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Measuring thyroid peroxidase antibodies on the day nulliparous women present for management of miscarriage: a descriptive cohort study

BACKGROUND: There has been recent evidence suggesting the presence of anti-thyroid peroxidase antibodies (TPOAb) increases the risk of miscarriage, and levothyroxine can rescue miscarriages associated with TPOAb. We propose the most clinically pragmatic cohort to screen for TPOAb are women presentin...

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Autores principales: Grossmann, Mathis, Hoermann, Rudolf, Francis, Claire, Hamilton, Emma J, Tint, Aye, Kaitu’u-Lino, Tu’uhevaha, Kuswanto, Kent, Lappas, Martha, Sikaris, Ken, Zajac, Jeffery D, Permezel, Michael, Tong, Stephen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655833/
https://www.ncbi.nlm.nih.gov/pubmed/23672306
http://dx.doi.org/10.1186/1477-7827-11-40
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author Grossmann, Mathis
Hoermann, Rudolf
Francis, Claire
Hamilton, Emma J
Tint, Aye
Kaitu’u-Lino, Tu’uhevaha
Kuswanto, Kent
Lappas, Martha
Sikaris, Ken
Zajac, Jeffery D
Permezel, Michael
Tong, Stephen
author_facet Grossmann, Mathis
Hoermann, Rudolf
Francis, Claire
Hamilton, Emma J
Tint, Aye
Kaitu’u-Lino, Tu’uhevaha
Kuswanto, Kent
Lappas, Martha
Sikaris, Ken
Zajac, Jeffery D
Permezel, Michael
Tong, Stephen
author_sort Grossmann, Mathis
collection PubMed
description BACKGROUND: There has been recent evidence suggesting the presence of anti-thyroid peroxidase antibodies (TPOAb) increases the risk of miscarriage, and levothyroxine can rescue miscarriages associated with TPOAb. We propose the most clinically pragmatic cohort to screen for TPOAb are women presenting for management of a missed miscarriage and have never birthed a liveborn. We measured serum TPOAb among nulliparous women presenting for management of miscarriage, and compared levels with women who have had 2 or more livebirths (and never miscarried). Given its potential role in immunomodulation, we also measured Vitamin D levels. METHODS: We performed a prospective descriptive cohort study at a tertiary hospital (Mercy Hospital for Women, Victoria, Australia). We measured TPOAb and Vitamin D levels in serum obtained from 118 nulliparous women presenting for management of miscarriage, and 162 controls with 2 or more livebirths (and no miscarriages). Controls were selected from a serum biobank prospectively collected in the first trimester at the same hospital. RESULTS: Nulliparous women with 1 or more miscarriages had higher thyroid peroxidase antibody (TPOAb) levels than those with 2 or more livebirths; TPOAb in miscarriage group was 0.3 mIU/L (interquartile range [IR]: 0.2-0.7) vs 0.2 mIU/L among controls (IR 0.0-0.5; p < 0.0001). We confirmed TPOAb levels were not correlated with serum human chorionic gonadotrophin (hCG) concentrations in either the miscarriage or control groups. In contrast, thyroid stimulating hormone, fT3 and fT4 levels (thyroid hormones) either trended towards a correlation, or were significantly correlated with serum hCG levels in the two groups. Of the entire cohort that was predominantly caucasian, only 12% were Vitamin D sufficient. Low Vitamin D levels were not associated with miscarriage. CONCLUSIONS: We have confirmed the association between miscarriage and increased TPOAb levels. Furthermore, it appears TPOAb levels in maternal blood are not influenced by serum hCG levels. Therefore, we propose the day nulliparous women present for management for miscarriage is a clinically relevant, and pragmatic time to screen for TPOAb.
