Does Maternal Thyroid Hormone Treatment for Subclinical Hypothyroidism Without TPOAb Improve Pregnancy Outcomes?
BACKGROUND AND PURPOSE:
Evidence on thyroid hormone levothyroxine (LT4) treatment in pregnancy is conflicting, especially in the context of subclinical hypothyroidism (SCH) without thyroid peroxidase antibodies (TPOAb) positivity
Sitoris et al. (Thyroid Research, 2023) assessed pregnancy outcomes in women with SCH without TPOAb who were and were not treated with LT4
Single center, cross-sectional study
SCH: (TSH > 3.74 mIU/L) without TPOAb
A euthyroid reference was used to compare
LT4 treatment, initiated at a median 13 (range 10 to 22) weeks gestation
Control: No treatment
Prevalence of pregnancy complications
SCH women: 1460 | Euthyroid women: 1389 women
The prevalence of preeclampsia and gestational diabetes (GDM) was higher in the control group vs the reference euthyroid population
Control: 16.7% | Reference: 5.0% | P=0.017
Control: 27.8% | Reference: 18.9% | P=0.016
The prevalence of GDM and preeclampsia were similar between the treated and reference group
Treated: 7.6% | P=0.918
Treated: 22.6% | P=0.676
The prevalence of iron-deficiency anemia was lower in the treated vs the REF group
Treated: 17.0% | Reference: 32.5% | P=0.017
Women with untreated SCH and no TPOAb had a higher prevalence of preeclampsia and GDM than euthyroid women or those treated with levothyroxine
The authors state
In this real-world retrospective study, women with SCH and no TPOAb positivity might have had a higher prevalence of gestational diabetes and preeclampsia compared with euthyroid controls
However, considering the retrospective nature of our study and some methodological issues, our findings should be confirmed in large prospective studies
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