Thyroid hormone treatment among pregnant women with subclinical hypothyroidism: US national assessment

Maraka, Spyridoula; Mwangi, Raphael; McCoy, Rozalina G.; Yao, Xiaoxi; Sangaralingham, Lindsey R.; Ospina, Naykky M Singh; O’Keeffe, Derek; Ycaza, Ana E. Espinosa De; Rodríguez-Gutiérrez, René; Coddington, Charles C.; Stan, Marius N.; Brito, Juan P.; Montori, Víctor M.

doi:10.1136/bmj.i6865

Cited by 159 publications

(182 citation statements)

References 25 publications

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“…This emphasizes the importance of screening all the mothers for hypothyroidism. 8 Effects of maternal hypothyroidism on fetal brain development are not well defined, several recent reports indicate that IQ is modestly affected (24-26). These studies have increased the concern that even mild hypothyroidism can interfere with normal brain development.…”

Section: Discussionmentioning

confidence: 99%

Maternal hypothyroidism and neonatal outcome

Shravani

Tharashree

Yashodha

2018

Int J Contemp Pediatr

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INTRODUCTIONHypothyroidism is widely prevalent in pregnant women and the rate of detection, especially in a developing country like India, has not kept pace with the magnitude of the problem. Since hypothyroidism is easily treated, timely detection and treatment of the disorder could reduce the burden of adverse fetal and maternal outcomes, which are very commonly encountered.Pregnancy influences thyroid function in multiple ways. Maternal hypothalamic-pituitary-thyroid (HPT) axis undergo a series of adjustments, fetus develops its own HPT axis and the placenta plays an active role in iodide and T4 transport and metabolism. Thus, an integrated three-compartment thyroid model exists during gestation.1 Early in pregnancy estrogen promotes production of a more highly sialylated T4-binding globulin isoform that is less rapidly degraded, resulting in increased serum T4-binding globulin and T4 concentrations. The thyroxine-binding globulin (TBG) begins to increase early in the first trimester, plateaus during midgestation, and persists until shortly after delivery. This increased TBG concentration leads to an expansion of the extra-thyroidal pool and results in elevated total T3 and T4 levels. A high circulating HCG level in the first trimester leads to HCG cross-reactivity with the TSH receptor, resulting in temporary increase in free T4 and partial suppression of TSH. The final physiologic change results from placental deiodination of maternal T4, which increases T4 turnover. In normal pregnant women, the thyroid gland maintains euthyroidism with only minor fluctuations in serum T4 and TSH. However, in women with limited thyroid reserve, due to thyroid autoimmunity or iodine ABSTRACT Background: Hypothyroidism is widely prevalent in pregnant women and the rate of detection, especially in a developing country like India, has not kept pace with the magnitude of the problem. The present study was conducted to evaluate thyroid function in neonates born to mothers with hypothyroidism. Methods: A prospective observational study was conducted in KIMS Hospital Tertiary care center for 6 months. A total of 106 neonates born to mothers with hypothyroidism were included in the study. Thyroid functions of these babies were assessed at 72 hours of life. Results: In present study, 11.8 % of mothers were hypothyroid of which 87 % were subclinical hypothyroidism and 13 % of overt hypothyroidism due to adaptation of universal screening rather than targeted screening for hypothyroidism which would otherwise go unrecognised and untreated. Conclusions: All the babies had normal TSH and T4 levels which was probably due to early diagnosis and timely initiation of treatment to the mothers with hypothyroidism.

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Section: Discussionmentioning

confidence: 99%

Maternal hypothyroidism and neonatal outcome

Shravani

Tharashree

Yashodha

2018

Int J Contemp Pediatr

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“…Additionally, a recent national survey in USA showed that thyroid hormone treatment was associated with decreased risk of pregnancy loss in women with subclinical hypothyroidism, but increased risk of other pregnancy related adverse outcomes such as preterm delivery, gestational diabetes or preeclampsia (11). All these data highlight the need of selective indications of therapy, based on sensible treatment threshold for women who have mildly increased TSH without other risk factors.…”

Section: Against Treating Subclinical Thyroid Dysfunctionmentioning

confidence: 99%

“…At present, much effort is being invested in order to reduce their impact on families and health services. In this regard, the recent results of levothyroxine use in reducing pregnancy loss and preterm delivery are certainly promising (11,76). However, it is important to highlight that all the interventions with levothyroxine (LT4) replacement performed to date did not include any other preventive or therapeutic approach: data are lacking regarding the effectiveness of LT4 in combination with aspirin for recurrent miscarriages or progesterone and/or pessary for preterm delivery; and these approaches should be evaluated through further studies.…”

