Cargando…
Early Levothyroxine Treatment for Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy: The St Carlos Gestational and Thyroid Protocol
The optimal maternal levels of thyroid hormones (TH) during the first trimester of gestation have not been established, nor has the ideal moment to initiate levothyroxine treatment (LT) to improve the evolution of gestation and fetal development. Cut-off points for Thyroid-stimulating hormone (TSH)...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8560890/ https://www.ncbi.nlm.nih.gov/pubmed/34737722 http://dx.doi.org/10.3389/fendo.2021.743057 |
_version_ | 1784593016294473728 |
---|---|
author | Runkle, Isabelle de Miguel, María Paz Barabash, Ana Cuesta, Martin Diaz, Ángel Duran, Alejandra Familiar, Cristina de la Torre, Nuria García Herraiz, Miguel Ángel Izquierdo, Nuria Diaz, Ángel Marcuello, Clara Matia, Pilar Melero, Verónica Montañez, Carmen Moraga, Inmaculada Perez-Ferre, Natalia Perez, Noelia Assaf-Balut, Carla Rubio, Miguel Ángel Ruiz-Sanchez, Jorge Gabriel Sanabria, Concepción Torrejon, María José Valerio, Johanna del Valle, Laura Calle-Pascual, Alfonso |
author_facet | Runkle, Isabelle de Miguel, María Paz Barabash, Ana Cuesta, Martin Diaz, Ángel Duran, Alejandra Familiar, Cristina de la Torre, Nuria García Herraiz, Miguel Ángel Izquierdo, Nuria Diaz, Ángel Marcuello, Clara Matia, Pilar Melero, Verónica Montañez, Carmen Moraga, Inmaculada Perez-Ferre, Natalia Perez, Noelia Assaf-Balut, Carla Rubio, Miguel Ángel Ruiz-Sanchez, Jorge Gabriel Sanabria, Concepción Torrejon, María José Valerio, Johanna del Valle, Laura Calle-Pascual, Alfonso |
author_sort | Runkle, Isabelle |
collection | PubMed |
description | The optimal maternal levels of thyroid hormones (TH) during the first trimester of gestation have not been established, nor has the ideal moment to initiate levothyroxine treatment (LT) to improve the evolution of gestation and fetal development. Cut-off points for Thyroid-stimulating hormone (TSH) <2.5 µIU/mL and free thyroxine (FT4)>7.5 pg/mL have been recommended. There are no data on whether initiation of LT <9th Gestational Week (GW) can have a favourable impact. OBJECTIVE: To define the TSH/FT4 percentiles corresponding with 2.5 µIU/mL and 7.5 pg/mL levels, respectively, at GW8 (Study 1), and evaluate the effects of protocol-based LT before GW9 on gestation evolution, in women with TSH ≥2.5 µIU/mL and/or FT4≤ 7.5 pg/mL (study 2). SUBJECTS: 2768 consecutive pregnant women attending the first gestational visit from 2013-2014 and 3026 from 2015-2016 were eligible for Study I and 2 respectively. A final 2043 (study 1) and 2069 (study 2) women were assessed in these studies. RESULTS: Study 1: The FT4 level of 7.5 pg/mL corresponds with the 17.9th percentile, a TSH level of 2.5 µIU/mL with the 75.8(th). Women with TSH ≥2.5 µIU/mL had a history of fetal losses more frequently than those <2.5 (OR 2.33 (95%CI): 1.58-3.12), as did those with FT4 ≤7.5 pg/ml compared to those >7.5 (OR 4.81; 3.25-8.89). Study 2: A total of 1259 women had optimal TSH/FT4 levels (Group 1), 672 (32.4%, Group 2) had suboptimal TSH or T4l, and 138 (6.7%, Group 3) had suboptimal values of both. 393 (58.5%) in Group 2 and 88 (63.8%) in Group 3 started LT before GW9. Mean (SD) GW24 levels were TSH: 1.96 ± 1.22 µIU/mL and FT4: 7.07 ± 1.25 pg/mL. The highest FT4 value was 12.84 pg/mL. The adjusted risk for an adverse event if LT was started early was 0.71 (0.43-0.91) for Group 2 and 0.80 (0.66-0.94) for Group 3. CONCLUSIONS: Early LT in women with suboptimum levels of TSH/FT4 (≥2.5µIU/mL/≤7.5 pg/ml) at or before GW9 is safe and improves gestation progression. These data support the recommendation to adopt these cut-off points for LT initiation, which should be started as early as possible. |
format | Online Article Text |
id | pubmed-8560890 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-85608902021-11-03 Early Levothyroxine Treatment for Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy: The St Carlos Gestational and Thyroid Protocol Runkle, Isabelle de Miguel, María Paz Barabash, Ana Cuesta, Martin Diaz, Ángel Duran, Alejandra Familiar, Cristina de la Torre, Nuria García Herraiz, Miguel Ángel Izquierdo, Nuria Diaz, Ángel Marcuello, Clara Matia, Pilar Melero, Verónica Montañez, Carmen Moraga, Inmaculada Perez-Ferre, Natalia Perez, Noelia Assaf-Balut, Carla Rubio, Miguel Ángel Ruiz-Sanchez, Jorge Gabriel Sanabria, Concepción Torrejon, María José Valerio, Johanna del Valle, Laura Calle-Pascual, Alfonso Front Endocrinol (Lausanne) Endocrinology The optimal maternal levels of thyroid hormones (TH) during the first trimester of gestation have not been established, nor has the ideal moment to initiate levothyroxine treatment (LT) to improve the evolution of gestation and fetal development. Cut-off points for Thyroid-stimulating hormone (TSH) <2.5 µIU/mL and free thyroxine (FT4)>7.5 pg/mL have been recommended. There are no data on whether initiation of LT <9th Gestational Week (GW) can have a favourable impact. OBJECTIVE: To define the TSH/FT4 percentiles corresponding with 2.5 µIU/mL and 7.5 pg/mL levels, respectively, at GW8 (Study 1), and evaluate the effects of protocol-based LT before GW9 on gestation evolution, in women with TSH ≥2.5 µIU/mL and/or FT4≤ 7.5 pg/mL (study 2). SUBJECTS: 2768 consecutive pregnant women attending the first gestational visit from 2013-2014 and 3026 from 