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J Clin Endocrinol Metab. 2017 Nov 6. doi: 10.1210/jc.2017-01850. [Epub ahead of print]

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

Author information

1
Department of Midwifery, College of Medical Sciences, Islamic Azad University, Varamin-Pishva Branch, Tehran, Iran/ Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2
Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3
Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
5
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran/Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
6
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Context:

Currently, there is no consensus on universal thyroid screening and Levothyroxine (LT4) treatment of subclinical hypothyroid pregnant women who are negative for thyroid peroxidase antibody (SCH-TPOAb-).

Objective:

We aimed to evaluate the benefits of LT4 treatment on pregnancy outcomes in SCH-TPOAb- women.

Design:

This study was conducted within the framework of the Tehran Thyroid and pregnancy study. A single-blind randomized clinical trial was undertaken on SCH-TPOAb- pregnant women.

Setting:

Prenatal care centers of Shahid Beheshti University of Medical Sciences.

Patients:

Using the thyrotropin (TSH) cut-point of 2.5mIU/L, 366 SCH-TPOAb- and 1092 euthyroid TPOAb- women were recruited.

Intervention:

SCH-TPOAb- women were randomly assigned into two groups; group A (n=183) treated with LT4 and group B (n=183) who received no treatment. One thousand and twenty-eight euthyroid TPOAb- women served as the control group (group C).

Main Outcome Measures:

Primary outcome was the rate of preterm delivery.

Results:

Using the TSH cut-off 2.5 mIU/L, no significant difference in preterm delivery was observed between groups A and B (RR=0.86, 95% CI: 0.47-1.55, P=0.61). However, log-binomial model analysis based on cut-point of 4.0mIU/L, demonstrated a significantly lower rate of preterm delivery in LT4-treated women, compared with those who received no treatment (RR=0.38, 95% CI: 0.15-0.98, P=0.04).

Conclusions:

Despite no beneficial effect of LT4 therapy in reducing preterm delivery in SCH-TPOAb- women with TSH cut-point of 2.5-4mIU/L, LT4 could precisely decrease this complication using the newly recommended cut-off ≥4.0mIU/L.

PMID:
29126290
DOI:
10.1210/jc.2017-01850
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