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Negro R, Žarković M, Attanasio R, Hegedüs L, Nagy EV, Papini E, Akarsu E, Alevizaki M, Ayvaz G, Bednarczuk T, Beleslin BN, Berta E, Bodor M, Borissova AM, Boyanov M, Buffet C, Burlacu MC, Ćirić J, Cohen CA, Díez JJ, Dobnig H, Fadeyev V, Field BCT, Fliers E, Führer D, Galofré JC, Hakala T, Jan J, Kopp P, Krebs M, Kršek M, Kužma M, Leenhardt L, Luchytskiy V, Puga FM, McGowan A, Melo M, Metso S, Moran C, Morgunova T, Niculescu DA, Perić B, Planck T, Poiana C, Robenshtok E, Rosselet PO, Ruchala M, Riis KR, Shepelkevich A, Tronko M, Unuane D, Vardarli I, Visser E, Vryonidou A, Younes YR, Perros P. Use of levothyroxine for euthyroid, thyroid antibody positive women with infertility: Analyses of aggregate data from a survey of European thyroid specialists (Treatment of Hypothyroidism in Europe by Specialists: An International Survey). Clin Endocrinol (Oxf) 2024; 101:180-190. [PMID: 38856700 DOI: 10.1111/cen.15099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/25/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES The use of levothyroxine (LT4) treatment aiming to improve fertility in euthyroid women with positive thyroid peroxidase antibodies (TPOAb) is not supported by the available evidence. The aim of the study was to document the use of LT4 by European thyroid specialists in such patients. DESIGN The data presented derive from Treatment of Hypothyroidism in Europe by Specialists, an International Survey (THESIS), a questionnaire conducted between 2019 and 2021 to document the management of hypothyroidism by European thyroid specialists. Here, we report the aggregate results on the use of LT4 in infertile, euthyroid women with positive TPOAb. RESULTS A total of 2316/5406 (42.8%) respondents stated that LT4 may be indicated in TPOAb positive euthyroid women with infertility. The proportion of those replying positively to this question varied widely across different countries (median 39.4, range 22.9%-83.7%). In multivariate analyses males (OR: 0.8; CI: 0.7-0.9) and respondents >60 years (OR: 0.7; 0.6-0.8) were the least inclined to consider LT4 for this indication. Conversely, respondents managing many thyroid patients ("weekly" [OR: 1.4; CI: 1.0-1.9], "daily" [OR: 1.8; CI: 1.3-2.4]) and practicing in Eastern Europe (OR: 1.5; CI: 1.3-1.9) were most likely to consider LT4. CONCLUSIONS A remarkably high number of respondents surveyed between 2019 and 2021, would consider LT4 treatment in TPOAb positive euthyroid women with infertility. This view varied widely across countries and correlated with sex, age and workload, potentially influencing patient management. These results raise concerns about potential risks of overtreatment.