2015-2016 were eligible for Study I and 2 respectively. A final 2043 (study 1) and 2069 (study 2) women were assessed in these studies. RESULTS: Study 1: The FT4 level of 7.5 pg/mL corresponds with the 17.9th percentile, a TSH level of 2.5 µIU/mL with the 75.8(th). Women with TSH ≥2.5 µIU/mL had a history of fetal losses more frequently than those <2.5 (OR 2.33 (95%CI): 1.58-3.12), as did those with FT4 ≤7.5 pg/ml compared to those >7.5 (OR 4.81; 3.25-8.89). Study 2: A total of 1259 women had optimal TSH/FT4 levels (Group 1), 672 (32.4%, Group 2) had suboptimal TSH or T4l, and 138 (6.7%, Group 3) had suboptimal values of both. 393 (58.5%) in Group 2 and 88 (63.8%) in Group 3 started LT before GW9. Mean (SD) GW24 levels were TSH: 1.96 ± 1.22 µIU/mL and FT4: 7.07 ± 1.25 pg/mL. The highest FT4 value was 12.84 pg/mL. The adjusted risk for an adverse event if LT was started early was 0.71 (0.43-0.91) for Group 2 and 0.80 (0.66-0.94) for Group 3. CONCLUSIONS: Early LT in women with suboptimum levels of TSH/FT4 (≥2.5µIU/mL/≤7.5 pg/ml) at or before GW9 is safe and improves gestation progression. These data support the recommendation to adopt these cut-off points for LT initiation, which should be started as early as possible. Frontiers Media S.A. 2021-10-19 /pmc/articles/PMC8560890/ /pubmed/34737722 http://dx.doi.org/10.3389/fendo.2021.743057 Text en Copyright © 2021 Runkle, de Miguel, Barabash, Cuesta, Diaz, Duran, Familiar, de la Torre, Herraiz, Izquierdo, Diaz, Marcuello, Matia, Melero, Montañez, Moraga, Perez-Ferre, Perez, Assaf-Balut, Rubio, Ruiz-Sanchez, Sanabria, Torrejon, Valerio, del Valle and Calle-Pascual https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Endocrinology Runkle, Isabelle de Miguel, María Paz Barabash, Ana Cuesta, Martin Diaz, Ángel Duran, Alejandra Familiar, Cristina de la Torre, Nuria García Herraiz, Miguel Ángel Izquierdo, Nuria Diaz, Ángel Marcuello, Clara Matia, Pilar Melero, Verónica Montañez, Carmen Moraga, Inmaculada Perez-Ferre, Natalia Perez, Noelia Assaf-Balut, Carla Rubio, Miguel Ángel Ruiz-Sanchez, Jorge Gabriel Sanabria, Concepción Torrejon, María José Valerio, Johanna del Valle, Laura Calle-Pascual, Alfonso Early Levothyroxine Treatment for Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy: The St Carlos Gestational and Thyroid Protocol |
title | Early Levothyroxine Treatment for Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy: The St Carlos Gestational and Thyroid Protocol |
title_full | Early Levothyroxine Treatment for Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy: The St Carlos Gestational and Thyroid Protocol |
title_fullStr | Early Levothyroxine Treatment for Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy: The St Carlos Gestational and Thyroid Protocol |
title_full_unstemmed | Early Levothyroxine Treatment for Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy: The St Carlos Gestational and Thyroid Protocol |
title_short | Early Levothyroxine Treatment for Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy: The St Carlos Gestational and Thyroid Protocol |
title_sort | early levothyroxine treatment for subclinical hypothyroidism or hypothyroxinemia in pregnancy: the st carlos gestational and thyroid protocol |
topic | Endocrinology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8560890/ https://www.ncbi.nlm.nih.gov/pubmed/34737722 http://dx.doi.org/10.3389/fendo.2021.743057 |
work_keys_str_mv | AT runkleisabelle earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT demiguelmariapaz earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT barabashana earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT cuestamartin earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT diazangel earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT duranalejandra earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT familiarcristina earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT delatorrenuriagarcia earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT herraizmiguelangel earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT izquierdonuria earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT diazangel earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT marcuelloclara earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT matiapilar earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT meleroveronica earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT montanezcarmen earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT moragainmaculada earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT perezferrenatalia earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT pereznoelia earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT assafbalutcarla earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT rubiomiguelangel earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT ruizsanchezjorgegabriel earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT sanabriaconcepcion earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT torrejonmariajose earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT valeriojohanna earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT delvallelaura earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol AT callepascualalfonso earlylevothyroxinetreatmentforsubclinicalhypothyroidismorhypothyroxinemiainpregnancythestcarlosgestationalandthyroidprotocol |