1064例复发性流产患者队列中甲状腺自身免疫的患病率及左甲状腺素治疗的效果

Prevalence of thyroid autoimmunity and effect of levothyroxine treatment in a cohort of 1064 patients with recurrent pregnancy loss.

作者信息

Leduc-Robert Geneviève, Iews Mahmoud, Abdelkareem Amr O, Williams Christina, Bloomenthal Dena, Abdelhafez Faten, Bedaiwy Mohamed A

机构信息

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynaecology, University of British Columbia, BC Women and Children's Hospital, Vancouver BC, Canada.

Department of Obstetrics and Gynaecology, South Valley University, Qena, Egypt.

出版信息

Reprod Biomed Online. 2020 Apr;40(4):582-592. doi: 10.1016/j.rbmo.2019.11.014. Epub 2019 Nov 30.

DOI:10.1016/j.rbmo.2019.11.014

PMID:32160949

Abstract

RESEARCH QUESTION

Does initiating levothyroxine treatment based on thyroid-stimulating hormone (TSH) >2.5 mIU/l or thyroid autoimmunity improve pregnancy continuation rates in recurrent pregnancy loss (RPL) patients?

DESIGN

A retrospective cohort study of 1064 RPL patients, in which subjects were classified as either euthyroid (TSH 0.1 to ≤2.5 mIU/l), borderline-subclinical hypothyroid (borderline-SCH, TSH 2.5 to ≤4 mIU/l) or subclinical hypothyroid (SCH, TSH 4 to ≤10 mIU/l). For subjects with ≥2 pregnancy losses and a subsequent pregnancy with known outcome, a comparison was done of the pregnancy continuation rate past 10 weeks of treated and untreated borderline-SCH (n = 98) and untreated euthyroid (n = 279) subjects, and between subjects with positive (n = 18) and negative (n = 206) thyroid peroxidase (TPOAb tests) within the borderline-SCH and euthyroid groups.

RESULTS

72.7% were euthyroid (721/992), 19.4% (192/992) were borderline-SCH, and 5.4% (54/992) were subclinically hypothyroid (SCH). Of 401 women with a subsequent pregnancy of known outcome at 10 gestational weeks, 21% received treatment with levothyroxine. 57.7% of subjects had a TPOAb test, which was positive in 9.25% (37/400) in euthyroid, 16.5% (22/133) in borderline-SCH subjects and 35.3% (12/34) in SCH subjects. Treatment did not improve pregnancy continuation rates in borderline-SCH subjects (P = 0.392). There was no difference in pregnancy outcomes based on TPOAb status and treatment for borderline-SCH subjects (P = 0.4214), or based on TPOAb status for euthyroid subjects (P = 0.2668).

CONCLUSIONS

Treatment of hypothyroidism in pregnancy should be initiated based on a TSH >4 mIU/l. Treatment initiation based on thyroid autoimmunity or a TSH >2.5 mIU/l may result in overtreatment.

摘要

研究问题

基于促甲状腺激素（TSH）>2.5 mIU/l或甲状腺自身免疫启动左甲状腺素治疗能否提高复发性流产（RPL）患者的妊娠持续率？

设计

一项对1064例RPL患者的回顾性队列研究，其中受试者被分类为甲状腺功能正常（TSH 0.1至≤2.5 mIU/l）、临界亚临床甲状腺功能减退（临界-SCH，TSH 2.5至≤4 mIU/l）或亚临床甲状腺功能减退（SCH，TSH 4至≤10 mIU/l）。对于有≥2次流产且随后有已知结局妊娠的受试者，比较了接受治疗和未接受治疗的临界-SCH（n = 98）和未接受治疗的甲状腺功能正常（n = 279）受试者超过10周的妊娠持续率，以及临界-SCH组和甲状腺功能正常组中甲状腺过氧化物酶（TPOAb检测）阳性（n = 18）和阴性（n = 206）的受试者之间的妊娠持续率。

结果

72.7%（721/992）为甲状腺功能正常，19.4%（192/992）为临界-SCH，5.4%（54/992）为亚临床甲状腺功能减退（SCH）。在401例妊娠10周时有已知结局后续妊娠的女性中，21%接受了左甲状腺素治疗。57.7%的受试者进行了TPOAb检测，其中甲状腺功能正常者中9.25%（37/400）呈阳性，临界-SCH受试者中16.5%（22/133）呈阳性，SCH受试者中35.3%（12/34）呈阳性。治疗并未提高临界-SCH受试者的妊娠持续率（P = 0.392）。基于TPOAb状态和临界-SCH受试者的治疗，或基于甲状腺功能正常受试者的TPOAb状态，妊娠结局无差异（P = 0.4214），或（P = 0.2668）。