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Affiliation(s)
- Roberto Negro
- Division of Endocrinology, Presidio Ospedaliero "V. Fazzi, Lecce, Italy
| | - Miloš Žarković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Roberto Attanasio
- Scientific Committee, Associazione Medici Endocrinologi, Milan, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Endre V Nagy
- Department of Medicine, Division of Endocrinology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Ersin Akarsu
- Department of Internal Medicine, Division of Endocrinology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Maria Alevizaki
- Department of Clinical Therapeutics, School of Medicine, Endocrine Unit and Diabetes Centre, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Göksun Ayvaz
- Department of Endocrinology and Metabolism, Koru Ankara Hospital, Ankara, Turkey
| | - Tomasz Bednarczuk
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | | | - Eszter Berta
- Department of Medicine, Division of Endocrinology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Miklos Bodor
- Department of Medicine, Division of Endocrinology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anna Maria Borissova
- Clinic of Endocrinology and Metabolism, Medical Faculty, University Hospital "Sofiamed", Sofia University "Saint Kliment Ohridski", Sofia, Bulgaria
| | - Mihail Boyanov
- Department of Internal Medicine, Clinic of Endocrinology and Metabolism, University Hospital "Alexandrovska", Medical University Sofia, Sofia, Bulgaria
| | - Camille Buffet
- Thyroid Diseases and Endocrine Tumor Department, GRC 16 Thyroid Tumors, APHP, Hôpital Pitié-Salpêtriére, Sorbonne University, Paris, France
| | - Maria-Cristina Burlacu
- Department of Endocrinology and Nutrition, Université Catholique de Louvain, Brussels, Belgium
| | - Jamina Ćirić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Juan J Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Harald Dobnig
- Thyroid and Osteoporosis Praxis, Kumberg, Austria, Thyroid Practice for Radiofrequency Ablation, Vienna, Austria
| | - Valentin Fadeyev
- Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov 1st Moscow State Medical University, Moscow, Russian Federation
| | - Benjamin C T Field
- Section of Clinical Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Eric Fliers
- Department of Endocrinology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University-Duisburg-Essen, Essen, Germany
| | - Juan C Galofré
- Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Spain, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Tommi Hakala
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Jiskra Jan
- 3rd Department of Medicine, 1st Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Peter Kopp
- Division of Endocrinology, Diabetes and Metabolism, University of Lausanne, Lausanne, Switzerland
| | - Michael Krebs
- Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Michal Kršek
- 3rd Department of Medicine, 1st Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Martin Kužma
- 5th Department of Internal Medicine, Medical Faculty of Comenius University and University Hospital, Bratislava, Slovakia
| | - Laurence Leenhardt
- Thyroid Diseases and Endocrine Tumor Department, GRC 16 Thyroid Tumors, APHP, Hôpital Pitié-Salpêtriére, Sorbonne University, Paris, France
| | - Vitaliy Luchytskiy
- Department of Reproductive Endocrinology, Institute of Endocrinology and Metabolism V.P. Komissarenko, National Academy of Medical Science of Ukraine, Kyiv, Ukraine
| | - Francisca Marques Puga
- Endocrinology, Diabetes and Metabolism Service, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Anne McGowan
- Robert Graves Institute, Tallaght University Hospital, Dublin, Ireland
| | - Miguel Melo
- Department of Endocrinology, Diabetes and Metabolism, Medical Faculty, University of Coimbra, Coimbra, Portugal
| | - Saara Metso
- Department of Endocrinology, Tampere University Hospital, Tampere, Finland
| | - Carla Moran
- Diabetes & Endocrinology Section, Beacon Hospital, Dublin, Ireland
- Endocrine Department, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Tatyana Morgunova
- Department of Endocrinology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov 1st Moscow State Medical University, Moscow, Russian Federation
| | - Dan Alexandru Niculescu
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Božidar Perić
- Department of Endocrinology, Diabetes and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sisters of Mercy", Zagreb, Croatia
| | - Tereza Planck
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Catalina Poiana
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Eyal Robenshtok
- Endocrinology and Metabolism Institute and Davidoff Center, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | | | - Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Kamilla Ryom Riis
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Alla Shepelkevich
