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

2.50
Hdl Handle:
http://hdl.handle.net/11287/593824
Title:
TSH levels and risk of miscarriage in women on long-term levothyroxine: a community-based study
Authors:
Taylor, P. N.; Minassian, C.; Rehman, A.; Iqbal, A.; Draman, M. S.; Hamilton, W.; Dunlop, D.; Robinson, A.; Vaidya, Bijay; Lazarus, J. H.; Thomas, S.; Dayan, C. M.; Okosieme, O. E.
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 2.5 mU/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.
Citation:
J Clin Endocrinol Metab. 2014 Oct;99(10):3895-902.
Publisher:
Endocrine Society
Journal:
The Journal of clinical endocrinology and metabolism
Issue Date:
1-Oct-2014
URI:
http://hdl.handle.net/11287/593824
DOI:
10.1210/jc.2014-1954
PubMed ID:
25057882
Additional Links:
http://press.endocrine.org/doi/10.1210/jc.2014-1954?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
Type:
Journal Article; Research Support, Non-U.S. Gov't
Language:
eng
ISSN:
1945-7197
Appears in Collections:
2014 RD&E publications; Diabetes/Endocrine Services

Full metadata record

DC FieldValue Language
dc.contributor.authorTaylor, P. N.en
dc.contributor.authorMinassian, C.en
dc.contributor.authorRehman, A.en
dc.contributor.authorIqbal, A.en
dc.contributor.authorDraman, M. S.en
dc.contributor.authorHamilton, W.en
dc.contributor.authorDunlop, D.en
dc.contributor.authorRobinson, A.en
dc.contributor.authorVaidya, Bijayen
dc.contributor.authorLazarus, J. H.en
dc.contributor.authorThomas, S.en
dc.contributor.authorDayan, C. M.en
dc.contributor.authorOkosieme, O. E.en
dc.date.accessioned2016-01-19T12:35:25Zen
dc.date.available2016-01-19T12:35:25Zen
dc.date.issued2014-10-01en
dc.identifier.citationJ Clin Endocrinol Metab. 2014 Oct;99(10):3895-902.en
dc.identifier.issn1945-7197en
dc.identifier.pmid25057882en
dc.identifier.doi10.1210/jc.2014-1954en
dc.identifier.urihttp://hdl.handle.net/11287/593824en
dc.description.abstractCONTEXT: 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 2.5 mU/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.en
dc.language.isoengen
dc.publisherEndocrine Societyen
dc.relation.urlhttp://press.endocrine.org/doi/10.1210/jc.2014-1954?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmeden
dc.titleTSH levels and risk of miscarriage in women on long-term levothyroxine: a community-based studyen
dc.typeJournal Articleen
dc.typeResearch Support, Non-U.S. Gov'ten
dc.identifier.journalThe Journal of clinical endocrinology and metabolismen

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