Scher Jonathan, Dabao Carmen, Rukat Caitlin
Jonathan Scher MD, LLC, New York, New York, USA.
Placental Analytics, LLC, New Rochelle, New York, USA.
Am J Reprod Immunol. 2025 Jan;93(1):e70042. doi: 10.1111/aji.70042.
Hashimoto's disease is the commonest autoimmune disease of pregnancy. The presence of Anti-Thyroid antibodies (ATAs) alone [subclinical hypothyroidism] has also been shown to have adverse pregnancy effects. These can result in failure to conceive, recurrent miscarriages, anemia, preeclampsia, and abruption. Hashimoto's disease in reproduction can cause difficulty in conception through hormonal interference. It can also cause miscarriages, growth retardation, and preterm birth. The current recommended treatment is the administration of levothyroxine. This corrects the thyroid balance and may relieve the patient's hypothyroid symptoms. However, repeated recent studies have shown that it is no more effective than a placebo in correcting obstetric complications.
As a result, we decided to use an anti-autoimmune-directed treatment for this disorder. We selected to use IVIG for both its known powerful anti-inflammatory and anti-autoimmune benefits. There are several studies and observational reports in the literature on the use of IVIG in pregnancy for treating recurrent miscarriages and repeated failed IVF. However, there are no reports in the literature on using IVIG to treat Hashimoto's disease, or the presence of ATAs alone, in pregnancy.
This study showed an increase in live births in the IVIG-treated group versus the non-IVIG-treated group after adjustment for maternal age at delivery (OR = 4.6, 95% CI (1.1, 18.1)). There were no adverse effects in the patients who received IVIG.
IVIG is effective in significantly improving the obstetric outcome in patients with Hashimoto's disease, or the presence of ATAs alone.
桥本氏病是妊娠期最常见的自身免疫性疾病。仅存在抗甲状腺抗体（ATA）[亚临床甲状腺功能减退]也已被证明会对妊娠产生不良影响。这些影响可能导致不孕、反复流产、贫血、先兆子痫和胎盘早剥。生殖期的桥本氏病可通过激素干扰导致受孕困难。它还可导致流产、生长发育迟缓及早产。目前推荐的治疗方法是服用左甲状腺素。这可纠正甲状腺平衡，并可能缓解患者的甲状腺功能减退症状。然而，近期反复研究表明，在纠正产科并发症方面，它并不比安慰剂更有效。
因此，我们决定针对这种疾病采用抗自身免疫导向治疗。我们选择使用静脉注射免疫球蛋白（IVIG），因为其具有已知的强大抗炎和抗自身免疫益处。文献中有多项关于在妊娠中使用IVIG治疗反复流产和反复体外受精失败的研究及观察报告。然而，文献中没有关于在妊娠中使用IVIG治疗桥本氏病或仅存在ATA的报告。
本研究显示，在调整分娩时的产妇年龄后，IVIG治疗组的活产率高于非IVIG治疗组（比值比=4.6，95%置信区间（1.1，18.1））。接受IVIG治疗的患者未出现不良反应。
IVIG可有效显著改善患有桥本氏病或仅存在ATA的患者的产科结局。
