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Subclinical hypothyroidism treatment pregnancy: NEJM Journal Watch

Hwy 98, Pensacola, FL e-mail: leo. Hypothyroidism, overt.

William Thompson
Wednesday, August 28, 2019
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  • Emergency Medicine. Mild increases in blood pressure, heart rate and diabetes during pregnancy were also seen.

  • Navy, or the U. Serum TSH is a more accurate indicator of maternal thyroid status than alternative FT 4 assay methods.

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  • All women had normal T4 levels. Treatment requires taking thyroid hormone pills.

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Although most women with SCH are asymptomatic, previous studies have shown that SCH may be associated with adverse subclinical hypothyroidism treatment pregnancy during pregnancy [ 123 ]. Second, the meta-analysis was repeated after excluding studies that assessed women with a history of infertility or recurrent miscarriages, as women with these conditions may have a higher risk of adverse pregnancy outcomes. Conclusion Treatment of SCH with levothyroxine during pregnancy is associated with decreased risks of pregnancy loss and neonatal death.

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  • During the period from throughparticipants must read the learning objectives and faculty disclosures and study the educational activity. The optimal method to assess serum FT 4 during pregnancy uses direct measurement techniques.

  • Hypothyroidism in pregnancy.

  • First, to address the influence of levothyroxine treatment for women with SCH caused by an autoimmune condition, we repeated our analyses including only studies that addressed the risk of adverse pregnancy outcomes among women with TPOAb positivity who were treated with levothyroxine versus untreated women.

Share your opinions. Effects of levothyroxine therapy on pregnancy outcomes in women with subclinical hypothyroidism. Effects of levothyroxine on pregnant women with subclinical hypothyroidism, negative for thyroid peroxidase antibodies. Six of the included RCTs were randomized [ 353637383942 ], however half did not perform appropriate allocation concealment [ 383942 ]. Given that there was no distribution in the quality of the RCTs, a stratified analysis on the quality of RCT studies was not feasible. In all except one study [ 37 ], participants and personnel were not blinded [ 313536383942 ]. Nazarpour S.

Meta-analysis in context. Heterogeneity was assessed by the tau-squared estimators, and the I 2 statistics. Thus, this emphasizes the need to conduct a meta-analysis in this area of research. Enjoying our content? They found a decreased risk of preterm delivery associated with levothyroxine treatment compared to no treatment 7.

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All patients with overt hypothyroidism are usually treated with subcliinical hormone pills. Type 1 Diabetes. The funding bodies played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. In the influence analysis, the results remained consistent, showing an association between levothyroxine treatment versus no treatment was associated with a decreased risk of pregnancy loss. The remaining women

Treatment was associated with a reduced risk of pregnancy loss in women with a TSH level between 4. Effects similar to overt hypothyroidism, but less documentation exists. In pregnant women treatemnt are being treated for hyperthyroidism, serum TSH and FT 4 should be measured every two weeks until the patient is on a stable medication dosage. Next: Common Questions About Pacemakers. Thyroid disease is second only to diabetes mellitus as the most common endocrinopathy that occurs in women during their reproductive years. ObG Library Hysteroscopy Fertility. However, a randomized study suggested that levothyroxine does not benefit euthyroid women with thyroid autoimmunity.

Pregnancy fertility, increased miscarriage. Value of combined clinical information and thyroid peroxidase antibodies in pregnancy for the prediction of postpartum thyroid dysfunction. Enlarge Print Table 5. Navy Medical Corps, the U. Clinical symptoms of hyperthyroidism include tachycardia, nervousness, tremor, sweating, heat intolerance, proximal muscle weakness, frequent bowel movements, decreased exercise tolerance, and hypertension. Toggle navigation.

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These activities will be marked as such and will provide links to the required software. Email Alerts Don't miss a single issue. Eur J Endocrinol. Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care.

But prefnancy benefit was seen only in women with pre-treatment TSH levels of 4. Pregnancy analyses that excluded studies of women with a history of infertility or who conceived with fertility treatments [ 3139 ] and women with recurrent miscarriages [ 32 ] were consistent with those of our primary analysis Figure S Additionally, the definition of subclinical hypothyroidism differs between the non-pregnant and pregnant state. Hum Reprod Update. Thyroid Diseases. Subclinical hypothyroidism in the infertile female population: a guideline. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology.

No recommendation regarding the treatment of subclinical hypothyroidism can be made at this time; prospective and randomized subclinical hypothyroidism treatment pregnancy are urgently needed. A radioactive iodine uptake scan can help distinguish postpartum thyroiditis from Graves disease, but is contraindicated in breastfeeding women. Triiodothyronine, free pg per mL. Abstract Thyroxine T 4 : the major hormone produced by the thyroid gland. The study included women in the age group of 18 to 55 years with a TSH level between 2.

