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Published in: Archives of Gynecology and Obstetrics 4/2019

01-10-2019 | Intrauterine Growth Restriction | Review

Levothyroxine treatment and pregnancy outcomes in women with subclinical hypothyroidism: a systematic review and meta-analysis

Authors: Sima Nazarpour, Fahimeh Ramezani Tehrani, Mina Amiri, Razieh Bidhendi Yarandi, Fereidoun Azizi

Published in: Archives of Gynecology and Obstetrics | Issue 4/2019

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Abstract

Purpose

To evaluate the benefits of LT4 treatment on pregnancy outcomes in SCH women.

Study design

PubMed [including Medline], Web of Science, Wiley, Google Scholar, Science direct and Scopus were searched for identifying and retrieving all English articles published up to May 2018 on the effects of levothyroxine treatment on pregnancy outcomes in pregnant women with SCH compared to untreated or healthy controls. In this systematic review and meta-analysis, both fixed and random effect models were applied to estimate the pooled effect size. Heterogeneity and publication bias were evaluated using the I-squared (I2) and Begg’s statistics, respectively. We also explored heterogeneity sources using meta-regression models and sensitivity analysis.

Results

Data of 13 cohort studies and randomized controlled trials with a total of 11,503 participants were analyzed. This meta-analysis showed that pregnant women with SCH treated with levothyroxine had lower chances of pregnancy loss (OR 0.78, 95% CI 0.66–0.94; I2 = 0%) and higher chances for live birth rates (OR 2.72, 95% CI 1.44–5.11; I2 = 25%) than the placebo group. Compared to euthyroid women, SCH patients treated with levothyroxine had higher odds ratio for preterm labor (OR 1.82, 95% CI 1.14–2.91; I2 = 0%).

