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TSH levels and risk of miscarriage in women on long-term levothyroxine: a community-based study

Taylor, Peter, Minassian, Caroline, Rehman, Anis, Iqbal, Ahmed, Draman, Mohd Shazli, Hamilton, William, Dunlop, Diana, Robinson, Anthony, Vaidya, Bijay, Lazarus, John, Thomas, Sara, Dayan, Colin and Okosieme, Onyebuchi 2014. TSH levels and risk of miscarriage in women on long-term levothyroxine: a community-based study. Journal of Clinical Endocrinology & Metabolism 99 (10) , pp. 3895-3902. 10.1210/jc.2014-1954

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Abstract

Context: Thyroid dysfunction is associated with adverse obstetric outcomes, but there is limited information on pregnancy outcomes in women established on levothyroxine. Objective: The objective of the study was to determine the relationship between TSH levels and pregnancy outcomes in levothyroxine-treated women in a large community-based database. Design: This was a historical cohort analysis. Patients: Individuals with a first prescription of levothyroxine from 2001 through 2009 (n = 55 501) were identified from the UK General Practice Research Database (population 5 million). Of these, we identified 7978 women of child-bearing age (18–45 y) and 1013 pregnancies in which levothyroxine had been initiated at least 6 months before conception. Main Outcome Measures: TSH, miscarriage/delivery status, and obstetric outcomes were measured. Results: Forty-six percent of levothyroxine-treated women aged 18–45 years had a TSH level greater than 2.5mU/L (recommended upper level in the first trimester). Among pregnant women who had their TSH measured in the first trimester, 62.8% had a TSH level greater than 2.5 mU/L, with 7.4% greater than 10 mU/L. Women with TSH greater than 2.5 mU/L in the first trimester had an increased risk of miscarriage compared with women with TSH 0.2–2.5 mU/L after adjusting for age, year of pregnancy, diabetes, and social class (P = .008). The risk of miscarriage was increased in women with TSH 4.51–10 mU/L [odds ratio (OR) 1.80, 95% confidence interval (CI) 1.03, 3.14)] and TSH greater than 10 mU/L (OR 3.95, 95% CI 1.87, 8.37) but not with TSH 2.51–4.5 mU/L (OR 1.09, 95% CI 0.61, 1.93). Conclusions: The majority of levothyroxine-treated women have early gestational TSH levels above the recommended targets (>2.5 mU/L) with a strong risk of miscarriage at levels exceeding 4.5 mU/L. There is an urgent need to improve the adequacy of thyroid hormone replacement in early pregnancy.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Systems Immunity Research Institute (SIURI)
Subjects: R Medicine > R Medicine (General)
Publisher: The Endocrine Society
ISSN: 0021-972X
Date of Acceptance: 17 June 2014
Last Modified: 07 Feb 2019 10:36
URI: http://orca-mwe.cf.ac.uk/id/eprint/79272

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