Thyroid Function Tests in Pregnancy

Login Register. In all except one study [ 37 ], participants and personnel were not blinded [ 313536383942 ]. Competing interests No conflict of interests to declare.

Thyroid Diseases. Levothyroxine treatment compared to no treatment among women with SCH was associated with a decreased risk of neonatal death RR 0. Plastic Surgeon. Sixth, since there is no distribution in the quality of RCTs, we were unable to perform stratified analysis on the quality of these studies. TPO antibodies: these are antibodies that attack the thyroid instead of bacteria and viruses, they are a marker for autoimmune thyroid disease, which is the main underlying cause for hypothyroidism and hyperthyroidism in the United States.

Finally, we repeated our meta-analyses using a continuity correction of 0. Compared with non-use, levothyroxine treatment among women with SCH was associated with a decreased risk of pregnancy loss RR: 0. Three domains of bias drove this overall quality assessment: confounding, participant selection, and selective reporting of results. Quality assessment and data extraction were performed for all included studies by two independent reviewers MB and OYwith disagreements resolved by consensus or by a third reviewer IK or KBF. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. In addition, this previous meta-analysis did not assess neonatal and cognitive outcomes in children. We conducted the analyses using the meta package [ 29 ] in R [ 30 ].

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Int J Gynaecol Obstet. Targeted screening for thyroid disease should be performed in pregnant women at high risk, including those with a history of thyroid disease, type 1 diabetes mellitus, or other autoimmune disease; current or past use of thyroid therapy; or a family history of autoimmune thyroid disease. Treatment seems to reduce the incidence of miscarriage and preterm birth, and to improve fetal intellectual development; however, it has little impact on hypertensive disorders and placental abruption.

  • Thyroid hormone is critical during pregnancy for the healthy development of the fetal brain and nervous system.

  • More in Pubmed Citation Related Articles. Associated data ClinicalTrials.

  • We included interventional and observational studies that reported the risk of adverse pregnancy outcomes with and without levothyroxine treatment among women with SCH. Because of a lack of clarity pertaining to the benefits of universal screening for thyroid dysfunction in pregnancy, the ATA guidelines recommend targeted screening in patients with certain risk factors eg, signs or symptoms of thyroid dysfunction or a history of infertility.

  • During the period from throughparticipants must read the learning objectives and faculty disclosures and study the educational activity.

  • Subclinical hypothyroidism is defined by an increased TSH but a normal T 4. PubMed Article Google Scholar

Treatment was associated with a reduced yypothyroidism of pregnancy loss in women with a TSH level between 4. Published by Elsevier Inc. In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Levothyroxine: little to no effect on hypertensive disorders and abruption; reduces miscarriage and preterm birth, and improves fetal intellectual development.

Yamamoto JM et al. Abstract Background Levothyroxine replacement therapy may decrease the risk hypothyrokdism adverse pregnancy outcomes among women with subclinical hypothyroidism SCH. Influence of maternal thyroid subclinical hypothyroidism during gestation on fetal brain development. Optimal management of hypothyroidism, hypothyroxinaemia and euthyroid TPO antibody positivity preconception and in pregnancy. Randomized controlled studies RCTs and observational studies examining the association between treatment of SCH during pregnancy and our outcomes of interest were included. By including the totality of evidence in this area of research, we increase precision of our estimates [ 24 ]. Overt hypothyroidism—when TSH levels are increased and the free thyroxine level is low—can cause severe symptoms and is associated with an increased incidence of infertility and miscarriage, both in women who are trying to conceive or are already pregnant, according to the ATA.

We also performed a secondary analysis whereby we used meta-regression to study the effects of study design i. Hypohyroidism this study, the Practice Committee of the American Society for Reproductive Medicine reviewed the evidence and developed guidelines for treating subclinical hypothyroidism in women with a history of infertility and miscarriage. The reduced risk of pregnancy loss was not observed in those with pre-treatment TSH levels of 2. Although most women with SCH are asymptomatic, previous studies have shown that SCH may be associated with adverse outcomes during pregnancy [ 123 ]. The funding bodies played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Navy Medical Corps, the U. Subclinical thyroid disease abnormal TSH but normal free T4 does not require treatment. Search date: August 22, Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Methimazole Tapazole; preferred agent after first trimester10 to 40 mg per day orally in two divided doses.

Search date: August 22, Fetal: goiter, intrauterine growth restriction, small for gestational age, stillbirth, thyroid dysfunction. Designated for 0. JEFF D. Try ObGFirst Free!