Conclusions

Results of this study showed that the effects of treatment with levothyroxine in SCH pregnant women are not the same for all pregnancy outcomes. Levothyroxine treatment in these patients can reduce pregnancy loss. Considering the limited number of studies available, further studies are warranted to document more precise data on other consequences.
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Literature
1.
go back to reference Maraka S, Ospina NM, O’Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR, Erwin PJ, Coddington CC 3rd, Stan MN, Murad MH, Montori VM (2016) Subclinical hypothyroidism in pregnancy: a systematic review and meta-analysis. Thyroid 26(4):580–590PubMedPubMedCentralCrossRef Maraka S, Ospina NM, O’Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR, Erwin PJ, Coddington CC 3rd, Stan MN, Murad MH, Montori VM (2016) Subclinical hypothyroidism in pregnancy: a systematic review and meta-analysis. Thyroid 26(4):580–590PubMedPubMedCentralCrossRef
2.
go back to reference Al Shanqeeti SA, Alkhudairy YN, Alabdulwahed AA, Ahmed AE, Al-Adham MS, Mahmood NM (2018) Prevalence of subclinical hypothyroidism in pregnancy in Saudi Arabia. Saudi Med J 39(3):254–260PubMedPubMedCentralCrossRef Al Shanqeeti SA, Alkhudairy YN, Alabdulwahed AA, Ahmed AE, Al-Adham MS, Mahmood NM (2018) Prevalence of subclinical hypothyroidism in pregnancy in Saudi Arabia. Saudi Med J 39(3):254–260PubMedPubMedCentralCrossRef
3.
go back to reference Garmendia Madariaga A, Santos Palacios S, Guillen-Grima F, Galofre JC (2014) The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab 99(3):923–931PubMedCrossRef Garmendia Madariaga A, Santos Palacios S, Guillen-Grima F, Galofre JC (2014) The incidence and prevalence of thyroid dysfunction in Europe: a meta-analysis. J Clin Endocrinol Metab 99(3):923–931PubMedCrossRef
4.
go back to reference Chen LM, Du WJ, Dai J, Zhang Q, Si GX, Yang H, Ye EL, Chen QS, Yu LC, Zhang C, Lu XM (2014) Effects of subclinical hypothyroidism on maternal and perinatal outcomes during pregnancy: a single-center cohort study of a Chinese population. PLoS One 9(10):e109364PubMedPubMedCentralCrossRef Chen LM, Du WJ, Dai J, Zhang Q, Si GX, Yang H, Ye EL, Chen QS, Yu LC, Zhang C, Lu XM (2014) Effects of subclinical hypothyroidism on maternal and perinatal outcomes during pregnancy: a single-center cohort study of a Chinese population. PLoS One 9(10):e109364PubMedPubMedCentralCrossRef
5.
go back to reference Su PY, Huang K, Hao JH, Xu YQ, Yan SQ, Li T, Xu YH, Tao FB (2011) Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China. J Clin Endocrinol Metab 96(10):3234–3241PubMedCrossRef Su PY, Huang K, Hao JH, Xu YQ, Yan SQ, Li T, Xu YH, Tao FB (2011) Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China. J Clin Endocrinol Metab 96(10):3234–3241PubMedCrossRef
6.
go back to reference Tudela CM, Casey BM, McIntire DD, Cunningham FG (2012) Relationship of subclinical thyroid disease to the incidence of gestational diabetes. Obstet Gynecol 119(5):983–988PubMedCrossRef Tudela CM, Casey BM, McIntire DD, Cunningham FG (2012) Relationship of subclinical thyroid disease to the incidence of gestational diabetes. Obstet Gynecol 119(5):983–988PubMedCrossRef
7.
go back to reference Wang S, Teng WP, Li JX, Wang WW, Shan ZY (2012) Effects of maternal subclinical hypothyroidism on obstetrical outcomes during early pregnancy. J Endocrinol Invest 35(3):322–325PubMed Wang S, Teng WP, Li JX, Wang WW, Shan ZY (2012) Effects of maternal subclinical hypothyroidism on obstetrical outcomes during early pregnancy. J Endocrinol Invest 35(3):322–325PubMed
9.
go back to reference Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A (2010) Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab 95(4):1699–1707PubMedCrossRef Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A (2010) Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab 95(4):1699–1707PubMedCrossRef
10.
go back to reference Maraka S, Singh Ospina NM, O’Keeffe DT, Rodriguez-Gutierrez R, Espinosa De Ycaza AE, Wi CI, Juhn YJ, Coddington CC 3rd, Montori VM, Stan MN (2016) Effects of levothyroxine therapy on pregnancy outcomes in women with subclinical hypothyroidism. Thyroid 26(7):980–986PubMedPubMedCentralCrossRef Maraka S, Singh Ospina NM, O’Keeffe DT, Rodriguez-Gutierrez R, Espinosa De Ycaza AE, Wi CI, Juhn YJ, Coddington CC 3rd, Montori VM, Stan MN (2016) Effects of levothyroxine therapy on pregnancy outcomes in women with subclinical hypothyroidism. Thyroid 26(7):980–986PubMedPubMedCentralCrossRef
11.
