Xing Wang1, Yu Zhang2, Huiwen Tan1, Yu Bai3, Liangxue Zhou1, Fang Fang4, Andrew Faramand5, Weelic Chong6, Yang Hai7. 1. West China Hospital, Sichuan University, Sichuan, People's Republic of China. 2. West China Hospital, Sichuan University, Sichuan, People's Republic of China; Affiliated Hospital of Chengdu University, Sichuan, People's Republic of China. 3. West China Second University Hospital, Sichuan University, Sichuan, People's Republic of China. 4. West China Hospital, Sichuan University, Sichuan, People's Republic of China. Electronic address: fangfang01@scu.edu.cn. 5. University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania. 6. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania. 7. Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, New York.
Abstract
OBJECTIVE: To investigate whether levothyroxine is associated with improved live birth and other benefits in women with thyroid autoimmunity. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENT(S): Women positive for thyroid peroxidase antibody. INTERVENTION(S): MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched without any language restrictions. Pooled effect sizes were calculated using random-effects models. MAIN OUTCOME MEASURE(S): The primary outcome was the incidence of live birth, miscarriage, preterm birth, clinical pregnancy, ectopic pregnancy, neonatal admission, and birth weight. The summary measures were reported as relative risk (RR) with 95% confidence interval. RESULT(S): Levothyroxine supplementation was not associated with an increased rate of live birth or a decreased risk of miscarriage. Results were similar in subgroup analyses of live birth by age, baseline thyrotropin, baseline thyroid peroxidase antibody, body mass index, and use of assisted conception. For live birth, the effect estimate lay within the futility boundary for RR of 20% and 15%, but at a 10% RR, the effect estimate lay between the futility boundary and the inferior boundary. CONCLUSION(S): High- to moderate-quality evidence demonstrated that the use of levothyroxine was not associated with improvements in clinical pregnancy outcomes among women positive for thyroid peroxidase antibody. REGISTRATION NUMBER: PROSPERO CRD42019132976.
OBJECTIVE: To investigate whether levothyroxine is associated with improved live birth and other benefits in women with thyroid autoimmunity. DESIGN: Systematic review and meta-analysis. SETTING: Not applicable. PATIENT(S): Women positive for thyroid peroxidase antibody. INTERVENTION(S): MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched without any language restrictions. Pooled effect sizes were calculated using random-effects models. MAIN OUTCOME MEASURE(S): The primary outcome was the incidence of live birth, miscarriage, preterm birth, clinical pregnancy, ectopic pregnancy, neonatal admission, and birth weight. The summary measures were reported as relative risk (RR) with 95% confidence interval. RESULT(S): Levothyroxine supplementation was not associated with an increased rate of live birth or a decreased risk of miscarriage. Results were similar in subgroup analyses of live birth by age, baseline thyrotropin, baseline thyroid peroxidase antibody, body mass index, and use of assisted conception. For live birth, the effect estimate lay within the futility boundary for RR of 20% and 15%, but at a 10% RR, the effect estimate lay between the futility boundary and the inferior boundary. CONCLUSION(S): High- to moderate-quality evidence demonstrated that the use of levothyroxine was not associated with improvements in clinical pregnancy outcomes among women positive for thyroid peroxidase antibody. REGISTRATION NUMBER: PROSPERO CRD42019132976.
Authors: K R Riis; J S Frølich; L Hegedüs; R Negro; R Attanasio; E V Nagy; E Papini; P Perros; S J Bonnema Journal: J Endocrinol Invest Date: 2021-03-28 Impact factor: 4.256