When preferred FT 4 assay techniques are unavailable, a serum TSH level is a more accurate assessment of maternal thyroid status, and measurements of total thyroxine and the FT 4 subclinical hypothyroidism treatment can be used instead. Anemia, fetal neurocognitive deficits, gestational hypertension, low birth weight, miscarriage, placental abruption, preeclampsia, preterm birth. A comparison of propylthiouracil versus methimazole in the treatment of hyperthyroidism in pregnancy. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. C 36 Targeted screening for thyroid disease should be performed in pregnant women at high risk, including those with a history of thyroid disease, type 1 diabetes mellitus, or other autoimmune disease; current or past use of thyroid therapy; or a family history of autoimmune thyroid disease.

Thanks for visiting Endocrinology Advisor. Data from included studies were extracted and quality assessment was performed by two independent reviewers. Randomized Controlled Trial: is a type of clinical study where the people being studied are randomly allocated one or other of the different treatments.

Las Cruces, New Mexico. Thyroid function testing and management during and after pregnancy among women without thyroid disease before pregnancy. Use of this website is conditional upon your acceptance of our user agreement. Systematic reviews in health care. Additional studies may have been published since this time. There were also some differences in the definition of pregnancy loss across studies, a lack of information relating to TSH levels used to define SCH, and the timing of initiation of levothyroxine therapy. Neonatal outcomes assessed included neonatal death, 5-min Apgar score, and low birthweight Table 2Table 3.

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Information from references 2 and 3. Levothyroxine, to mcg per day orally 2. The most common cause of postpartum thyroid dysfunction is postpartum thyroiditis, which affects 1. Enlarge Print Table 1. The current study investigated the harms and benefits associated with the treatment of subclinical hypothyroidism during pregnancy.

These analyses would have been clinically relevant given that the concurrent presence of an autoimmune treatmment may affect fetal outcomes among women with SCH [ 5152 ]. RCTs and observational studies on the association between levothyroxine treatment and pregnancy loss and other adverse outcomes among women with SCH. Full size image. However, there was heterogeneity with respect to study populations and timing of initiation of levothyroxine between the included studies. Al-Anbari L. Glinoer D.

Related CE

We were therefore not able to perform a subgroup analyses among women with SCH treatment pregnancy to an autoimmune condition. On the other hand, they were more likely to have a preterm delivery, or experience gestational diabetes or preeclampsia. Indian J Endocrinol Metab. Endocr Pract16 5 — Previous meta-analyses have been performed on this topic.

In pregnant women who are being treated for hyperthyroidism, serum TSH and FT 4 should be measured every two weeks until the patient is on a stable medication dosage. Eur J Endocrinol. Describe the treatment protocols for thyroid disease in pregnancy Estimated time to complete activity: 0. Postgraduate Institute for Medicine PIM requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest COI they may have as related to the content of this activity.

  • Thyroid Cancer.

  • Postpartum thyroid dysfunction. Postgraduate Institute for Medicine PIM requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest COI they may have as related to the content of this activity.

  • Effects of levothyroxine on pregnant women with subclinical hypothyroidism, negative for thyroid peroxidase antibodies.

  • References 1.

  • Conclusion s : Based on the limited observational studies available, no association exists between RPL and subclinical hypothyroidism, nor does levothyroxine improve subsequent pregnancy outcomes.

Enlarge Print Table 6. Am J Obstet Gynecol. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. Treatment was associated with a lower risk of pregnancy loss but a higher risk of premature delivery, diabetes and high blood pressure during pregnancy and in high heart rates. Postgraduate Institute for Medicine PIM requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest COI they may have as related to the content of this activity. Thyroid disease is the second most common endocrine disorder affecting women of reproductive age, and when untreated during pregnancy is associated with an increased risk of miscarriage, placental abruption, hypertensive disorders, and growth restriction.

Symptoms usually improve during the subclinical hypothyroidism treatment pregnancy half of the pregnancy, only to worsen again in the postpartum period. Address correspondence to Leo A. The information presented in this activity is not meant to serve as a guideline for patient management. Overt and subclinical hypothyroidism have been associated with adverse effects on pregnancy and fetal development Table 4. Toggle navigation. C 3 In pregnant women who are being treated for hyperthyroidism, serum TSH and FT 4 should be measured every two weeks until the patient is on a stable medication dosage. Overt hyperthyroidism and hypothyroidism during pregnancy.

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Subclinixal of the hyperthyroid phase of postpartum thyroiditis from Graves disease is important because Graves disease requires antithyroid therapy. Feb 15, Issue. Endocr Rev. Transient hyperthyroidism may also be associated with hyperemesis gravidarum and gestational transient thyrotoxicity, most likely resulting from the stimulatory effect of human chorionic gonadotropin on the thyroid. During pregnancy, reference ranges for thyroid-stimulating hormone TSH are lower because of the cross-reactivity of the alpha subunit of human chorionic gonadotropin with the TSH receptor.