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spelling pubmed-36558332013-05-17 Measuring thyroid peroxidase antibodies on the day nulliparous women present for management of miscarriage: a descriptive cohort study Grossmann, Mathis Hoermann, Rudolf Francis, Claire Hamilton, Emma J Tint, Aye Kaitu’u-Lino, Tu’uhevaha Kuswanto, Kent Lappas, Martha Sikaris, Ken Zajac, Jeffery D Permezel, Michael Tong, Stephen Reprod Biol Endocrinol Research BACKGROUND: There has been recent evidence suggesting the presence of anti-thyroid peroxidase antibodies (TPOAb) increases the risk of miscarriage, and levothyroxine can rescue miscarriages associated with TPOAb. We propose the most clinically pragmatic cohort to screen for TPOAb are women presenting for management of a missed miscarriage and have never birthed a liveborn. We measured serum TPOAb among nulliparous women presenting for management of miscarriage, and compared levels with women who have had 2 or more livebirths (and never miscarried). Given its potential role in immunomodulation, we also measured Vitamin D levels. METHODS: We performed a prospective descriptive cohort study at a tertiary hospital (Mercy Hospital for Women, Victoria, Australia). We measured TPOAb and Vitamin D levels in serum obtained from 118 nulliparous women presenting for management of miscarriage, and 162 controls with 2 or more livebirths (and no miscarriages). Controls were selected from a serum biobank prospectively collected in the first trimester at the same hospital. RESULTS: Nulliparous women with 1 or more miscarriages had higher thyroid peroxidase antibody (TPOAb) levels than those with 2 or more livebirths; TPOAb in miscarriage group was 0.3 mIU/L (interquartile range [IR]: 0.2-0.7) vs 0.2 mIU/L among controls (IR 0.0-0.5; p < 0.0001). We confirmed TPOAb levels were not correlated with serum human chorionic gonadotrophin (hCG) concentrations in either the miscarriage or control groups. In contrast, thyroid stimulating hormone, fT3 and fT4 levels (thyroid hormones) either trended towards a correlation, or were significantly correlated with serum hCG levels in the two groups. Of the entire cohort that was predominantly caucasian, only 12% were Vitamin D sufficient. Low Vitamin D levels were not associated with miscarriage. CONCLUSIONS: We have confirmed the association between miscarriage and increased TPOAb levels. Furthermore, it appears TPOAb levels in maternal blood are not influenced by serum hCG levels. Therefore, we propose the day nulliparous women present for management for miscarriage is a clinically relevant, and pragmatic time to screen for TPOAb. BioMed Central 2013-05-14 /pmc/articles/PMC3655833/ /pubmed/23672306 http://dx.doi.org/10.1186/1477-7827-11-40 Text en Copyright © 2013 Grossmann et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Grossmann, Mathis
Hoermann, Rudolf
Francis, Claire
Hamilton, Emma J
Tint, Aye
Kaitu’u-Lino, Tu’uhevaha
Kuswanto, Kent
Lappas, Martha
Sikaris, Ken
Zajac, Jeffery D
Permezel, Michael
Tong, Stephen
Measuring thyroid peroxidase antibodies on the day nulliparous women present for management of miscarriage: a descriptive cohort study
title Measuring thyroid peroxidase antibodies on the day nulliparous women present for management of miscarriage: a descriptive cohort study
title_full Measuring thyroid peroxidase antibodies on the day nulliparous women present for management of miscarriage: a descriptive cohort study
title_fullStr Measuring thyroid peroxidase antibodies on the day nulliparous women present for management of miscarriage: a descriptive cohort study
title_full_unstemmed Measuring thyroid peroxidase antibodies on the day nulliparous women present for management of miscarriage: a descriptive cohort study
title_short Measuring thyroid peroxidase antibodies on the day nulliparous women present for management of miscarriage: a descriptive cohort study
title_sort measuring thyroid peroxidase antibodies on the day nulliparous women present for management of miscarriage: a descriptive cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655833/
https://www.ncbi.nlm.nih.gov/pubmed/23672306
http://dx.doi.org/10.1186/1477-7827-11-40
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