- Department of Endocrinology, Belarusian State Medical University, Minsk, Republic of Belarus
| | - Mykola Tronko
- Institute of Endocrinology and Metabolism V.P. Komisarenko, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - David Unuane
- Department of Internal Medicine, Endocrine Unit, Brussel, Belgium
| | - Irfan Vardarli
- Department of Medicine I, Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Mannheim, Germany
- 5th Medical Department, Division of Endocrinology and Diabetes, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Edward Visser
- Department of Internal Medicine, Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Andromachi Vryonidou
- Department of Endocrinology, Diabetes Centre, Hellenic Red Cross Hospital, Athens, Greece
| | - Younes R Younes
- East Surrey Hospital, Surrey & Sussex Healthcare NHS Trust, Redhill, Surrey, UK
| | - Petros Perros
- Institute of Translational and Clinical Research, Newcastle University, Newcastle upon Tyne, UK
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Wu S, Yang Y, Chen Y, Xie W, Huang J, Liu M, Liu Y, Xu D, Lyu X, Wu H, Lei J, Zhao C, Zhang Y, Zhang H, He Y, Peng Z, Wang Y, Shen H, Wang Q, Zhang Y, Yan D, Wang L, Guan H, Ma X. Husband smoking is associated with Wife's thyrotropin abnormality: A population-based cohort study among Chinese reproductive-aged women. Int J Hyg Environ Health 2024; 257:114338. [PMID: 38354683 DOI: 10.1016/j.ijheh.2024.114338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES To comprehensively assess the association of husband smoking with wives' thyrotropin abnormality. METHODS This population-based retrospective cohort study included 2 406 090 Chinese reproductive-aged women who had participated twice in the National Free Pre-pregnancy Checkups Project between 2010 and 2020. Multivariate-adjusted odds ratios and 95% confidence intervals for subnormal and supranormal thyrotropin were estimated according to the husband's smoking status. RESULTS Husband smoking at the first visit was associated with a 17% (15%-20%) and 26% (24%-28%) increased odds of subnormal thyrotropin and supranormal thyrotropin respectively compared to participants in neither-smoker group. In non-smoking participants with normal thyrotropin levels at the first visit, the corresponding increased risk of subnormal thyrotropin and supranormal thyrotropin at the second visit were 15% (12%-18%) and 19% (16%-21%) in contrast to participants without husband-smoking exposure. In non-smoking participants with abnormal thyrotropin levels at their first visit, husband smoking cessation was associated with 27% (17%-35%) and 36% (31%-40%) reduced odds of subnormal thyrotropin and supranormal thyrotropin at the second visit compared with the participants whose husband still smoking at the second visit. CONCLUSION Husband smoking was associated with wives' subnormal thyrotropin and supranormal thyrotropin, and cessation of husband smoking could reduce the odds of thyrotropin abnormality. Couple-focused smoking intervention should be developed to reduce the burden of asymptomatic thyroid disease in females.
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Affiliation(s)
- Siyu Wu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yunzhi Chen
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Wenlu Xie
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jiaxin Huang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Meiya Liu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Youhong Liu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Die Xu
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Xinyi Lyu
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hanbin Wu
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Jueming Lei
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Chuanyu Zhao
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ya Zhang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Yuan He
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health Commission of the PR China, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health Commission of the PR China, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health Commission of the PR China, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health Commission of the PR China, Beijing, China
| | - Long Wang
- Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China.
| | - Haixia Guan