Consequently, further studies are required to address whether levothyroxine treatment among women with SCH improves pregnancy outcomes if given earlier during pregnancy, in women with autoimmune thyroid disease, and in women with a history of infertility or recurrent pregnancy loss. RCTs demonstrated several sources of bias, with lack of blinding of the participants or research personnel; only one study was fully blinded. Confidence intervals for the between-study variance in random effects meta-analysis using generalised Cochran heterogeneity statistics. Four studies examined stillbirth [ 31353639 ] but no stillbirths occurred among study participants. Endocr Rev.

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Treayment assessment and data extraction were performed for all included studies by two independent reviewers MB and OYwith disagreements resolved by consensus or by a third reviewer IK or KBF. Register for free and gain unlimited access to:. Availability of data and materials Not applicable. Consequently, further studies are required to address whether levothyroxine treatment among women with SCH improves pregnancy outcomes if given earlier during pregnancy, in women with autoimmune thyroid disease, and in women with a history of infertility or recurrent pregnancy loss. Patients with subclinical hypothyroidism before 20 weeks of pregnancy have a higher risk of miscarriage: A systematic review and meta-analysis.

Given the limited quality of the available data and its heterogeneity, additional high-quality studies are needed. The former is diagnosed when the TSH is above 4. Obstet Gynecol. First, to address the influence of levothyroxine treatment for women with SCH caused by an autoimmune condition, we repeated our analyses including only studies that addressed the risk of adverse pregnancy outcomes among women with TPOAb positivity who were treated with levothyroxine versus untreated women. Google Scholar Compared with non-use, levothyroxine treatment among women with SCH was associated with a decreased risk of pregnancy loss RR: 0.

Background

Impact of levothyroxine therapy on treatment pregnancy, neonatal and childhood outcomes in women with subclinical hypothyroidism diagnosed in pregnancy: a systematic review and meta-analysis of randomised controlled trials. Maternal thyroid hormones early in pregnancy and fetal brain development. Pearce noted, however, that the recent BMJ study was observational and that randomized, controlled clinical trials are needed to definitively determine whether or not thyroid replacement therapy improves obstetric outcomes in subclinically hypothyroid pregnant women. We also scanned the references of relevant articles, searched for citing articles snowballingand conducted a search of the grey literature to retrieve studies not identified by our primary search.

  • Citation s : Yamamoto JM et al. A recent systematic review and meta-analysis of studies comparing women with SCH and euthyroid women during pregnancy found that SCH was associated with an increased risk of multiple adverse maternal and fetal outcomes [ 10 ], including pregnancy loss RR: 2.

  • Levothyroxine: little to no effect on hypertensive disorders and abruption; reduces miscarriage and preterm birth, and improves fetal intellectual development. Family history of autoimmune thyroid disease.

  • A continuity correction of 0.

  • Nazarpour et al.

  • The potential for chance findings due to multiple testing should thus be considered when interpreting our findings.

This study included 3 trials and found no difference in obstetrical treatment pregnancy neonatal outcomes, including childhood IQ and neurocognitive outcomes among teratment born to women with SCH who were treated with levothyroxine compared to those who received no treatment [ 16 ]. We were therefore not able to perform a subgroup analyses among women with SCH secondary to an autoimmune condition. Thyroxine T 4 : the major hormone produced by the thyroid gland. We also performed a secondary analysis whereby we used meta-regression to study the effects of study design i. Pooled analyses showed decreased risk of pregnancy loss RR: 0.

Email Print Discuss. But there was subclinical hypothyroidism treatment pregnancy evidence to support treatment with thyroid hormone when TSH levels prior to pregnancy are only between 2. Gynecol Endocrinol. Received : 18 June Treatment was associated with a lower risk of pregnancy loss but a higher risk of premature delivery, diabetes and high blood pressure during pregnancy and in high heart rates. Related CE.

Clin Endocrinol. Bloomington, Indiana. Concord, Massachusetts.

  • Use of this website is conditional upon your acceptance of our user agreement.

  • Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. Levothyroxine is the mainstay of treatment for maternal hypothyroidism Table 5.

  • Third, given that one of the prospective clinical trials did not utilize randomization compared to the other prospective clinical studies [ 31 ], we repeated our primary meta-analysis excluding this study.

  • The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. For women with infertility or recurrent miscarriage, testing for and treating subclinical hypothyroidism seems reasonable — but routine testing and treatment during pregnancy remains fraught with uncertainty.

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  • Worldwide, the most common cause of hypothyroidism is iodine deficiency. Table 3.

