27 Jan Thyroid Hormone Treatment In Pregnant Women With Subclinical Hypothyroidism

MedicalResearch.com Interview with:

Dr. Spyridoula Maraka

Dr. Spyridoula Maraka
Assistant professor of medicine
Division of Endocrinology and Metabolism
Center for Osteoporosis and Metabolic Bone Diseases
University of Arkansas for Medical Sciences and
Central Arkansas Veterans Health Care System
Little Rock Arkansas

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Subclinical hypothyroidism, a mild thyroid dysfunction, has been associated in pregnancy with multiple adverse outcomes. Our aim was to estimate the effectiveness and safety of thyroid hormone treatment among pregnant women with subclinical hypothyroidism.

Using a large national US dataset, we identified 5,405 pregnant women diagnosed with subclinical hypothyroidism. Of these, 843 women, with an average pretreatment TSH concentration of 4.8 milli-international units per liter, were treated with thyroid hormone. The remaining 4,562, with an average pretreatment TSH concentration of 3.3 milli-international units per liter, were not treated.

Compared with the untreated group, treated women were 38 percent less likely to experience pregnancy loss. However, they were more likely to experience a preterm delivery, gestational diabetes or preeclampsia. Moreover, the benefit of thyroid hormone treatment on pregnancy loss was seen only among women with higher TSH levels (4.1 to 10 mIU/L) before treatment. We also found that for women with lower levels of TSH (2.5–4.0 mIU/L), the risk of gestational hypertension was significantly higher for treated women than for untreated women.

MedicalResearch.com: What should readers take away from your report?
Response: Thyroid hormone treatment was associated with decreased risk of pregnancy loss among women with subclinical hypothyroidism, especially those with pre-treatment TSH concentrations of 4.1-10 mIU/L.

However, given the smaller magnitude of effect in the group with TSH concentrations of 2.5-4.0 mIU/L, and in light of the possible increased risk of other adverse events, treatment may need to be withheld in this group.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The increased risk of other pregnancy related adverse outcomes calls for additional studies evaluating the safety of thyroid hormone treatment in this patient population. The timing of thyroid hormone initiation is another important area of research. Given that the observed benefit of thyroid hormone use was related to a decreased risk of pregnancy loss, an event most commonly occurring in early pregnancy, treatment may be needed only in the first trimester of pregnancy.

MedicalResearch.com: Is there anything else you would like to add?

Response: To facilitate the decision making process for pregnant women with subclinical hypothyroidism, clinicians are encouraged to use a shared decision making approach. With this approach, clinicians can discuss with patients the uncertainty behind our treatment recommendations and explore what is important to them when making decisions about their health with the goal of reaching a decision about treatment that best fits their situation.

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Last Updated on January 27, 2017 by Marie Benz MD FAAD