go back to reference Nazarpour S, Ramezani Tehrani F, Simbar M, Tohidi M, Minooee S, Rahmati M, Azizi F (2018) Effects of levothyroxine on pregnant women with subclinical hypothyroidism, negative for thyroid peroxidase antibodies. J Clin Endocrinol Metab 103(3):926–935PubMedCrossRef Nazarpour S, Ramezani Tehrani F, Simbar M, Tohidi M, Minooee S, Rahmati M, Azizi F (2018) Effects of levothyroxine on pregnant women with subclinical hypothyroidism, negative for thyroid peroxidase antibodies. J Clin Endocrinol Metab 103(3):926–935PubMedCrossRef
12.
go back to reference Nazarpour S, Ramezani Tehrani F, Simbar M, Tohidi M, Alavi Majd H, Azizi F (2017) Effects of levothyroxine treatment on pregnancy outcomes in pregnant women with autoimmune thyroid disease. Eur J Endocrinol 176(2):253–265PubMedCrossRef Nazarpour S, Ramezani Tehrani F, Simbar M, Tohidi M, Alavi Majd H, Azizi F (2017) Effects of levothyroxine treatment on pregnancy outcomes in pregnant women with autoimmune thyroid disease. Eur J Endocrinol 176(2):253–265PubMedCrossRef
13.
go back to reference Casey BM, Thom EA, Peaceman AM, Varner MW, Sorokin Y, Hirtz DG, Reddy UM, Wapner RJ, Thorp JM Jr., Saade G, Tita AT, Rouse DJ, Sibai B, Iams JD, Mercer BM, Tolosa J, Caritis SN, VanDorsten JP, Eunice Kennedy Shriver National Institute of Child H, Human Development Maternal-Fetal Medicine Units N (2017) Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med 376(9):815–825PubMedPubMedCentralCrossRef Casey BM, Thom EA, Peaceman AM, Varner MW, Sorokin Y, Hirtz DG, Reddy UM, Wapner RJ, Thorp JM Jr., Saade G, Tita AT, Rouse DJ, Sibai B, Iams JD, Mercer BM, Tolosa J, Caritis SN, VanDorsten JP, Eunice Kennedy Shriver National Institute of Child H, Human Development Maternal-Fetal Medicine Units N (2017) Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med 376(9):815–825PubMedPubMedCentralCrossRef
14.
go back to reference Ma L, Qi H, Chai X, Jiang F, Mao S, Liu J, Zhang S, Lian X, Sun X, Wang D, Ren J, Yan Q (2016) The effects of screening and intervention of subclinical hypothyroidism on pregnancy outcomes: a prospective multicenter single-blind, randomized, controlled study of thyroid function screening test during pregnancy. J Matern Fetal Neonatal Med 29(9):1391–1394PubMed Ma L, Qi H, Chai X, Jiang F, Mao S, Liu J, Zhang S, Lian X, Sun X, Wang D, Ren J, Yan Q (2016) The effects of screening and intervention of subclinical hypothyroidism on pregnancy outcomes: a prospective multicenter single-blind, randomized, controlled study of thyroid function screening test during pregnancy. J Matern Fetal Neonatal Med 29(9):1391–1394PubMed
15.
go back to reference Nasirkandy MP, Badfar G, Shohani M, Rahmati S, YektaKooshali MH, Abbasalizadeh S, Soleymani A, Azami M (2017) The relation of maternal hypothyroidism and hypothyroxinemia during pregnancy on preterm birth: an updated systematic review and meta-analysis. Int J Reprod Biomed 15(9):543–552CrossRef Nasirkandy MP, Badfar G, Shohani M, Rahmati S, YektaKooshali MH, Abbasalizadeh S, Soleymani A, Azami M (2017) The relation of maternal hypothyroidism and hypothyroxinemia during pregnancy on preterm birth: an updated systematic review and meta-analysis. Int J Reprod Biomed 15(9):543–552CrossRef
16.
go back to reference Toulis KA, Goulis DG, Venetis CA, Kolibianakis EM, Negro R, Tarlatzis BC, Papadimas I (2010) Risk of spontaneous miscarriage in euthyroid women with thyroid autoimmunity undergoing IVF: a meta-analysis. Eur J Endocrinol 162(4):643–652PubMedCrossRef Toulis KA, Goulis DG, Venetis CA, Kolibianakis EM, Negro R, Tarlatzis BC, Papadimas I (2010) Risk of spontaneous miscarriage in euthyroid women with thyroid autoimmunity undergoing IVF: a meta-analysis. Eur J Endocrinol 162(4):643–652PubMedCrossRef
17.
go back to reference Zhang Y, Wang H, Pan X, Teng W, Shan Z (2017) Patients with subclinical hypothyroidism before 20 weeks of pregnancy have a higher risk of miscarriage: a systematic review and meta-analysis. PLoS One 12(4):e0175708PubMedPubMedCentralCrossRef Zhang Y, Wang H, Pan X, Teng W, Shan Z (2017) Patients with subclinical hypothyroidism before 20 weeks of pregnancy have a higher risk of miscarriage: a systematic review and meta-analysis. PLoS One 12(4):e0175708PubMedPubMedCentralCrossRef
18.
go back to reference Velkeniers B, Van Meerhaeghe A, Poppe K, Unuane D, Tournaye H, Haentjens P (2013) Levothyroxine treatment and pregnancy outcome in women with subclinical hypothyroidism undergoing assisted reproduction technologies: systematic review and meta-analysis of RCTs. Hum Reprod Update 19(3):251–258PubMedCrossRef Velkeniers B, Van Meerhaeghe A, Poppe K, Unuane D, Tournaye H, Haentjens P (2013) Levothyroxine treatment and pregnancy outcome in women with subclinical hypothyroidism undergoing assisted reproduction technologies: systematic review and meta-analysis of RCTs. Hum Reprod Update 19(3):251–258PubMedCrossRef