Log in. Substances Thyroxine. Information from references 23and 14 through J Clin Endocrinol Metab. Eur J Endocrinol. A meta-analysis of five studies revealed the prevalence of subclinical hypothyroidism in RPL to be

The information presented in this activity is not meant to serve as a guideline for patient management. Background: Subclinical thyroid disease during pregnancy may be associated with adverse outcomes, including a lower-than-normal IQ in offspring. Associated data ClinicalTrials. This content is owned by the AAFP. Decreased fertility, increased miscarriage.

However, these meta-analyses have focused on comparing women with SCH with euthyroid women during pregnancy [ 1012 ] subclinnical only included randomized controlled trials RCTswhich are very few to this date [ 16 ]. Diagnosis and management of thyroid disease during pregnancy and the postpartum period. It is clear that overt hypothyroidism should be treated with thyroid hormone replacement- usually levothyroxine. For observational studies, adjusted effect estimates were extracted. Gynecol Endocrinol.

Controversy exists whether the subtle abnormalities of thyroid function in subclinical hypothyroidism are truly associated with infertility and miscarriage and whether treatment with thyroid hormone reduces these events. A medical librarian FF designed and conducted the searches see Appendix for full search strategies. Heterogeneity was assessed by the tau-squared estimators, and the I 2 statistics. It is clear that overt hypothyroidism should be treated with thyroid hormone replacement- usually levothyroxine. Given the limited quality of the available data and its heterogeneity, additional high-quality studies are needed. Acknowledgements None.

  • Subclinical hypothyroidism SCH is a common biochemical entity identified in women during pregnancy.

  • Methods: We screened women with a singleton pregnancy before 20 weeks of gestation for subclinical hypothyroidism, defined as a thyrotropin level of 4. Results: A total of women with subclinical hypothyroidism underwent randomization at a mean of

  • Neonatal outcomes assessed included neonatal death, 5-min Apgar score, and low birthweight Table 2Table 3. Subclinical hypothyroidism SCH is a common biochemical entity identified in women during pregnancy.

  • Second, pregnancy meta-analysis was repeated after excluding studies that assessed women with a history of infertility or recurrent miscarriages, as women with these conditions may have a higher risk of adverse pregnancy outcomes. The potential for chance findings due to multiple testing should thus be considered when interpreting our findings.

This study included 3 trials and found no difference in obstetrical and neonatal outcomes, including childhood IQ and neurocognitive outcomes among children born to women hypothyriodism SCH who were treated with levothyroxine compared to those who received no treatment [ 16 ]. Hypothyriidism the paucity of RCTs that assessed the risk of adverse events during pregnancy with levothyroxine treatment among women with subclinical hypothyroidism, we performed our primary analysis, pooling findings from RCTs and observational studies [ 24 ]. Levothyroxine treatment compared to no treatment among women with SCH was associated with a decreased risk of neonatal death RR 0. J Maternal-fetal Neonatal Med. However, these meta-analyses have focused on comparing women with SCH with euthyroid women during pregnancy [ 1012 ] or only included randomized controlled trials RCTswhich are very few to this date [ 16 ]. If you wish to read unlimited content, please log in or register below.

Effects of maternal subclinical hypothyroidism on obstetrical outcomes during early pregnancy. Resources Community Advice Patient Guides. Meta-analysis in context. We excluded uncontrolled studies, systematic reviews and meta-analyses, cross-sectional studies, letters to the editor and commentaries, and animal studies. Previous meta-analyses have been performed on this topic. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy.

Sign subclinical hypothyroidism treatment pregnancy for the free AFP email table of contents. Thyroid Disease in Pregnancy. Cochrane Database Syst Rev. A meta-analysis of 17 studies revealed a statistically significant association between RPL and thyroid autoimmunity odds ratio 1. Note: Maternal antibodies found in Graves disease cross the placenta and are cleared slowly Notify neonatology of maternal diagnosis as neonatal Graves disease may not present immediately following delivery.

Methimazole Tapazole; preferred agent after first trimester10 to 40 mg per day orally in two divided doses. Subclinical hypothyroidism treatment pregnancy from references 2 and 3. Tap the button to learn more about ObGFirst. However, a randomized study suggested that levothyroxine does not benefit euthyroid women with thyroid autoimmunity. Enlarge Print Table 1. Decrease or no change. Potential adverse fetal effects of antithyroid medications include congenital abnormalities and neonatal hypothyroidism caused by transplacental transfer.

In January, the American Thyroid Association published updated care guidelines with treatment recommendations for women experiencing thyroid disease during pregnancy. Seven RCTs and six cohort studies were pretnancy from a total of articles identified by our search Fig. These analyses would have been clinically relevant given that the concurrent presence of an autoimmune disorder may affect fetal outcomes among women with SCH [ 5152 ]. Discussion In this systematic review and meta-analysis, we assessed the available evidence regarding the use of levothyroxine in treating SCH during pregnancy. Sensitivity analyses that excluded studies of women with a history of infertility or who conceived with fertility treatments [ 3139 ] and women with recurrent miscarriages [ 32 ] were consistent with those of our primary analysis Figure S Abstract Background Levothyroxine replacement therapy may decrease the risk of adverse pregnancy outcomes among women with subclinical hypothyroidism SCH.

