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Clinical Summary

Subclinical or borderline hypothyroidism and repeated miscarriage: treat or not?

Takeaway

  • Treatment of subclinical and borderline hypothyroidism does not improve pregnancy continuation rates in women with a history of repetitive miscarriage.

Why this matters

  • Recurrent pregnancy loss is defined as 2 or more spontaneous abortions and has been associated with thyroid disease.
  • Treatment should be initiated with serum thyroid-stimulating hormone (TSH) >4 mIU/L.

Key results

  • 1.8% of cohort were hyperthyroid, 72% were euthyroid, 19.4% were borderline, 5.4% were subclinical, and 0.7% had overt hypothyroidism.
  • Of the 58.7% participants who had a thyroid peroxidase antibody test, 9.25% were positive in euthyroid, 16.5% positive in borderline, and 35.3% positive in subclinical hypothyroid.
  • Pregnancy continuation rates did not differ between participants who were euthyroid vs borderline (with and without treatment).
  • Thyroid autoimmunity treatment did not improve pregnancy in subclinical hypothyroid cases.

Study design

  • Retrospective cohort study.
  • Participants who attended a recurrent pregnancy loss clinic and had a TSH level measured between 2011 and 2016 were identified (n=992).
  • Participants were offered preconception levothyroxine if TSH level was >2.5 mIU/L.
  • Outcome measure was continued pregnancy beyond 10 weeks.
  • Funding: Department of Obstetrics and Gynaecology, University of British Columbia.

Limitations

  • Treatment guidelines may have changed over the course of the study.

References


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