Thyroid Function in Women Found to Have Early Pregnancy Loss

Vivo, Antonio De; Mancuso, Alfredo; Giacobbe, Annamaria; Moleti, Mariacarla; Savasta, Laura Maggio; Dominici, Rosanna De; Priolo, A.; Vermiglio, Francesco

doi:10.1089/thy.2009.0323

Cited by 71 publications

(57 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The increased rate of pregnancy loss in TAI-positive women with TSH levels < 2.5 mIU/L (isolated TAI) indicates that the presence of TAI without subclinical thyroid dysfunction is significantly associated with an increase in the miscarriage rate, which is consistent with the results of previous studies (12,20,(22)(23)(24), although this remains controversial. A minor increase in the TSH level (1.48 mIU/L vs. 1.11 mIU/L) might be associated with an increased miscarriage rate, and there is no significant difference in the positive incidence of TPOAb (3).…”

Section: Discussionsupporting

confidence: 89%

Maternal Subclinical Hypothyroidism, Thyroid Autoimmunity, and the Risk of Miscarriage: A Prospective Cohort Study

Liu

Shan

et al. 2014

Thyroid

226

154

View full text Add to dashboard Cite

Background: Increasing data suggest that subclinical hypothyroidism (SCH) and thyroid autoimmunity (TAI) are associated with adverse pregnancy outcomes, but there are limited data on the association of these conditions in early pregnancy with subsequent miscarriage. Methods: In this prospective cohort study, we screened 3315 women at low risk for thyroid dysfunction at four to eight weeks' gestation from iodine-sufficient areas of China between January 2012 and September 2012. Thyrotropin (TSH), free thyroxine (fT4), and the autoantibodies thyroid-peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) were measured. Based on these results, women were divided into four groups for comparison: euthyroidism (ET), isolated SCH, isolated TAI (positive TPOAb or/and TgAb), and SCH with TAI (SCH + TAI). The SCH group was stratified into two subgroups (SCH 1 and SCH 2) on the basis of the level of TSH (2.5 £ TSH < 5.22 or 5.22 £ TSH < 10 respectively). Accordingly, the SCH + TAI group was also stratified into two subgroups (SCH + TAI 1 and SCH + TAI 2). The outcome of interest was miscarriage, defined as spontaneous pregnancy loss prior to 20 weeks. Results: Compared to women with ET, the risk of miscarriage was significantly higher among women with SCH 2 (7.1% vs. .28]; p = 0.000). The gestational ages of 110 women at miscarriage were lower among women with subclinical thyroid abnormalities compared to ET (11.13 -3.21 weeks with subclinical thyroid abnormalities vs. 9.33 -1.71 weeks with ET; p = 0.024). In parallel with the higher TSH levels, there were earlier gestation ages at miscarriage between subgroups of SCH and SCH + TAI (SCH 1 vs. SCH 2: 10.79 -1.77 vs. 9.70 -1.47 weeks, p = 0.039; SCH + TAI 1 vs. SCH + TAI 2: 9.59 -1.97 vs. 8.88 -1.24 weeks, p = 0.031). Conclusions: Women with SCH and TAI are at an increased risk of miscarriage between four and eight gestational weeks. Women with a combination of SCH and TAI were found to have the highest risk and earlier gestational ages of miscarriage.

show abstract

Section: Discussionsupporting

confidence: 89%

Maternal Subclinical Hypothyroidism, Thyroid Autoimmunity, and the Risk of Miscarriage: A Prospective Cohort Study

Liu

Shan

et al. 2014

Thyroid

226

154

View full text Add to dashboard Cite

show abstract

“…On the other hand, in several studies, patients with positive TgAb and/or TPOAb tended to show a high miscarriage rate [12][13][14]. However, in our study, we could not observe such a tendency.…”

Section: Discussioncontrasting

confidence: 99%

Evaluation of the Clinical Features of Infertile Women With Subclinical Hypothyroidism in Relatively High-Iodine-Intake Area

et al. 2015

View full text Add to dashboard Cite

Background: It is well known that hypothyroidism may cause menstrual abnormalities, infertility, increased risk of miscarriage, obstetric complications, and adverse outcomes in offspring. On the other hand, some studies have reported the efficacy of supplementation of levothyroxine (LT4) for subclinical hypothyroidism (SCH) in infertile women. The aim of this study was to evaluate the clinical features of infertile SCH patients in Japan.