No recommendation regarding the treatment of subclinical hypothyroidism can be made at this time; prospective and randomized studies are urgently needed. Free T4 immunoassays are flawed during pregnancy. Maternal hyperthyroidism and congenital malformation in the offspring.

  • Given the limited quality of the available data and its heterogeneity, additional high-quality studies are needed.

  • During the period from throughparticipants must read the learning objectives and faculty disclosures and study the educational activity.

  • Ju et al.

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Adverse effects of prenatal methimazole exposure. Preconception counseling for subclinical hypothyroidism treatment pregnancy with known hyperthyroidism should include discussion of available treatments and potential adverse effects, as well as the impact on future pregnancies. During the period from throughparticipants must read the learning objectives and faculty disclosures and study the educational activity. Reprints are not available from the authors. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the U. Current thyroid therapy.

Navy Medical Corps, the U. J Clin Endocrinol Metab. However, overt hyperthyroidism and hypothyroidism warrant further management. Serum TSH is a more accurate indicator of maternal thyroid status than alternative FT 4 assay methods. Effects similar to overt hypothyroidism, but less documentation exists.

Depression in Type 1 and Type 2 Diabetes. Due to the small number of studies included in our meta-analysis, our ability to examine the impact of study-level covariates on estimated treatment effects via meta-regression was limited. Levothyroxine and the risk of adverse pregnancy outcomes in women with subclinical hypothyroidism: a systematic review and meta-analysis. Of the women who were treated, Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy.

Indian J Endocrinol Metab. Given that these more recent guidelines heavily rely on the evidence of thyroid autoimmune disease, the use of this definition in our meta-analysis would have resulted in far fewer included studies and could have been affected by selection bias due to the systematic pregnany of older studies. While this approach reduces potential selection bias, it can introduce bias for small studies with imbalances in numbers. Second, the meta-analysis was repeated after excluding studies that assessed women with a history of infertility or recurrent miscarriages, as women with these conditions may have a higher risk of adverse pregnancy outcomes. Impact of levothyroxine therapy on obstetric, neonatal and childhood outcomes in women with subclinical hypothyroidism diagnosed in pregnancy: a systematic review and meta-analysis of randomised controlled trials. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology.

Maternal: heart failure, placental abruption, preeclampsia, preterm delivery. Measurement prenancy serum TSH and free subclinical hypothyroidism treatment pregnancy every two weeks until on stable medication dosage 23. Children underwent annual developmental and behavioral testing for 5 years. Postgraduate Institute for Medicine designates this enduring material for a maximum of 0. Stagnaro-Green A. Setting: University obstetrics and gynecology departments. The preferred treatment for hyperthyroidism is antithyroid medications, with a goal of maintaining a serum free thyroxine level in the upper one-third of the normal range.

Impact of levothyroxine therapy treatment pregnancy obstetric, neonatal and childhood outcomes treztment women with subclinical hypothyroidism diagnosed in pregnancy: a systematic review and meta-analysis of randomised controlled trials. Third, outcomes were inconsistently reported, and some of our analyses therefore included a small number of studies. Use of this website is conditional upon your acceptance of our user agreement. Several of these studies reported increased risks of these outcomes among women with untreated SCH during pregnancy [ 2314 ].

Graves disease is typically characterized by an initial exacerbation of symptoms in the first trimester, and is thought to be caused by treatment pregnancy initial stimulatory effect of human chorionic gonadotropin on the thyroid. Hypothyroidism during pregnancy should be treated with levothyroxine, with a serum TSH goal of less than 2. Preconception counseling for women with known hyperthyroidism should include discussion of available treatments and potential adverse effects, as well as the impact on future pregnancies. Adverse effects of prenatal methimazole exposure.

In this study, the Practice Committee of the American Society for Reproductive Medicine reviewed the evidence and developed guidelines for treating subclinical hypothyroidism in women with a hypothyroiidsm of infertility and miscarriage. Home » Topics » Thyroid. Quality assessment and data extraction were performed for all included studies by two independent reviewers MB and OYwith disagreements resolved by consensus or by a third reviewer IK or KBF. Effects of levothyroxine treatment on pregnancy outcomes in pregnant women with autoimmune thyroid disease. Although available data are limited, there is also evidence that levothyroxine treatment is associated with improved fetal outcomes, including reductions in fetal distress and macrosomia. A new study published in The BMJ offers evidence that lack of treatment can have worse consequences than previously observed, including pregnancy loss. R News.

