Thyroid hormone treatment among pregnant women with subclinical hypothyroidism: US national assessment
Open accessAbstract
OBJECTIVE: To estimate the effectiveness and safety of thyroid hormone treatment among pregnant women with subclinical hypothyroidism. DESIGN: Retrospective cohort study. SETTING: Large US administrative database between 1 January 2010 and 31 December 2014. PARTICIPANTS: 5405 pregnant women with subclinical hypothyroidism, defined as untreated thyroid stimulating hormone (TSH) concentration 2.5-10 mIU/L. EXPOSURE: Thyroid hormone therapy. MAIN OUTCOME MEASURE: Pregnancy loss and other pre-specified maternal and fetal pregnancy related adverse outcomes. RESULTS: Among 5405 pregnant women with subclinical hypothyroidism, 843 with a mean pre-treatment TSH concentration of 4.8 (SD 1.7) mIU/L were treated with thyroid hormone and 4562 with a mean baseline TSH concentration of 3.3 (SD 0.9) mIU/L were not treated (P<0.01). Pregnancy loss was significantly less common among treated women (n=89; 10.6%) than among untreated women (n=614; 13.5%) (P<0.01). Compared with the untreated group, treated women had lower adjusted odds of pregnancy loss (odds ratio 0.62, 95% confidence interval 0.48 to 0.82) but higher odds of preterm delivery (1.60, 1.14 to 2.24), gestational diabetes (1.37, 1.05 to 1.79), and pre-eclampsia (1.61, 1.10 to 2.37); other pregnancy related adverse outcomes were similar between the two groups. The adjusted odds of pregnancy loss were lower in treated women than in untreated women if their pre-treatment TSH concentration was 4.1-10 mIU/L (odds ratio 0.45, 0.30 to 0.65) but not if it was 2.5-4.0 mIU/L (0.91, 0.65 to 1.23) (P<0.01). CONCLUSION: Thyroid hormone treatment was associated with decreased risk of pregnancy loss among women with subclinical hypothyroidism, especially those with pre-treatment TSH concentrations of 4.1-10 mIU/L. However, the increased risk of other pregnancy related adverse outcomes calls for additional studies evaluating the safety of thyroid hormone treatment in this patient population.
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Excessive levothyroxine treatment in young fertile women is related to gestational hypertension.
“On the other hand, excessive LT4 treatment has been related to gestational hypertension, preeclampsia and preterm birth.”
From Risks of suboptimal and excessive thyroid hormone replacement across ages (2023) · cites this paper as [28]
Excessive levothyroxine treatment in young fertile women is related to preeclampsia.
“On the other hand, excessive LT4 treatment has been related to gestational hypertension, preeclampsia and preterm birth.”
From Risks of suboptimal and excessive thyroid hormone replacement across ages (2023) · cites this paper as [28]
Excessive levothyroxine treatment in young fertile women is related to preterm birth.
“On the other hand, excessive LT4 treatment has been related to gestational hypertension, preeclampsia and preterm birth.”
From Risks of suboptimal and excessive thyroid hormone replacement across ages (2023) · cites this paper as [28]
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- Authors
- Maraka, S., Mwangi, R., McCoy, R. G., Yao, X., Sangaralingham, L. R., Singh Ospina, N. M., O’Keeffe, D. T., De Ycaza, A. E. E., Rodriguez-Gutierrez, R., Coddington, C. C., Stan, M. N., Brito, J. P., & Montori, V. M.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- McCoy, Rozalina G
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2017-01-25
- Volume
- 356
- Pages
- i6865
- ISSN
- 1756-1833 (ISSN-L)
- 0959-8138
- PMC
- PMC5266622
- OpenAlex
- W2580448337
- Cited by
- 249
- References
- 26
- Citations by year
- 2026: 6 · 2025: 14 · 2024: 22 · 2023: 55 · 2022: 43 · 2021: 24 · 2020: 27 · 2019: 18 · 2018: 25 · 2017: 14
- FWCI
- 18.17
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (acceptedVersion, cc-by-nc)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (submittedVersion, cc-by-nc-nd)
- HighWire Press Open Archive (submittedVersion)
- ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) (submittedVersion, cc-by-nc)
- Research Repository UCD (University College Dublin) (cc-by-nc)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- subclinical hypothyroidism, thyroid hormone replacement, miscarriage, preterm birth, gestational diabetes mellitus, preeclampsia, thyroid-stimulating hormone, maternal and fetal outcomes, treatment thresholds
- MeSH terms
- Adolescent, Adult, Female, Follow-Up Studies, Humans, Hypothyroidism, Middle Aged, Pregnancy, Pregnancy Complications, Retrospective Studies, Thyroid Hormones, United States, Multivariate Analysis, Logistic Models, Databases, Factual, Treatment Outcome, Young Adult, Asymptomatic Diseases
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