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China; Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Gao R, Lyu X, Yang Y, Fu J, Zhao C, Guan H, Ma X. Evaluating the progression to abnormal thyrotropin in euthyroid preconception women: a population-based study. Thyroid Res 2024; 17:5. [PMID: 38462616 PMCID: PMC10926655 DOI: 10.1186/s13044-024-00192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/22/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Abnormal preconception thyrotropin levels were associated with fecundability and adverse fetomaternal outcomes, however, little is known regarding the natural change of serum thyrotropin in euthyroid preconception women. Thus, we performed a population-based study to evaluate the progression to abnormal thyrotropin in euthyroid preconception women. METHODS This retrospective cohort study used data from the National Free Prepregnancy Checkups Project (NFPCP) collected between 2010 and 2020. Female Han Chinese participants aged 20-49 years who had two repeated NFPCP participations with a time interval of 1.5-3.0 years, confirmed non-pregnant status within this duration, and normal thyrotropin levels during their first participation were included for the analysis of thyrotropin abnormalities during the second NFPCP examination. Data were analyzed between June 1 and October 1, 2023. RESULTS This study included 186,095 euthyroid women of reproductive age (mean ± SD, 26.72 ± 4.70 years) whose preconception thyrotropin levels were between 0.37 and 4.87 mIU/L. The median follow-up time was 2.13 (IQR, 1.85-2.54) years. A total of 8,497 (4.57%) women developed abnormal thyrotropin, including 4,118 (2.21%) subnormal thyrotropin and 4,379 (2.35%) supranormal thyrotropin. Compared with the reference group (thyrotropin 1.01-2.00 mIU/L), the lower baseline thyrotropin group had greater risk of developing subnormal thyrotropin, and the higher baseline thyrotropin group had greater risk of developing supranormal thyrotropin. Moreover, the restricted cubic spline analysis revealed a U-shaped dose-response association of baseline thyrotropin levels or thyrotropin multiples of the median (MOM) levels against risk of subnormal thyrotropin in the follow-up, and a J-shaped dose-response association against risk of supranormal thyrotropin levels in the follow-up. We further found that baseline thyrotropin outside of 1.43-1.93 mIU/L or baseline thyrotropin MOM outside 0.59-1.36 would hava a higher risk of developing of abnormal thyrotropin. CONCLUSIONS Both low and high baseline thyrotropin were associated with a significantly increased risk of developing abnormal thyrotropin outcomes. The optimal preconception baseline thyrotropin levels may be between 1.43 mIU/L and 1.93 mIU/L or baseline thyrotropin MoM between 0.59 and 1.36 to minimize progression toward abnormal thyrotropin after 1.5-3.0 years. These findings may help with counseling of preconception thyroid function monitoring.
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Affiliation(s)
- Rili Gao
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xinyi Lyu
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Jinrong Fu
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Chuanyu Zhao
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Haixia Guan
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China.
- National Human Genetic Resources Center, Beijing, China.
- Graduate School of Peking Union Medical College, Beijing, China.
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Wang L, Xu H, Yang Y, Guan H, He X, Wu R, Wu J, Yuan N, Guo T, Zhang Y, Zhang H, He Y, Peng Z, Wang Y, Shen H, Wang Q, Zhang Y, Yan D, Song X, Zhang Q, Wang Z, Ma X, Huang W. Association between short-term air pollution exposure and perturbation in thyrotropin levels in 1.38 million Chinese women: A national longitudinal analysis, 2014-2019. JOURNAL OF HAZARDOUS MATERIALS 2024; 465:133094. [PMID: 38029589 DOI: 10.1016/j.jhazmat.2023.133094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
Prevalence of subclinical hypothyroidism substantially increased during the last decade in China, which has been commonly/clinically diagnosed as elevation in thyrotropin (thyroid-stimulating hormone [TSH]). Tobacco smoke containing toxic substances has been linked to thyroid dysfunction; however, data on perturbation of TSH following air pollution exposure in human has not been assessed at nationwide population level. We investigated the longitudinal impact of daily ambient air pollution estimated at residential level on serum TSH in 1.38 million women from China's 29 mainland provinces between 2014 and 2019. We observed that particulate matter with aerodynamic diameter ≤ 10 and ≤ 2.5 µm (PM10, PM2.5) and nitrogen dioxide (NO2) at cumulative lag 0-7 days of exposure were associated with percent elevations in TSH (0.88% [95% CI: 0.71, 1.05] per [interquartile range, IQR: 54.8 μg/m3] of PM10; 0.89% [95% CI, 0.71, 1.07] per IQR [40.3 μg/m3] of PM2.5; 2.01% [95% CI: 1.81, 2.22] per IQR [27.4 μg/m3] of NO2). Greater associations were observed in participants living in areas with ≥adequate iodine intake and those with low BMI levels and high inflammation status. Our results suggest that increased concentrations of recent ambient air pollutants at exposure ranges commonly encountered in Asia were associated with increases in TSH, supporting disturbing role of short-term air pollution exposure on the regulation of thyroid hormone homeostasis.
