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Treatment with thyroxine reduces the rates of miscarriage and preterm delivery in pregnant women with autoimmune thyroid disease
The background of the study. The frequency of miscarriage is increased in women who have autoimmune thyroid disease, as manifested by high serum antithyroid antibody concentrations. In this study, the effect of thyroxine (T4) treatment on the outcome of pregnancy was studied in pregnant women with high serum concentrations of these antibodies.
How the study was done. Serum antithyroid peroxidase (anti-TPO) antibodies were measured at the first prenatal visit (mean, 10 weeks of gestation), at 20 and 30 weeks, and at 3 days postpartum in 984 women. Among these women, 88 percent had a normal serum anti-TPO antibody concentration (
100 U/L) and 12 percent a high concentration. The latter women were randomly divided into two groups; 57 were treated with T4 for the remainder of their pregnancy and 58 were not treated. The main study outcomes were the rates of miscarriage and preterm (<37 weeks) birth.
The results of the study. At first study, the mean serum TSH concentrations were slightly higher in the women with high serum anti-TPO antibody concentrations. Thereafter, serum TSH increased slightly in the no-treatment group, but changed little in the other two groups.
Among the women with high serum anti-TPO antibody concentrations, 4 percent of those in the T4-treatment group had a miscarriage, as compared with 14 percent of those in the no-treatment group and 2 percent of the normal women. Preterm delivery was also less common in the T4-treatment group than in the no-treatment group (7 vs. 22 percent).
The conclusions of the study. The rates of miscarriage and preterm delivery are higher in women with high serum antithyroid antibody concentrations than in normal women early in pregnancy, and the rates are decreased if they are treated with T4.
The original article. Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab 2006;91:2587-9.
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