show abstract

“…Patients with poorly controlled diabetes mellitus may have up to a 50% risk of loss (179). Thyroid dysfunction has also been associated with increased rates of pregnancy loss (25,180). Stagnaro-Green and colleagues (181) published the first paper that demonstrated an association between pregnancy loss and thyroid antibodies.…”

Section: Stagnaro-green Et Almentioning

confidence: 99%

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Alexander

Pearce

Brent

et al. 2017

Thyroid

1,903

2,716

View full text Add to dashboard Cite

INTRODUCTION Pregnancy has a profound impact on the thyroid gland and thyroid function. The gland increases 10% in size during pregnancy in iodine-replete countries and by 20%-40% in areas of iodine deficiency. Production of thyroxine (T 4 ) and triiodothyronine (T 3 ) increases by 50%, along with a 50% increase in the daily iodine requirement. These physiological changes may result in hypothyroidism in the later stages of pregnancy in iodine-deficient women who were euthyroid in the first trimester. The range of thyrotropin (TSH), under the impact of placental human chorionic gonadotropin (hCG), is decreased throughout pregnancy with the lower normal TSH level in the first trimester being poorly defined and an upper limit of 2.5 mIU/L. Ten percent to 20% of all pregnant women in the first trimester of pregnancy are thyroid peroxidase (TPO) or thyroglobulin (Tg) antibody positive and euthyroid. Sixteen percent of the women who are euthyroid and positive for TPO or Tg antibody in the first trimester will develop a TSH that exceeds 4.0 mIU/L by the third trimester, and 33%-50% of women who are positive for TPO or Tg antibody in the first trimester will develop postpartum thyroiditis. In essence, pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency, and postpartum thyroiditis in women with underlying Hashimoto's disease who were euthyroid prior to conception.Knowledge regarding the interaction between the thyroid and pregnancy/the postpartum period is advancing at a rapid pace. Only recently has a TSH of 2.5 mIU/L been accepted as the upper limit of normal for TSH in the first trimester. This has important implications in regards to interpretation of the literature as well as a critical impact for the clinical diagnosis of hypothyroidism. Although it is well accepted that overt hypothyroidism and overt hyperthyroidism have a deleterious impact on pregnancy, studies are now focusing on the potential impact of subclinical hypothyroidism and subclinical hyperthyroidism on maternal and fetal health, the association between miscarriage and preterm delivery in euthyroid women positive for TPO and/or Tg antibody, and the prevalence and long-term impact of postpartum thyroiditis. Recently completed prospective randomized studies have begun to produce critically needed data on the impact of treating thyroid disease on the mother, fetus, and the future intellect of the unborn child.It is in this context that the American Thyroid Association (ATA) charged a task force with developing clinical guidelines on the diagnosis and treatment of thyroid disease during pregnancy and the postpartum. The task force consisted of international experts in the field of thyroid disease and pregnancy, and included representatives from the ATA, Asia and Oceania Thyroid Association, Latin American Thyroid Society, American College of Obstetricians and Gynecologists, and the Midwives Alliance of North America. Inclusion of thyroidologists, obstetricians, and midwives ...

show abstract

Thyroid Function in Women Found to Have Early Pregnancy Loss

Abstract: Both thyroid diseases SH and autoimmune disorder are independently associated with very early embryo loss, but women suffering from SH have a lower gestational age at abortion.

Cited by 71 publications

References 24 publications

Maternal Subclinical Hypothyroidism, Thyroid Autoimmunity, and the Risk of Miscarriage: A Prospective Cohort Study

Maternal Subclinical Hypothyroidism, Thyroid Autoimmunity, and the Risk of Miscarriage: A Prospective Cohort Study

Evaluation of the Clinical Features of Infertile Women With Subclinical Hypothyroidism in Relatively High-Iodine-Intake Area

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Contact Info

Product

Resources

About