BACKGROUND: A failure in thyroid hormone availability during early pregnancy is associated with recurrent miscarriage (RM) and several adverse outcomes. In order to hypothesize the involvement of a transient impairment of the pituitary–thyroid axis in early pregnancy as responsible of miscarriage, we have evaluated data collected by the follow-up of euthyroid women affected by unexplained recurrent miscarriage (RM) treated with levothyroxine (LT4) comparing the outcome with a control group of untreated women. METHODS: This is a retrospective study evaluating a cohort of 458 euthyroid women affected by RM followed over 5 years. Starting from at least 3 months before expected programmed pregnancy, 227 out of 458 women were treated with low doses of levothyroxine (LT4), while 231 did not receive any thyroid hormone supply. In both groups we assessed the number of full-term pregnancies, abortions and failure to conceive. RESULTS: We have observed a significant improvement of full-term pregnancy in the group of treated women (59%) compared to the control group of untreated women (13%). In the group of women treated with LT4 there was a lower percentage of miscarriage and failure to conceive respect to the control group, respectively 12 vs 30% and 29 vs 57%. CONCLUSIONS: In euthyroid women affected with RM who underwent low-dose levothyroxine treatment, a statistically higher pregnancy and parturition rate was observed comparing to the control group (p<0.0001). A better response to treatment was obtained starting LT4 treatment at least three months before planning pregnancy. A frequent evaluation of serum TSH and FT4 was crucial to prevent transient thyroid impairment in pregnant women and in order to tailor the therapy to every single patient. We conclude that transient impairment of thyroid hormone availability may be responsible of RM even in euthyroid women and treatment with low doses of LT4 can improve the pregnancy outcome.
Low dose levothyroxine treatment improves outcome in euthyroid women affected by unexplained recurrent miscarriage / C. G., Moretti; M., Colicchia; A., Dal Lago; Ulisse, Salvatore. - ELETTRONICO. - (2014), pp. SAT-0032-SAT-0032. (Intervento presentato al convegno 96th Annual meeting of the Endocrine Society tenutosi a Chicago, USA nel 21-24 Giugno, 2014).
Low dose levothyroxine treatment improves outcome in euthyroid women affected by unexplained recurrent miscarriage.
ULISSE, SALVATORE
2014
Abstract
BACKGROUND: A failure in thyroid hormone availability during early pregnancy is associated with recurrent miscarriage (RM) and several adverse outcomes. In order to hypothesize the involvement of a transient impairment of the pituitary–thyroid axis in early pregnancy as responsible of miscarriage, we have evaluated data collected by the follow-up of euthyroid women affected by unexplained recurrent miscarriage (RM) treated with levothyroxine (LT4) comparing the outcome with a control group of untreated women. METHODS: This is a retrospective study evaluating a cohort of 458 euthyroid women affected by RM followed over 5 years. Starting from at least 3 months before expected programmed pregnancy, 227 out of 458 women were treated with low doses of levothyroxine (LT4), while 231 did not receive any thyroid hormone supply. In both groups we assessed the number of full-term pregnancies, abortions and failure to conceive. RESULTS: We have observed a significant improvement of full-term pregnancy in the group of treated women (59%) compared to the control group of untreated women (13%). In the group of women treated with LT4 there was a lower percentage of miscarriage and failure to conceive respect to the control group, respectively 12 vs 30% and 29 vs 57%. CONCLUSIONS: In euthyroid women affected with RM who underwent low-dose levothyroxine treatment, a statistically higher pregnancy and parturition rate was observed comparing to the control group (p<0.0001). A better response to treatment was obtained starting LT4 treatment at least three months before planning pregnancy. A frequent evaluation of serum TSH and FT4 was crucial to prevent transient thyroid impairment in pregnant women and in order to tailor the therapy to every single patient. We conclude that transient impairment of thyroid hormone availability may be responsible of RM even in euthyroid women and treatment with low doses of LT4 can improve the pregnancy outcome.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
