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Meta-Analysis
. 2024 Jun;309(6):2387-2393.
doi: 10.1007/s00404-024-07512-3. Epub 2024 Apr 27.

Levothyroxine for subclinical hypothyroidism during pregnancy: an updated systematic review and meta-analysis of randomized controlled trials

Henrique Provinciatto  1 , Marcus Vinicius Barbosa Moreira  2 , Gabriel Rezende Neves  3 , Lucas Rezende De Freitas  4 , Henrique Costa Mitsui  4 , Julio Min Fei Zhang  5 , Edward Araujo Júnior  6   7
Affiliations
Meta-Analysis

Levothyroxine for subclinical hypothyroidism during pregnancy: an updated systematic review and meta-analysis of randomized controlled trials

Henrique Provinciatto et al. Arch Gynecol Obstet. 2024 Jun.

Abstract

Purpose: We aimed to perform a systematic review and meta-analysis addressing the efficacy of levothyroxine therapy in pregnant women with subclinical hypothyroidism considering most recent evidence and subgroups of interest for clinical practice.

Methods: PubMed, Embase, and Cochrane Central were searched from inception for randomized controlled trials (RCTs) comparing levothyroxine with placebo or no intervention in pregnant women with subclinical hypothyroidism. We used a random-effects model and conducted subgroup analyses based on thyroid peroxidase antibody status, thyroid stimulating hormone levels, fertility treatment, and recurrent miscarriage.

Results: We included 11 RCTs comprising 2,749 pregnant women with subclinical hypothyroidism. Patients treated with levothyroxine (1,439; 52.3%) had significantly lower risk of pregnancy loss (risk ratio 0.69; 95% confidence interval 0.52-0.91; p < 0.01; 6 studies). However, there was no significant association between levothyroxine and live birth (risk ratio 1.01; 95% confidence interval 0.99-1.03; p = 0.29; 8 studies). No statistically significant interaction was observed across subgroups (p > 0.05).

Conclusion: Levothyroxine replacement therapy for subclinical hypothyroidism during pregnancy may decrease pregnancy loss when early prescribed. Nevertheless, further investigation is needed in patients with thyroid stimulating hormone above four milliunits per liter, especially when associated with recurrent miscarriage or infertility.

Keywords: Pregnancy; Recurrent miscarriage; Subclinical hypothyroidism; Thyroid autoimmunity; Thyroid peroxidase antibody.

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References

    1. Cooper DS (2001) Subclinical hypothyroidism. N Engl J Med 345(4):260–265. https://doi.org/10.1056/NEJM200107263450406 - DOI - PubMed
    1. Shan ZY, Chen YY, Teng WP et al (2009) A study for maternal thyroid hormone deficiency during the first half of pregnancy in China. Eur J Clin Invest 39(1):37–42. https://doi.org/10.1111/j.1365-2362.2008.02055.x - DOI - PubMed
    1. Dhanwal D, Prasad S, Agarwal A, Dixit V, Banerjee A (2013) High prevalence of subclinical hypothyroidism during first trimester of pregnancy in North India. Indian J Endocrinol Metab 17(2):281. https://doi.org/10.4103/2230-8210.109712 - DOI - PubMed - PMC
    1. Karcaaltincaba D, Ozek MA, Ocal N, Calis P, Inan MA, Bayram M (2020) Prevalences of subclinical and overt hypothyroidism with universal screening in early pregnancy. Arch Gynecol Obstet 301(3):681–686. https://doi.org/10.1007/s00404-020-05462-0 - DOI - PubMed
    1. Sohail R, Yasmin H, Tasneem N, et al (2021) The prevalence of subclinical hypothyroidism during early pregnancy in Pakistan: a cross-sectional study. Cureus. Published online December 10, 2021. https://doi.org/10.7759/cureus.20316

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