The Prevalence of Thyroid Dysfunction and Autoimmunity in Women With History of Miscarriage or Subfertility

Autor: Rachel Small, Lee J Middleton, Davor Jurkovic, Yacoub Khalaf, Arri Coomarasamy, Khashia Mulbagal, Andrew Sizer, Martyn Underwood, Pratima Gupta, Mark D. Kilby, Samantha Farrell-Carver, Justin Chu, Kristien Boelaert, Ayman Ewies, Natalie Nunes, Rina Agrawal, Raj Rai, Lynne Robinson, Shiao Chan, Aurelio Tobias, Kalsang Bhatia, Edmond Edi-Osagie, Paul P. Smith, Siobhan Quenby, Rima K Dhillon-Smith, Jane P Daniels, Caroline Overton, Kirandeep K Sunner, Jackie Ross, Ruth Bender-Atik, Tarek Ghobara, Shakila Thangaratinam, Krystyna Baker, Nick Raine-Fenning
Rok vydání: 2020
Předmět:
endocrine system diseases
Endocrinology
Diabetes and Metabolism
Clinical Biochemistry
Thyrotropin
Thyroid Function Tests
Biochemistry
Cohort Studies
0302 clinical medicine
Endocrinology
Pregnancy
Reference Values
Prevalence
Prospective Studies
Subclinical infection
030219 obstetrics & reproductive medicine
biology
Obstetrics
Thyroid disease
Female
medicine.symptom
Thyroid function
hormones
hormone substitutes
and hormone antagonists
medicine.drug
Adult
endocrine system
medicine.medical_specialty
Adolescent
Levothyroxine
030209 endocrinology & metabolism
Asymptomatic
Young Adult
03 medical and health sciences
Hypothyroidism
Thyroid peroxidase
Internal medicine
medicine
Humans
Autoantibodies
business.industry
Biochemistry (medical)
Odds ratio
medicine.disease
United Kingdom
Abortion
Spontaneous
Infertility
Asymptomatic Diseases
biology.protein
business
Body mass index
Zdroj: The Journal of Clinical Endocrinology & Metabolism. 105:2667-2677
ISSN: 1945-7197
0021-972X
Popis: Objective To describe the prevalence of and factors associated with different thyroid dysfunction phenotypes in women who are asymptomatic preconception. Design Observational cohort study. Setting A total of 49 hospitals across the United Kingdom between 2011 and 2016. Participants Women aged 16 to 41years with history of miscarriage or subfertility trying for a pregnancy. Methods Prevalences and 95% confidence intervals (CIs) were estimated using the binomial exact method. Multivariate logistic regression analyses were conducted to identify risk factors for thyroid disease. Intervention None. Main Outcome Measure Rates of thyroid dysfunction. Results Thyroid function and thyroid peroxidase antibody (TPOAb) data were available for 19213 and 19237 women, respectively. The prevalence of abnormal thyroid function was 4.8% (95% CI, 4.5-5.1); euthyroidism was defined as levels of thyroid-stimulating hormone (TSH) of 0.44 to 4.50 mIU/L and free thyroxine (fT4) of 10 to 21 pmol/L. Overt hypothyroidism (TSH > 4.50 mIU/L, fT4 < 10 pmol/L) was present in 0.2% of women (95% CI, 0.1-0.3) and overt hyperthyroidism (TSH < 0.44 mIU/L, fT4 > 21 pmol/L) was present in 0.3% (95% CI, 0.2-0.3). The prevalence of subclinical hypothyroidism (SCH) using an upper TSH concentration of 4.50 mIU/L was 2.4% (95% CI, 2.1-2.6). Lowering the upper TSH to 2.50 mIU/L resulted in higher rates of SCH, 19.9% (95% CI, 19.3-20.5). Multiple regression analyses showed increased odds of SCH (TSH > 4.50 mIU/L) with body mass index (BMI) ≥ 35.0 kg/m2 (adjusted odds ratio [aOR] 1.71; 95% CI, 1.13-2.57; P = 0.01) and Asian ethnicity (aOR 1.76; 95% CI, 1.31-2.37; P < 0.001), and increased odds of SCH (TSH ≥ 2.50 mIU/L) with subfertility (aOR 1.16; 95% CI, 1.04-1.29; P = 0.008). TPOAb positivity was prevalent in 9.5% of women (95% CI, 9.1-9.9). Conclusions The prevalence of undiagnosed overt thyroid disease is low. SCH and TPOAb are common, particularly in women with higher BMI or of Asian ethnicity. A TSH cutoff of 2.50 mIU/L to define SCH results in a significant proportion of women potentially requiring levothyroxine treatment.
Databáze: OpenAIRE
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