Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review

Boogaard, E. van den; Vissenberg, Rosa; Land, Jolande A.; Wely, Madelon van; Post, Joris A. M. ven der; Goddijn, Mariëtte; Bisschop, Peter H.

doi:10.1093/humupd/dmw003

Cited by 72 publications

(83 citation statements)

References 4 publications

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“…However, clinicians and their patients need reliable evidence to decide whether pregnant women with SCH will have better outcomes with levothyroxine replacement therapy. The uncertainty documented in this review, the variability in expert recommendations, and the impact on the pregnancy experience of a large proportion of pregnant women underscore the need for randomized trials to estimate the effectiveness of levothyroxine therapy in this population, a point that has been emphasized by others (2,22,41,42). An ongoing randomized trial will hopefully offer some answers in the near future (clinicaltrials.gov/ NCT00388297).…”

Section: Implications For Practice and Researchmentioning

confidence: 95%

“…Moreover, there is uncertainty regarding the impact of levothyroxine replacement on improving outcomes in pregnant women with SCH (4). A previous systematic review in 2011 included five articles reporting on the adverse outcomes associated with SCH, and the meta-analysis included a maximum of three studies for each of the evaluated outcomes (22). In 2013, a Cochrane review on interventions for SCH during pregnancy did not identify any studies evaluating the effectiveness of levothyroxine therapy on maternal and neonatal outcomes (23).…”

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confidence: 99%

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Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis

Maraka

Ospina

O’Keeffe

et al. 2016

Thyroid

292

210

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Background: The impact of subclinical hypothyroidism (SCH) and of levothyroxine replacement in pregnant women with SCH is unclear. The aims of this study were to assess (i) the impact of SCH during pregnancy on maternal and neonatal outcomes, and (ii) the effect of levothyroxine replacement therapy in these patients. Methods: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, the Cochrane Controlled Trials Register, Ovid EMBASE, Web of Science, and Scopus were searched from inception to January 2015. Randomized trials and cohort studies of pregnant women with SCH that examined adverse pregnancy and neonatal outcomes were included. Reviewers extracted data and assessed methodological quality in duplicate. Eighteen cohort studies at low-to-moderate risk of bias were included. Compared with euthyroid pregnant women, pregnant women with SCH were at higher risk for pregnancy loss (relative risk [RR] . One study at high risk of bias compared pregnant women with SCH who received levothyroxine to those who did not and found no significant decrease in the rate of pregnancy loss, preterm delivery, gestational hypertension, low birth weight, or low Apgar score. Conclusions: SCH during pregnancy is associated with multiple adverse maternal and neonatal outcomes. The value of levothyroxine therapy in preventing these adverse outcomes remains uncertain.

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Section: Implications For Practice and Researchmentioning

confidence: 95%

mentioning

confidence: 99%

Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis

Maraka

Ospina

O’Keeffe

et al. 2016

Thyroid

292

210

View full text Add to dashboard Cite

show abstract

“…A recent systematic review revealed increased risk of pre-eclampsia in females with SCH compared with euthyroid females [van den Boogaard et al 2011]. These findings were subsequently confirmed by another prospective populationbased study [Wilson et al 2012].…”

Section: Gestational Hypertension and Pre-eclampsiamentioning

confidence: 81%

Levothyroxine treatment of mild subclinical hypothyroidism: a review of potential risks and benefits

Javed

Sathyapalan

2015

Therapeutic Advances in Endocrinology

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Subclinical hypothyroidism (SCH) is defined as elevated thyroid stimulating hormone (TSH) with normal levels of free triiodothyronine (FT3) and free thyroxine (FT4). SCH is further classified into a milder condition with TSH levels between 4.0 and 10.0 milli-international units (mIU)/l (mild-SCH) and a severe form with TSH >10.0 mIU/l (severe-SCH). SCH is a common problem (prevalence is greater in women than men), which increases further with increasing age and TSH levels. Even though the risk of progression to overt hypothyroidism is higher in patients with severe-SCH, the risk is also significant in patients having mild-SCH; it has been suggested that every twofold rise in serum TSH would increase the risk from 1 to 4%, which further increases to 38% if thyroid antibodies are positive. Current data have shown increased cardiovascular risk in patients with mild-SCH and have demonstrated some benefits of levothyroxine treatment in reducing these events. However, evidence on the association of mild-SCH and musculoskeletal system, cognitive dysfunction, mood disorders, dyslipidaemia, diabetes and goitre is conflicting. Similarly, the discussion regarding the exact upper limit of normal for serum TSH remains controversial. The data have also shown increased risk of adverse pregnancy outcomes in patient with mild-SCH, with some benefits of thyroxine treatment. The recent available guidelines related to management of patients with serum TSH <10 mIU/l have suggested decisions should be made taking into account the age of the patient, associated risk factors and comorbid conditions. This chronicle review assesses current evidence regarding the risks associated and the recommendations related to benefits of levothyroxine treatment in patients having mild-SCH.

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“…Using non-probability; convenient sampling technique 260 pregnant women were recruited. Sample size of 260 cases was calculated with 95% confidence level, 3% margin of error and expected percentage of subclinical hypothyroidism 6.47% in pregnant women with bad obstetrical history [9]. Patients included in study were all pregnant women of age 18-40 years with bad obstetrical history BOH (unexplained stillbirth/neonatal death, three or more consecutive miscarriages, congenital anomalies, and intrauterine growth restriction).…”

Section: Methodsmentioning

confidence: 99%

Subclinical Thyroid Dysfunction among Pregnant Women with Bad Obstetrical History

Butt¹,

Chohan²

2017

MOJWH

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Background: Subclinical maternal thyroid dysfunction adversely affects the obstetrical outcome. Treatment of subclinical hyper or hypothyroidism clearly improves the pregnancy outcome. Therefore screening of thyroid function in pregnancy is the need of time.Objective: To determine the frequency of subclinical thyroid dysfunction among pregnant women with bad obstetrical history Design: Cross sectional studySampling technique: Non-probability convenient sampling Materials and methods:This study was done at Chohan Reproduction and Assisted Fertility Treatment Center (CRAFT-IVF) in duration of 2 year. 260 pregnant women of age 18-40 years with bad obstetrical history were enrolled. Informed consent was obtained and demographic history like, age, gestational age, obstetrical details were taken. Blood samples were taken for thyroid hormones i.e. fT3, fT4, and TSH levels in first antenatal visit in outpatient department. Interpretation of thyroid dysfunction was done. Data analysis was done on SPSS version 16.0.Mean and standard deviation calculated for fT4, fT3 and TSH. Frequency and percentages were calculated for subclinical thyroid dysfunction.Results: 260 pregnant females were enrolled in study to evaluate subclinical thyroid dysfunction. Mean age of the patients was 30.31 + 3.11. Mean fT4 level was 1.84 ±1.12ng/dl, fT3 2.62 + 1.14ng/dl and TSH level was 4.32 ± 0.91mIU/l. Thyroid dysfunction was observed in 118 (45.4%). Out of which subclinical hypothyroidism was noted in 77 (65.2%) pregnant whereas subclinical hyperthyroidism in 41 (34.7%) of patients with bad obstetrical history. Conclusion:Frequency of subclinical thyroid dysfunction is high in our population so it should be considered and managed in pregnant women especially with bad obstetrical history.

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Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review

Cited by 72 publications

References 4 publications

Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis

Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis

Levothyroxine treatment of mild subclinical hypothyroidism: a review of potential risks and benefits

Subclinical Thyroid Dysfunction among Pregnant Women with Bad Obstetrical History

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