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Affiliation(s)
- Long Wang
- National Research Institute for Family Planning, Beijing, China; Institute of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Hongbing Xu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China
| | - Haixia Guan
- Department of Endocrinology and Metabolism, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xinghou He
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
| | - Rongshan Wu
- State Key Laboratory of Environmental Criteria and Risk Assessment, State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing, China
| | - Jianbin Wu
- State Key Laboratory of Atmospheric Boundary Layer Physics and Atmospheric Chemistry, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing, China
| | - Ningman Yuan
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
| | - Tonglei Guo
- National Research Institute for Family Planning, Beijing, China
| | - Ya Zhang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Yuan He
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health Commission, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health Commission, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health Commission, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health Commission, Beijing, China
| | - Xiaoming Song
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; National Human Genetic Resources Centre, Beijing, China
| | - Qinghong Zhang
- Department of Atmospheric and Oceanic Sciences, School of Physics, Peking University, Beijing, China
| | - Zifa Wang
- State Key Laboratory of Atmospheric Boundary Layer Physics and Atmospheric Chemistry, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing, China.
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China; National Human Genetic Resources Centre, Beijing, China; Graduate School of Peking Union Medical College, Beijing, China.
| | - Wei Huang
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China.
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Urgatz B, Poppe KG. Update on therapeutic use of levothyroxine for the management of hypothyroidism during pregnancy. Endocr Connect 2024; 13:e230420. [PMID: 38190256 PMCID: PMC10895322 DOI: 10.1530/ec-23-0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/08/2024] [Indexed: 01/10/2024]
Abstract
Hypothyroidism is a relatively common finding during pregnancy. This may be due either to the presence of existing thyroid disease and/or to the increased demands that pregnancy places the thyroid gland to provide thyroid hormones for the mother and the developing fetus. There is no doubt that overt hypothyroidism is associated strongly with adverse pregnancy outcomes, including miscarriage. Meta-analyses show that thyroid hormone replacement with levothyroxine (LT4) reduces the risk of adverse pregnancy outcomes in the setting of overt hypothyroidism. Accordingly, management guidelines in this area are unanimous in recommending intervention with to control the level of thyrotropin (TSH) to below 2.5 μIU/mL. The evidence for an adverse impact of subclinical hypothyroidism (SCH) on pregnancy outcomes is less clear, although meta-analyses suggest that SCH reduces the chance of a successful pregnancy outcome. Guidelines also support intervention for some patients with SCH, particularly where TSH is high (>10 μIU/mL), or where TSH is above its trimester-specific reference range in a woman with thyroid autoimmunity (giving LT4 to euthyroid women with thyroid autoimmunity is not supported). Real-world evidence suggests that hypothyroidism in pregnancy is often overlooked or that LT4 is not given appropriately to gain tight control of TSH. More research is needed to identify the barriers to optimal thyroid care with LT4 at this crucial time.
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Affiliation(s)
| | - Kris G Poppe
- University Hospital CHU Saint Pierre, Free University of Brussels, Brussels, Belgium
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Concepción-Zavaleta MJ, Coronado-Arroyo JC, Quiroz-Aldave JE, Concepción-Urteaga LA, Paz-Ibarra J. Thyroid dysfunction and female infertility. A comprehensive review. Diabetes Metab Syndr 2023; 17:102876. [PMID: 37866272 DOI: 10.1016/j.dsx.2023.102876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Female infertility is defined as the inability to achieve pregnancy following one year of consistent, unprotected sexual intercourse. Among the various endocrine factors contributing to this complex issue, thyroid dysfunction assumes a pivotal and noteworthy role. METHODS A narrative review, encompassing 134 articles up to 2023, was conducted utilizing the PubMed/Medline, EMBASE, and Scielo databases. The primary focus of this review was to investigate the effects of thyroid dysfunction on female infertility. RESULTS Thyroid disorders exert a significant influence on folliculogenesis, fertilization, and implantation processes. Thyroid autoimmunity, although associated with diminished ovarian reserve, does not typically necessitate levothyroxine therapy. On the other hand, both subclinical and overt hypothyroidism often require levothyroxine treatment to enhance fertility and optimize obstetric outcomes. Hyperthyroidism warrants prompt intervention due to its heightened risk of miscarriage. Furthermore, thyroid dysfunction exerts notable effects on assisted reproductive technologies, underscoring the importance of achieving euthyroidism prior to ovarian stimulation. CONCLUSION Women presenting with thyroid dysfunction must undergo meticulous and individualized assessments since fertility outcomes, whether achieved through natural conception or assisted reproductive technologies, can be significantly influenced by thyroid-related factors.
