Thyroxine Replacement for Subfertile Females With Subclinical Hypothyroidism and Autoimmune Thyroiditis: A Systematic Review

Abstract Background Levothyroxine replacement therapy may decrease the risk of adverse pregnancy outcomes among women with subclinical hypothyroidism (SCH). The aim of this study is to conduct a systematic review and meta-analysis to examine the risk of adverse pregnancy, perinatal, and early childhood outcomes among women with SCH treated with levothyroxine. Methods A systematic literature search was conducted using Ovid-Medline, Ovid-EMBASE, Pubmed (non-Medline), Ebsco-CINAHL Plus with full text and Cochrane Library databases. Randomized controlled studies (RCTs) and observational studies examining the association between treatment of SCH during pregnancy and our outcomes of interest were included. Studies that compared levothyroxine treatment versus no treatment were eligible for inclusion. Data from included studies were extracted and quality assessment was performed by two independent reviewers. Results Seven RCTs and six observational studies met our inclusion criteria. A total of 7342 individuals were included in these studies. RCTs demonstrated several sources of bias, with lack of blinding of the participants or research personnel; only one study was fully blinded. In the observational studies, there was moderate to serious risk of bias due to lack of adjustment for certain confounding variables, participant selection, and selective reporting of results. Pooled analyses showed decreased risk of pregnancy loss (RR: 0.79; 95% CI: 0.67 to 0.93) and neonatal death (RR: 0.35; 95% CI: 0.17 to 0.72) associated with levothyroxine treatment during pregnancy among women with SCH. There were no associations between levothyroxine treatment and outcomes during labour and delivery, or cognitive status in children at 3 or 5 years of age. Conclusion Treatment of SCH with levothyroxine during pregnancy is associated with decreased risks of pregnancy loss and neonatal death. Given the paucity of available data and heterogeneity of included studies, additional studies are needed to address the benefits of levothyroxine use among pregnant women with SCH.

Download Full-text

Normocytic Normochromic Anemia Revealed an Early Onset Hashimoto’s Hypothyroidism in an Infant: A Case Report

Dubai Medical Journal ◽

10.1159/000519439 ◽

2021 ◽

pp. 1-5

Author(s):

Manal Mustafa Khadora ◽

Maysa Saleh ◽

Rawah Idres ◽

Sura Ahmed Al-Doory ◽

Mahmoud Ahmed Radaideh

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Autoimmune Thyroiditis ◽

Subclinical Hypothyroidism ◽

Early Onset ◽

Clinical Presentation ◽

Primary Hypothyroidism ◽

Normocytic Normochromic Anemia ◽

Wide Range ◽

Normochromic Anemia

Autoimmune thyroiditis is very rare etiology of primary hypothyroidism in infancy. Hypothyroidism has a wide range of clinical presentation, from subclinical hypothyroidism to overt type. It is unclear what pathological mechanisms connect thyroid function and erythropoiesis or how thyroid disease can contribute to anemia. We report a 12-month-old infant who presented with anemia associated with early onset of overt autoimmune thyroiditis. The peculiarity of our case enables us to draw attention of physician to consider acquired hypothyroidism in the differential diagnosis of unexplained anemia even if the neonatal screening is normal and congenital hypothyroidism is a remote possibility.

Download Full-text