Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies: a prospective study

Negro, Roberto; Mangieri, Tiziana; Coppola, Leonardo; Presicce, G.; Casavola, Eugenio Caroli; Gismondi, Riccardo; Locorotondo, Giancarlo; Caroli, Paolo; Pezzarossa, A.; Dazzi, Davide; Hassan, Hasliza

doi:10.1093/humrep/deh843

Cited by 200 publications

(198 citation statements)

References 31 publications

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“…We initially proposed that patients with anti-thyroid antibodies would be more likely to experience a significant change in TSH because they are naturally predisposed to develop hypothyroidism [9]. This is an important consideration given the negative impact of thyroid antibodies on pregnancy outcomes [5,22,23].…”

Section: Discussionmentioning

confidence: 99%

Thyroid stimulating hormone levels rise after assisted reproductive technology

Reinblatt

Herrero

Correa

et al. 2013

J Assist Reprod Genet

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Purpose The goal of this study was to determine whether high E2 levels after controlled ovarian hyperstimulation affect TSH. Methods Patients completing ART cycles between AprilOctober 2010 were eligible for this cohort study. 180 patients were recruited however those with known thyroid disease were excluded. The final analysis included 154 subjects. Blood was collected at each visit during the ART cycle as well as at the pregnancy test. Samples were frozen at −20°C and analyzed together for E2 and TSH using the same assay kit once all patients had completed their cycles. All participants were treated at the McGill University Health Center. A paired t-test was used to study the difference in TSH levels recorded at maximal and minimal Estradiol levels during ovarian stimulation. Multiple regression analysis was then used to determine if factors such as anti-thyroid antibodies and ovarian reserve measures affect this change in TSH. We used multiple imputation methods to account for missing data. Results As E2 levels rose from low to supra-physiologic levels during treatment, TSH levels also rose significantly. This increase was clinically significant by the time of pregnancy test. The factors that potentially affected the change in TSH were: male factor/tubal factor infertility, type of protocol used as well as the presence of thyroid antibodies. Conclusions Although TSH increases during ART, this change only becomes clinically significant on the day of pregnancy test. Future studies should examine TSH changes specifically in certain "at-risk" sub-groups such as those with antibodies and known thyroid disease.Capsule As estradiol levels rise during ART, TSH also rises. This rise may be affected by: cause of infertility, type of protocol used as well as the presence of anti-thyroid antibodies.

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Section: Discussionmentioning

confidence: 99%

Thyroid stimulating hormone levels rise after assisted reproductive technology

Reinblatt

Herrero

Correa

et al. 2013

J Assist Reprod Genet

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“…The studies differed in various aspects. Some had followed a cohort (235)(236)(237)248,250,252,253,(260)(261)(262)(263)(264)(265)(266)(267)(268)(269)(270)(271) (B,A,B,B,B,B,B,A,B-B) and others were "case-controlled" studies (251,254,(272)(273)(274)(275) (C,C,C,C,C).…”

Section: What Is the Role Of Thyroid Autoimmunity In Fertility And Prmentioning

confidence: 99%

Clinical practice guidelines for the management of hypothyroidism

Brenta

Vaisman

Sgarbi

et al. 2013

Arq Bras Endocrinol Metab

124

123

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Introduction: Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. Objectives: In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. Materials and methods: The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy. Results: Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D. Conclusions: These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given. Arq Bras Endocrinol Metab. 2013;57(4):265-99

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“…In contrast, TAbs may be merely reflective of a more general immune diathesis in the women. Although early studies found that levothyroxine (LT 4 ) treatment did not prevent miscarriage in women with TAbs after in vitro fertilization, 16 the same investigators recently reported successful prevention of pregnancy loss in euthyroid women using this approach. 17 If confirmed, these data suggest that it may be appropriate to start treatment with LT 4 at the time of pregnancy in order to reduce the risk of miscarriage and prematurity in euthyroid women with TAbs and suggest that a thyroid diathesis is responsible.…”

Section: Journal Of Women's Healthmentioning

confidence: 99%

“…17 If confirmed, these data suggest that it may be appropriate to start treatment with LT 4 at the time of pregnancy in order to reduce the risk of miscarriage and prematurity in euthyroid women with TAbs and suggest that a thyroid diathesis is responsible. 16 …”

Section: Journal Of Women's Healthmentioning

confidence: 99%

Autoimmune Thyroid Disease in Pregnancy: A Review

Galofré

Davies

2009

Journal of Women's Health

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The maternal physiological changes that occur in normal pregnancy induce complex endocrine and immune responses. During a normal pregnancy, thyroid gland volume may enlarge, and thyroid hormone production increases. Hence, the interpretation of thyroid function during gestation needs to be adjusted according to pregnancy-specific ranges. The elevated prevalence of gestation-related thyroid disorders (10%-15%) and the important repercussions for both mother and fetus reported in multiple studies throughout the world denote, in our opinion, the necessity for routine thyroid function screening both before and during pregnancy. Once thyroid dysfunction is suspected or confirmed, management of the thyroid disorder necessitates regular monitoring in order to ensure a successful outcome. The aim of treating hyperthyroidism in pregnancy with antithyroid drugs is to maintain serum thyroxine (T 4 ) in the upper normal range of the assay used with the lowest possible dose of drug, whereas in hypothyroidism, the goal is to return serum thyroid-stimulating hormone (TSH) to the range between 0.5 and 2.5 mU=L.

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Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies: a prospective study

Abstract: The pregnancy rate is not affected either by presence of TPOAb or treatment with LT4. However, TPOAb (+) women show a poorer delivery rate compared to TPOAb (-). LT4 treatment in TPOAb (+) does not affect the delivery rate.

Cited by 200 publications

References 31 publications

Thyroid stimulating hormone levels rise after assisted reproductive technology

Thyroid stimulating hormone levels rise after assisted reproductive technology

Clinical practice guidelines for the management of hypothyroidism

Autoimmune Thyroid Disease in Pregnancy: A Review

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