{"id":6094,"date":"2020-07-14T08:22:38","date_gmt":"2020-07-14T07:22:38","guid":{"rendered":"https:\/\/www.library.sath.nhs.uk\/research\/?p=6094"},"modified":"2021-07-01T10:46:12","modified_gmt":"2021-07-01T09:46:12","slug":"the-prevalence-of-thyroid-dysfunction-and-autoimmunity-in-women-with-history-of-miscarriage-or-subfertility-2020","status":"publish","type":"post","link":"https:\/\/www.library.sath.nhs.uk\/research\/2020\/07\/14\/the-prevalence-of-thyroid-dysfunction-and-autoimmunity-in-women-with-history-of-miscarriage-or-subfertility-2020\/","title":{"rendered":"The Prevalence of Thyroid Dysfunction and Autoimmunity in Women With History of Miscarriage or Subfertility (2020)"},"content":{"rendered":"

Type of publication:<\/strong>
\nJournal article<\/p>\n

Author(s):<\/strong>
\nRima K Dhillon-Smith, Aurelio Tobias, Paul P Smith, Lee J Middleton, Kirandeep K Sunner, Krystyna Baker, Samantha Farrell-Carver, Ruth Bender-Atik, Rina Agrawal, Kalsang Bhatia, Justin J Chu, Edmond Edi-Osagie, Ayman Ewies, Tarek Ghobara, Pratima Gupta, Davor Jurkovic, Yacoub Khalaf, Khashia Mulbagal, Natalie Nunes, Caroline Overton, Siobhan Quenby, Raj Rai, Nick Raine-Fenning, Lynne Robinson, Jackie Ross, Andrew Sizer, Rachel Small, *Martyn Underwood<\/a> \"\"<\/a>, Mark D Kilby, Jane Daniels, Shakila Thangaratinam, Shiao Chan, Kristien Boelaert, Arri Coomarasamy<\/p>\n

Citation:<\/strong>
\nThe Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 8, August 2020<\/p>\n

Abstract:<\/strong>
\nObjective: To describe the prevalence of and factors associated with different thyroid dysfunction phenotypes in women who are asymptomatic preconception.
\nDesign: Observational cohort study.
\nSetting: A total of 49 hospitals across the United Kingdom between 2011 and 2016.
\nParticipants: Women aged 16 to 41 years with history of miscarriage or subfertility trying for a pregnancy.
\nMethods: 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.
\nIntervention: None.
\nMain Outcome Measure: Rates of thyroid dysfunction.
\nResults: 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) \u2265 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 \u2265 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).
\nConclusions: 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.<\/p>\n

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