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Affiliation(s)
| | | | - Juan Eduardo Quiroz-Aldave
- Division of Non-communicable diseases, Endocrinology research line, Hospital de Apoyo Chepén, Chepén, Perú
| | | | - José Paz-Ibarra
- Department of Medicine, School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
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Huang N, Chen L, Lian Y, Chi H, Qiao J. Impact of thyroid-stimulating hormone levels after controlled ovarian hyperstimulation on in vitro fertilization/intracytoplasmic sperm injection outcomes in women with fresh embryo transfer: a prospective cohort study. Front Endocrinol (Lausanne) 2023; 14:1159991. [PMID: 37705573 PMCID: PMC10496015 DOI: 10.3389/fendo.2023.1159991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/11/2023] [Indexed: 09/15/2023] Open
Abstract
Objective Maternal hypothyroidism before and during pregnancy is associated with an increased risk of adverse pregnancy outcomes; many studies have evidenced that controlled ovarian hyperstimulation (COH) triggers a significant increase in the levels of TSH; however, no large-scale prospective studies have evaluated the impact of TSH levels after COH on assisted reproductive technology outcomes. The aim of this prospective study was to investigate whether in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes are affected by TSH levels after COH in women with fresh embryo transfer (ET). Methods A total of 664 patients who underwent IVF/ICSI treatment and received fresh ET at the Peking University Third Hospital were included in this study. The rates of clinical pregnancy, miscarriage, live birth, and preterm delivery were analyzed. Results The patients were categorized into two groups based on serum TSH levels after COH (0.55 mIU/L < TSH < 2.5 mIU/L: n= 449, 2.5 mIU/L ≤ TSH ≤ 4.78 mIU/L: n= 215). There were no significant differences in the rates of clinical pregnancy, miscarriage, and live birth between the two groups, even after adjusting for age, body mass index (BMI), thyroid antibody positivity, and COH protocols. However, the preterm delivery rate was significantly higher in women with TSH < 2.5 mIU/L than in those with TSH ≥ 2.5 mIU/L, even after adjusting for relevant confounding factors. There was no significant difference in live birth weight between the two groups. Discussion Mildly elevated TSH levels (TSH ≥ 2.5 mIU/L) after COH did not affect IVF/ICSI outcomes, and strict control of TSH levels within 2.5 mIU/L after COH might not be necessary. Additionally, strictly controlled TSH levels (TSH < 2.5 mIU/L) may increase preterm delivery risk.