Obstet Gynecol. This systematic review and meta-analysis found that, compared with treatment pregnancy, levothyroxine treatment was associated with decreased risks of pregnancy loss and neonatal death among pregnant women with SCH. Thyroid hormones in fetal growth and prepartum maturation. However, treatment of subclinical hypothyroidism in the mother during pregnancy has been recommended in the recently published guidelines of the American Thyroid Association as well as in prior guidelines from the Endocrine Society and the European Thyroid Association. There was also fair evidence that treatment of subclinical hypothyroidism with thyroid hormone replacement when TSH levels are greater than 4. Related Content.

Levothyroxine treatment in euthyroid pregnant women subcilnical autoimmune thyroid disease: effects on obstetrical complications. Cite this article Bein, M. Five studies did not meet the criteria in at least three domains of bias [ 3135383942 ] and one study was deficient in two criteria [ 36 ]. There is controversy as to whether this should be treated or not. This can cause severe symptoms and is associated with an increased incidence of infertility, miscarriage and other adverse outcomes in those women who are trying to conceive or those who are already pregnant.

Methods: We screened women with subclinical hypothyroidism treatment pregnancy singleton pregnancy before 20 weeks of gestation for subclinical hypothyroidism, defined as a thyrotropin level of 4. There is controversy as to whether this should be treated. Management of Graves' disease during pregnancy: the key role of fetal thyroid gland monitoring. Triiodothyronine, free pg per mL. Targeted screening for thyroid disease should be performed in pregnant women at high risk, including those with a history of thyroid disease, type 1 diabetes mellitus, or other autoimmune disease; current or past use of thyroid therapy; or a family history of autoimmune thyroid disease. Previous delivery of infant with thyroid disease. The incidence of hypothyroidism during pregnancy is estimated to be 0.

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Table 4. In women with hypothyroidism, levothyroxine is titrated to achieve a goal serum thyroid-stimulating hormone level less than 2. Enlarge Print Table 1. Postgraduate Institute for Medicine PIM requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest COI they may have as related to the content of this activity. Anemia, fetal neurocognitive deficits, gestational hypertension, low birth weight, miscarriage, placental abruption, preeclampsia, preterm birth.

All women had normal T4 levels. CAS Google Scholar Register for free and gain unlimited access to:. Meta-analysis in clinical trials. Abstract Background Levothyroxine replacement therapy may decrease the risk of adverse pregnancy outcomes among women with subclinical hypothyroidism SCH. Thyroid function testing and management during and after pregnancy among women without thyroid disease before pregnancy.

Search all BMC articles Search. Given the paucity of available data and heterogeneity of included studies, additional studies are needed to address the benefits of levothyroxine use among pregnant women with SCH. They point out that pregnant women typically produce a lower level than normal of thyroid-stimulating hormone TSH —0. BMJ Clinical research ed. Although this meta-analysis included fewer studies than our meta-analysis, [ 17 ] the findings are consistent with the current study.

  • The risks of selection bias, and bias due to selective reporting of results were moderate in three of six studies [ 333441 ], with one at serious risk [ 40 ].

  • Levothyroxine: little to no effect on hypertensive disorders and abruption; reduces miscarriage and preterm birth, and improves fetal intellectual subclinical hypothyroidism treatment pregnancy. Postgraduate Institute for Medicine PIM requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest COI they may have as related to the content of this activity.

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  • Two studies addressed whether levothyroxine treatment was associated with treatent outcomes among women with SCH caused by autoimmune treatment pregnancy diagnosed by elevated TPOAb levels [ 35 ]. The risks of selection bias, and bias due to selective reporting of results were moderate in three of six studies [ 333441 ], with one at serious risk [ 40 ].

The risks of selection bias, and bias due to selective reporting of results were moderate subclinical hypothyroidism treatment pregnancy three of six studies [ 333441 ], with one at serious risk [ 40 ]. J Clin Endocrinol Metab. Hormonal and nutritional drivers of intrauterine growth. The benefits of treating overt hypothyroidism in women who are pregnant or planning pregnancy are clear, given its association with adverse outcomes including increased risk for premature birth, pregnancy loss, and lower offspring IQ. In developing their recommendations, the authors performed a systematic literature search of English language studies examining overt and subclinical hypothyroidism in pregnancy which were published between We conducted the analyses using the meta package [ 29 ] in R [ 30 ].

  • We reviewed previous systematic reviews and meta-analyses of levothyroxine treatment among women with SCH during pregnancy and retrieved studies not identified in our search. Thanks for visiting Endocrinology Advisor.

  • The current study investigated the harms and benefits associated with the treatment of subclinical hypothyroidism during pregnancy. Treatment seems to reduce the incidence of miscarriage and preterm birth, and to improve fetal intellectual development; however, it has little impact on hypertensive disorders and placental abruption.

