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Submitted on August 11, 2005
Accepted on April 11, 2006
Department of Endocrinology, (R.N., G.F.), Azienda Ospedaliera LE/1, P.O. "V. Fazzi", Lecce, Italy; Department of Obstetrics and Gynecology, (T.M.), Casa di Cura "Salus", Brindisi, Italy; Department of Internal Medicine (A.P., D.D), Azienda Ospedaliera PR, "Di Vaio" Hospital, Fidenza, Italy; Endocrine Unit, (H.H.), RIPAS Hospital, Bandar Seri Begawan, Brunei
* To whom correspondence should be addressed. E-mail: robnegro{at}tiscali.it.
Context: Euthyroid women with autoimmune thyroid disease show impairment of thyroid function during gestation and seem to suffer from higher rate of obstetrical complications. Objective: We wished to examine if they suffer from a higher rate of obstetrical complications and if levothyroxine (LT4) treatment exerts beneficial effects. Design: This is a prospective study. Setting: The study was conducted in the Department of Obstetrics and Gynecology. Patients: 984 pregnant women were studied from November 2002 to October 2004; 11.7% were TPOAb (+). Intervention: TPOAb (+) patients were divided into two groups, one (Group A, n = 57), treated with LT4, and the other (Group B, n = 58), not treated. The 869 TPOAb (-) patients served as normal population control group (Group C). Main outcomes: Rates of obstetrical complications in treated and untreated groups were measured. Results: At baseline, TPOAb (+) had higher TSH compared with TPOAb (-); TSH remained higher in Group B compared with Groups A and C throughout gestation. FT4 values were lower in Group B than Groups A and C after 30 weeks and after parturition. Groups A and C showed a similar miscarriage rate (3.5% and 2.4% respectively), which was lower than Group B (13.8%) (P < 0.05; RR: 1.72, 95% CI = 1.13-2.25. P < 0.01; RR: 4.95, 95% CI = 2.59-9.48 respectively). Group B displayed a 22.4% rate of premature deliveries, which was higher than Group A (7%) (P < 0.05; RR: 1.66, 95% CI = 1.18-2.34) and Group C (8.2%) (P < 0.01; RR: 12.18, 95% CI = 7.93-18.7). Conclusions: Euthyroid pregnant women who are positive for TPOAb, develop impaired thyroid function, which is associated with an increased risk of miscarriage and premature deliveries. Substitutive treatment with LT4 is able to lower the chance of miscarriage and premature delivery.
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