Section: In Favour Of Treating Subclinical Thyroid Dysfunctionmentioning

confidence: 99%

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Identifying and treating subclinical thyroid dysfunction in pregnancy: emerging controversies

Velasco

Taylor

2018

European Journal of Endocrinology

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Thyroid hormones are essential for an adequate growth and development of the fetus. In addition to the classical association between maternal hypothyroidism and neurological impairment in the progeny, other adverse reproductive events have been associated with maternal thyroid dysfunction including infertility, miscarriage and preterm delivery. Although all scientific societies endorse the treatment of overt hypothyroidism; the management and/or treatment of subclinical hypothyroidism, hypothyroxinemia or antithyroid antibody-positive women should be considered with caution. Important trials have found no clear benefit of treatment of subclinical hypothyroidism in terms of cognitive outcomes; however, other interventional studies appear to reduce some of the obstetric and perinatal complications. As a result, the dilemma between universal screening or selective screening of women at high risk of thyroid dysfunction during pregnancy remains unresolved. Despite this, levothyroxine is also now regularly prescribed by gynaecologists and centres for reproductive medicine. In this context, there is increasing concern regarding the risk of over diagnosis and subsequent potential overtreatment. Taken together, we need to reconsider how thyroid dysfunction should be identified in pregnant women and highlight the arguments for and against the use of levothyroxine in obstetric practices. Our main findings: the mismatch between the guidelines recommendations and the use of LT4 in clinical settings as well as the disparity of criteria between scientific societies from different medical specialties. In conclusion, it is essential to reach agreements between both endocrinologists and obstetricians.

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“…But associated with increased risk of preterm delivery, PIH and GDM. [24] But it was a retrospective observational study and use of administrative claims like potential for misclassification of treatment and confounders, lack of clinical details, selection biases related to health plan enrolment, diagnostic testing and treatment choice. Women with treated hypothyroid disease had an increased risk for PIH(4.3% vs 2.6%,p=0.03) compared to women without thyroid disease.…”

Section: Section: Obstetrics and Gynaecologymentioning

confidence: 99%

Association of Thyroid Status with Pregnancy Induced Hypertension and Impact of Levothyroxine Treatment

Das¹,

Sahu²,

Pattanaik³

et al. 2017

AIMDR

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Background: Pregnancy induced hypertension is an important cause of maternal and fetal morbidity and mortality affecting 5-10% of pregnancies.PIH is more frequently associated with elevated TSH. Hypothyroidism is one of the causes of hypertension in nonpregnant state. Hypertension is completely reversible in 50% cases of hypothyroidism by levothyroxine therapy. Treating hypothyroidism in pregnancy may help to reduce PIH prevalence. Objectives-This is an observational study to find out association of PIH with hypothyroidism and to know result of levothyroxine treatment on PIH prevalence and its severity. Methods: 75 singleton pregnancies with PIH admitted to labour ward, evaluated with their TSH status in groupA. In Group B, 75 singleton pregnancies with subclinical or overt hypothyroidism treated with levothyroxine to maintain euthyroid state throughout pregnancy and observed for development of PIH. Overt hypothyroidism considered when TSH value ≥10 and subclinical hypothyroidism when TSH value between 3 and 10.. Result: Overt and subclinical hypothyroidism was present in 12% (9 out of 75) and 57.3%(43 out of 75) cases of PIH respectively. In group B, all hypothyroid pregnancies treated with levothyroxine throughout pregnancy, prevalence of PIH was 6.66% (5 out of 75) . Significant association of PIH and hypothyroidism demonstrated by Fisher's exact test (p<0.001). PIH prevalence significantly reduced in treatment group demonstrated by chi square test (p<0.001). Conclusion: Subclinical and overt hypothyroidism prevalence is significantly high among PIH patients. Treating subclinical and overt hypothyroidism in pregnancy, reduces prevalence of PIH and its severity.

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Thyroid hormone treatment among pregnant women with subclinical hypothyroidism: US national assessment

Cited by 159 publications

References 25 publications

Maternal hypothyroidism and neonatal outcome

Maternal hypothyroidism and neonatal outcome

Identifying and treating subclinical thyroid dysfunction in pregnancy: emerging controversies

Association of Thyroid Status with Pregnancy Induced Hypertension and Impact of Levothyroxine Treatment

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