  • Nazarpour S. Three domains of bias drove this overall quality assessment: confounding, participant selection, and selective reporting of results.

  • TSH: thyroid stimulating hormone — produced by the pituitary gland that regulates thyroid function; also the best screening test to determine if the thyroid is functioning normally. Correspondence to Kristian B.

Fifth, we conducted an influence analysis in assessing the association between levothyroxine treatment and pregnancy loss to determine if any study had a significant impact on our results. However, hjpothyroidism meta-analyses have focused on comparing women with SCH with euthyroid yhpothyroidism during pregnancy [ 1012 ] or only included randomized controlled trials RCTswhich are very few to this date [ 16 ]. Treatment was associated with a lower risk of pregnancy loss but a higher risk of premature delivery, diabetes and high blood pressure during pregnancy and in high heart rates. We based our definition of SCH on the ATA guidelines [ 21 ], which is a broader definition compared to that included in the more recent ATA guidelines which recommends treatment for SCH during pregnancy depending on the presence of thyroid autoimmune disease [ 9 ]. Treatment of subclinical hypothyroidism or Hypothyroxinemia in pregnancy. Effects of levothyroxine treatment on pregnancy outcomes in pregnant women with autoimmune thyroid disease. Optimal management of hypothyroidism, hypothyroxinaemia and euthyroid TPO antibody positivity preconception and in pregnancy.

In iodine-sufficient regions, the most common causes are autoimmune thyroiditis and iatrogenic hypothyroidism after treatment for hyperthyroidism. A meta-analysis of 17 studies revealed a subclijical significant association between RPL and thyroid autoimmunity odds ratio 1. Associated data ClinicalTrials. More in Pubmed Citation Related Articles. Sign up for the free AFP email table of contents. Poorly controlled thyroid disease is associated with adverse outcomes during pregnancy, and treatment is an essential part of prenatal care to ensure maternal and fetal well-being. C 3 In pregnant women who are being treated for hyperthyroidism, serum TSH and FT 4 should be measured every two weeks until the patient is on a stable medication dosage.

Related Content. Levothyroxine treatment was not associated subcliniacl the risk of low 5-min Apgar score Figure S 9 and low birthweight Figure S It is less clear of the benefits of treating subclinical hypothyroidism, just as it is controversial whether there are any problems with the pregnancy if the mother is not treated.

Postpartum thyroiditis is subclinical hypothyroidism treatment pregnancy most common form of postpartum thyroid dysfunction and may present as hyper- or hypothyroidism. Free T 4 is the proportion of this hormone not bound to a protein in the blood. Hypothyroidism during pregnancy should be treated with levothyroxine, with a serum TSH goal of less than 2. Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high-risk case finding?

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Certain educational activities may require additional software to view multimedia, presentation, or printable versions of subclinical hypothyroidism treatment pregnancy content. The optimal method to assess serum FT 4 during pregnancy uses direct measurement techniques. Of the women who were treated, Describe the treatment protocols for thyroid disease in pregnancy Estimated time to complete activity: 0. A meta-analysis of five studies revealed the prevalence of subclinical hypothyroidism in RPL to be Levothyroxine, to mcg per day orally 2. Treatment was associated with a reduced risk of pregnancy loss in women with a TSH level between 4.

Universal TSH screening for thyroid disease in pregnancy ptegnancy not recommended. There were no significant between-group differences in either trial in any other neurocognitive or pregnancy outcomes or in the incidence of adverse events, which was low in both groups. Enlarge Print Table 2. Learn More. ObGFirst Free Trial. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Navy Medical Corps, the U. Substances Thyroxine. Thyroxine, free ng per dL. Levothyroxine, to mcg per day orally 2. Serum free thyroxine in upper one-third of normal range 2.

Table 5. Postpartum thyroid dysfunction. Levothyroxine: little to no effect on hypertensive disorders and abruption; reduces miscarriage and preterm birth, and improves fetal intellectual development. Get Permissions.

Hormonal and nutritional drivers of intrauterine growth. The new study finds that treating subclinical hypothyroidism, which is below the level that would require subclinical hypothyroidism treatment pregnancy in nonpregnant women, can reduce pregnancy loss, especially for those with TSH levels on the upper end of normal or higher. Gene Mol Res. Download references. Several of these studies reported increased risks of these outcomes among women with untreated SCH during pregnancy [ 2314 ].

Six of the included RCTs were randomized [ 353637383942 ], however half did not subclinical hypothyroidism treatment pregnancy appropriate allocation concealment [ 383942 ]. Ask questions. Am J Epidemiol. Levothyroxine treatment for SCH during pregnancy may decrease the risk of pregnancy loss among women with infertility [ 93139 ], although the number of studies in this area is few and the results are conflicting.

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