Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death

Benhadi, N.; Wiersinga, Wilmar M.; Reitsma, Johannes B.; Vrijkotte, Tanja G. M.; Bonsel, Gouke J.

doi:10.1530/eje-08-0953

Cited by 249 publications

(183 citation statements)

References 31 publications

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“…ID as such is a known risk factor to develop obstetrical complication and, according to our current findings, this harmful impact might thus in part have been mediated through the thyroid pathway (38). It has indeed been shown that even a slight increased serum TSH within the normal range is associated with an increased first trimester miscarriage rate (39). In order to answer the question whether ID, TAI, SCH or a combination hampers a normal pregnancy evolution, prospective randomized trials are largely needed.…”

Section: :3supporting

confidence: 71%

Prevalence of thyroid autoimmunity and dysfunction in women with iron deficiency during early pregnancy: is it altered?

Veltri¹,

Decaillet²,

Kleynen³

et al. 2016

European Journal of Endocrinology

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Objective: Thyroid disorders and iron deficiency (ID) are associated with obstetrical and fetal complications. Iron is essential for the normal functioning of thyroid peroxidase (TPO-abs) and ID is frequent during pregnancy. The aim of this study was to compare the prevalence of thyroid autoimmunity (TAI) and dysfunction during the first trimester of pregnancy in women with and without ID. Design: Cross-sectional data analysis of 1900 pregnant women nested within an ongoing prospective collection of pregnant women's data. Method: The study was performed in a single, tertiary referral center. During the first antenatal visit, ferritin, TPO-abs, thyroid-stimulating hormone (TSH) and free T 4 (FT 4 ) were measured and age and BMI were recorded. ID was defined as ferritin <15 µg/L, TAI when TPO-abs was >60 kIU/L, and subclinical hypothyroidism (SCH) when TSH was >2.5 mIU/L. Results: ID was present in 35% of women. Age and BMI were comparable between both groups. In the ID group, the prevalence of TAI and SCH was significantly higher, compared with that in the non-ID group (10% vs 6% and 20% vs 16%; P = 0.011 and 0.049 respectively). Ferritin was inversely correlated with serum TSH (ρ = −0.076; P = 0.001) and positive with FT 4 levels (ρ = 0.112; P < 0.001). In the logistic regression model, ID remained associated with TAI after correction for confounding factors (P = 0.017). The association with SCH was absent after correction for the confounders in the logistic regression model (P = 0.082), but remained present in the linear regression model (P = 0.035). Conclusions: ID was frequent during the first trimester of pregnancy and was associated with a higher prevalence of TAI, higher serum TSH, and lower FT 4 levels.

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Section: :3supporting

confidence: 71%

Prevalence of thyroid autoimmunity and dysfunction in women with iron deficiency during early pregnancy: is it altered?

Veltri¹,

Decaillet²,

Kleynen³

et al. 2016

European Journal of Endocrinology

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“…Benhadi and cols. (140) found a positive linear relationship between fetal loss and increased TSH concentrations. Negro and cols.…”

Section: Does Sch Increase Maternal Risk?mentioning

confidence: 80%

Consenso brasileiro para a abordagem clínica e tratamento do hipotireoidismo subclínico em adultos: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

Sgarbi

Teixeira

Maciel

et al. 2013

Arq Bras Endocrinol Metab

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Introduction: Subclinical hypothyroidism (SCH), defined as elevated concentrations of thyroid stimulating hormone (TSH) despite normal levels of thyroid hormones, is highly prevalent in Brazil, especially among women and the elderly. Although an increasing number of studies have related SCH to an increased risk of coronary artery disease and mortality, there have been no randomized clinical trials verifying the benefit of levothyroxine treatment in reducing these risks, and the treatment remains controversial. Objective: This consensus, sponsored by the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism and developed by Brazilian experts with extensive clinical experience with thyroid diseases, presents these recommendations based on evidence for the clinical management of SCH patients in Brazil. Materials and methods: After structuring the clinical questions, the search for evidence in the literature was initially performed in the MedLine-PubMed database and later in the Embase and SciELO -Lilacs databases. The strength of evidence was evaluated according to the Oxford classification system and established based on the experimental design used, considering the best available evidence for each question and the Brazilian experience. Results: The topics covered included SCH definition and diagnosis, natural history, clinical significance, treatment and pregnancy, and the consensus issued 29 recommendations for the clinical management of adult patients with SCH. Conclusion: Treatment with levothyroxine was recommended for all patients with persistent SCH with serum TSH values ≥ 10 mU/L and for certain patient subgroups. Arq Bras Endocrinol Metab. 2013;57(3):166-83

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“…The risk of miscarriage, fetal and neonatal death increases with higher TSH levels. [17][18] The risk of fetal loss was found even when maternal FT3 was normal. 17 Based on the result of high number of cytologically proven autoimmune thyroiditis with a significant number of euthyroid disease, a follow up TFT in these cases from pre-conception to delivery stages may be indicated.…”

Section: Discussionmentioning

confidence: 99%

Fine needle aspiration cytology of thyroid and its correlation with serological findings

Karki

Shrestha

2017

J Pathol Nep

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Background: Thyroid autoimmunity can cause several forms of thyroid disorders i.e. Grave's disease, Hashimoto's thyroiditis, atrophic autoimmune thyroiditis, post-partum thyroidits etc. Cytological diagnosis may be sometimes difficult is some cases. In such conditions, cytology along with serological tests aid at reaching a correct diagnosis. Hence, this study was undertaken to evaluate the serum level of anti-TPO antibody with respect to serum concentrations of thyroid hormones and its importance in diagnosing autoimmune thyroiditis. Results: Ninety-five thyroid FNAC was included in the study, which comprises of 16.8 % males and 83.2% females with a M: F 1: 4.9. Maximum number of cases was seen in the age range 21-30 years (25.3%), mean age being 40.4years. The cytological diagnosis comprised colloid goiter(43.2%), lymphocytic thyroiditis(25.3%), Hashimoto thyroiditis(18.9%). Out of 42 cases of autoimmune thyroiditis diagnosed cytologically, 16 (38%) were hypothyroid, 4 (9.5%) hyperthyroid, 8 (19%) sub-clinical hypothyroid and 14 (33.5%) were euthyroid. The sensitivity and specificity of positive anti TPO in correctly identifying autoimmune thyroiditis was 85.7% and 79.2% respectively. The positive and negative predictive value for the test was 76.5% and 87.5% respectively. Conclusion

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Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death

Cited by 249 publications

References 31 publications

Prevalence of thyroid autoimmunity and dysfunction in women with iron deficiency during early pregnancy: is it altered?

Prevalence of thyroid autoimmunity and dysfunction in women with iron deficiency during early pregnancy: is it altered?

Consenso brasileiro para a abordagem clínica e tratamento do hipotireoidismo subclínico em adultos: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

Fine needle aspiration cytology of thyroid and its correlation with serological findings

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