between TAI and an increased risk of pregnancy loss is well documented. The pathophysiological background of these observations remains unclear, and researchers hypothesize on the direct infiltration of reproductive organs by thyroid antibodies, co-existence of TAI with other autoimmune diseases (either organ specific or systemic), immunological dysfunction leading to inhibition of immune tolerance, and relative thyroid hormone deficiency. Interestingly, in the current literature, better outcomes of assisted reproductive technology in women with TAI have been reported compared with those reported in earlier publications. One plausible explanation is the more widespread use of the intracytoplasmic sperm injection method. The results of randomized clinical trials have shown that levothyroxine supplementation is ineffective in preventing adverse pregnancy outcomes in women with TAI, and future research should probably be directed toward immunotherapy.

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Thyroid autoimmunity and pregnancy in euthyroid women

Cited by 13 publications

References 90 publications

Impact of thyroid hormone treatment on maternal pregnancy outcomes in women with subclinical hypothyroidism without TPOAb

Impact of thyroid hormone treatment on maternal pregnancy outcomes in women with subclinical hypothyroidism without TPOAb

Gestation-suppressed serum TSH levels during early pregnancy are not associated with altered maternal and neonatal outcomes

Thyroid autoimmunity and its negative impact on female fertility and maternal pregnancy outcomes

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