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Affiliation(s)
- Ning Huang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Lixue Chen
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Ying Lian
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Hongbin Chi
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
- Beijing Advanced Innovation Center for Genomics, Peking University, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
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Ortiz MI, Carrizo C, Russo Picasso MF, Otaño L, Knoblovits P. Impact of preconception thyrotrophin on obstetric outcomes in the fertile population. ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2023; 70:262-269. [PMID: 37024331 DOI: 10.1016/j.endien.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/07/2022] [Indexed: 04/07/2023]
Abstract
INTRODUCTION There is evidence that subclinical hypothyroidism is associated with infertility, miscarriage and obstetric complications. However, there is controversy regarding the optimal TSH value in women seeking pregnancy. Current guidelines recommend that hypothyroid women with levothyroxine replacement who are planning pregnancy should optimise the dose of levothyroxine to achieve thyrotrophin (TSH) levels <2.5 mU/l, since these requirements increase in pregnancy, thus reducing the risk of TSH elevation during the first trimester. In women with infertility, who undergo highly complex treatments and have positive thyroid autoimmunity, values of TSH <2.5 mU/l prior to fertility treatment are suggested. Although this is a different population, these «optimal» TSH levels were also extended to euthyroid women without evidence of infertility, who are seeking pregnancy. OBJECTIVES Determine whether preconception TSH levels between 2.5 and 4.64 mIU/l are associated with adverse obstetric outcomes in euthyroid women. MATERIALS AND METHODS Retrospective cohort study. We evaluated 3265 medical records of pregnant women aged 18-40 years, euthyroid (TSH 0.5-4.64 mU/ml), with TSH measurement at least one year before gestation. 1779 met inclusion criteria. The population was divided according to categories: TSH 0.5-2.4 mU/l (optimal) and TSH 2.5-4.6 mU/l (suboptimal). Information on maternal and fetal obstetric outcomes was collected from each group. RESULTS We found no statistical difference in the occurrence of adverse obstetric events between the two groups. There was also no difference when adjusting for thyroid autoimmunity, age, body mass index, previous diabetes and previous arterial hypertension. CONCLUSION Our results suggest that the reference range of TSH used in the general population could be used in women seeking pregnancy, even in the presence of thyroid autoimmunity. Treatment with levothyroxine should be considered only in patients with special situations.
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Hirsch D, Yackobovitch-Gavan M, Lazar L. Infertility and Pregnancy Rates in Female Thyroid Cancer Survivors: A Retrospective Cohort Study Using Health Care Administrative Data from Israel. Thyroid 2023; 33:456-463. [PMID: 36785948 DOI: 10.1089/thy.2022.0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Background: Thyroid cancer (TC) is one of the most common carcinomas in young women. Concerns have been raised regarding the impact of the disease and its treatment on reproductive function. The aim of the study was to investigate the association of TC diagnosis and radioactive iodine (RAI) treatment on infertility and pregnancy rates in women. Methods: The comprehensive computerized database of a health management organization in Israel was screened for all female patients who were diagnosed with TC at age ≤40 years in 2000-2020. Rates of infertility (based on a documented diagnosis or purchase of fertility medications in the patient files) and pregnancy were compared with healthy age-matched controls. Results: The cohort included 1164 patients with TC (median age at diagnosis 31.6 years; interquartile range [IQR]: 26.7-35.4) and 5030 controls, followed for a median period of 10 years (IQR: 5.0-15.0). The infertility rate was higher in the TC group than in the control group (23.9% vs. 20.4%, p = 0.008). Still, the postdiagnosis/referent date pregnancy rates were comparable in the whole cohort (46.9/47.7%, p = 0.625) and across all age quartiles. The median time to the first pregnancy postdiagnosis/referent date was longer in TC patients than in controls (37 vs. 31 months, p < 0.001). Within the TC group, women who received repeated radioactive iodine treatment (n = 611, 52.5%) had comparable rates of infertility and pregnancy as those who did not. However, their time to the first postdiagnosis pregnancy was longer (median 45 vs. 29 months, p = 0.020). Conclusions: Our study provides reassuring evidence about the reproductive characteristics of women treated for TC. Pregnancy rates in TC survivors were comparable with controls. However, a higher infertility rate and a longer time to conceive were observed in the TC group compared with the control group. These findings were consistent in women who received single or repeated RAI treatments.
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Affiliation(s)
- Dania Hirsch
- Institute of Endocrinology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Yackobovitch-Gavan
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Deptartment of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liora Lazar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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