Evaluating the Progression to Hypothyroidism in Preconception Euthyroid Thyroid Peroxidase Antibody-Positive Women
Evaluating the Progression to Hypothyroidism in Preconception Euthyroid Thyroid Peroxidase Antibody-Positive Women
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DOI：
10.1210/clinem/dgac525
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发表时间：
2022-09-14
影响因子：
5.8
通讯作者：
Dhillon-Smith, Rima K.
中科院分区：
文献类型：
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作者：
Gill, Sofia;Cheed, Versha;Dhillon-Smith, Rima K.
甲状腺过氧化物酶抗体（TPOAb）阳性在育龄妇女中很常见，易导致甲状腺功能障碍，特别是甲状腺功能减退，对妊娠有不良影响。目的本研究旨在报告入组TABLET试验的最初甲状腺功能正常的TPOAb阳性女性中甲状腺功能异常的发生率，以确定与甲状腺功能减退症发生相关的因素，并比较甲状腺功能正常和接受治疗的甲状腺功能减退症患者之间的结果。这项观察性队列研究于2011年至2016年在49家英国医院进行，包括甲状腺功能正常的TPOAb阳性女性，年龄16至40岁，有流产或低生育力史，计划怀孕，随机接受每日50 mcg左甲状腺素或安慰剂。分析了甲状腺功能异常、受孕率和活产率（LBR）>= 34周。结果70/940（7.4%）的妇女发生亚临床（SCH）或明显（OH）甲状腺功能减退症：服用左旋甲状腺素的27/470和安慰剂的43/470（相对危险度[RR] 0.63; 95%CI，0.39-1.00; P = 0.05）; 83%的病例出现孕前。发生甲减的患者基线时血清中位TSH浓度和TPOAb滴度显著高于未发生甲减的患者（P < 0.001）。与甲状腺功能正常的女性相比，接受SCH/OH治疗的女性的妊娠失败率更高（校正RR 2.02 [1.56-2.62]; P < 0.001）。SCH/OH治疗组和甲状腺功能正常组的LBR >= 34周相似（校正RR 1.09 [0.77-1.55]; P = 0.6）。结论甲状腺功能正常的TPOAb阳性妇女在孕前1年内或孕期发生甲减的比例约为7%。与甲状腺功能正常的女性相比，接受SCH/OH治疗的女性的受孕率较低，但LBR相似。TPOAb阳性妇女的甲状腺功能应定期监测，当试图怀孕，以确保及时诊断和适当的治疗开始。
Context Thyroid peroxidase antibody (TPOAb) positivity is prevalent in women of reproductive age and predisposes to thyroid dysfunction, particularly hypothyroidism, which has adverse effects on pregnancy. Objective This study aimed to report the rate of development of abnormal thyroid function among initially euthyroid TPOAb-positive women recruited into the TABLET trial, to identify factors associated with the development of hypothyroidism, and to compare outcomes between euthyroid and treated hypothyroid individuals. Methods This observational cohort study, conducted at 49 UK hospitals between 2011 and 2016, included euthyroid TPOAb-positive women 16 to 40 years of age with a history of miscarriage or subfertility, planning pregnancy, randomized to levothyroxine 50 mcg daily or placebo. Abnormal thyroid function, conception rate, and live birth rate (LBR) >= 34 weeks were analyzed. Results Among the women, 70/940 (7.4%) developed subclinical (SCH) or overt (OH) hypothyroidism: 27/470 taking levothyroxine and 43/470 placebo (relative risk [RR] 0.63; 95% CI, 0.39-1.00; P = 0.05); 83% of cases emerged prepregnancy. Baseline median serum TSH concentrations and TPOAb titers were significantly higher in those who developed hypothyroidism vs those who did not (P < 0.001). Treated SCH/OH demonstrated a higher failure-to-conceive rate compared with euthyroid women (adjusted RR 2.02 [1.56-2.62]; P < 0.001). The LBR >= 34 weeks was similar in the treated SCH/OH and euthyroid groups (adjusted RR 1.09 [0.77-1.55]; P = 0.6). Conclusion Approximately 7% of euthyroid TPOAb-positive women will develop hypothyroidism within 1 year preconception or in pregnancy. Conception rates are lower in women with treated SCH/OH compared with euthyroid women, but LBR are comparable. Thyroid function in TPOAb-positive women should be monitored regularly, when trying to conceive, to ensure prompt diagnosis and appropriate treatment initiation.