19.
go back to reference Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S (2017) 2017 guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 27(3):315–389PubMedCrossRef Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S (2017) 2017 guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 27(3):315–389PubMedCrossRef
20.
go back to reference Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B (2014) 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J 3(2):76–94PubMedPubMedCentralCrossRef Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B (2014) 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J 3(2):76–94PubMedPubMedCentralCrossRef
21.
go back to reference De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, Eastman CJ, Lazarus JH, Luton D, Mandel SJ, Mestman J, Rovet J, Sullivan S (2012) Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 97(8):2543–2565PubMedCrossRef De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, Eastman CJ, Lazarus JH, Luton D, Mandel SJ, Mestman J, Rovet J, Sullivan S (2012) Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 97(8):2543–2565PubMedCrossRef
22.
go back to reference Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605PubMedCrossRef Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605PubMedCrossRef
23.
24.
go back to reference Abdel Rahman AH, Aly Abbassy H, Abbassy AA (2010) Improved in vitro fertilization outcomes after treatment of subclinical hypothyroidism in infertile women. Endocr Pract 16(5):792–797PubMedCrossRef Abdel Rahman AH, Aly Abbassy H, Abbassy AA (2010) Improved in vitro fertilization outcomes after treatment of subclinical hypothyroidism in infertile women. Endocr Pract 16(5):792–797PubMedCrossRef
25.
go back to reference Cai Y, Zhong L, Guan J, Guo R, Niu B, Ma Y, Su H (2017) Outcome of in vitro fertilization in women with subclinical hypothyroidism. Reprod Biol Endocrinol 15(1):39PubMedPubMedCentralCrossRef Cai Y, Zhong L, Guan J, Guo R, Niu B, Ma Y, Su H (2017) Outcome of in vitro fertilization in women with subclinical hypothyroidism. Reprod Biol Endocrinol 15(1):39PubMedPubMedCentralCrossRef
26.
go back to reference Kim CH, Ahn JW, Kang SP, Kim SH, Chae HD, Kang BM (2011) Effect of levothyroxine treatment on in vitro fertilization and pregnancy outcome in infertile women with subclinical hypothyroidism undergoing in vitro fertilization/intracytoplasmic sperm injection. Fertil Steril 95(5):1650–1654PubMedCrossRef Kim CH, Ahn JW, Kang SP, Kim SH, Chae HD, Kang BM (2011) Effect of levothyroxine treatment on in vitro fertilization and pregnancy outcome in infertile women with subclinical hypothyroidism undergoing in vitro fertilization/intracytoplasmic sperm injection. Fertil Steril 95(5):1650–1654PubMedCrossRef
28.
go back to reference Bernardi LA, Cohen RN, Stephenson MD (2013) Impact of subclinical hypothyroidism in women with recurrent early pregnancy loss. Fertil Steril 100(5):1326–1331PubMedCrossRef Bernardi LA, Cohen RN, Stephenson MD (2013) Impact of subclinical hypothyroidism in women with recurrent early pregnancy loss. Fertil Steril 100(5):1326–1331PubMedCrossRef
29.
go back to reference Pearce E, Oken E, Gillman M, Lee S, Magnani B, Platek D, Braverman L (2008) Association of first-trimester thyroid function test values with thyroperoxidase antibody status, smoking, and multivitamin use. Endocrine Pract 14(1):33–39CrossRef Pearce E, Oken E, Gillman M, Lee S, Magnani B, Platek D, Braverman L (2008) Association of first-trimester thyroid function test values with thyroperoxidase antibody status, smoking, and multivitamin use. Endocrine Pract 14(1):33–39CrossRef
30.
go back to reference Banerjee S (2011) Thyroid disorders in pregnancy. J Assoc Physicians India 59(Suppl):32–34PubMed Banerjee S (2011) Thyroid disorders in pregnancy. J Assoc Physicians India 59(Suppl):32–34PubMed
31.
go back to reference Weetman AP (2010) Immunity, thyroid function and pregnancy: molecular mechanisms. Nat Rev Endocrinol 6(6):311–318PubMedCrossRef Weetman AP (2010) Immunity, thyroid function and pregnancy: molecular mechanisms. Nat Rev Endocrinol 6(6):311–318PubMedCrossRef
32.
go back to reference Sailakshmi M, Rekha B, Akash SS (2014) Autoimmune thyroid disease in pregnancy. Int J Reprod Contracept Obstetr Gynecol 3(2):321–324CrossRef Sailakshmi M, Rekha B, Akash SS (2014) Autoimmune thyroid disease in pregnancy. Int J Reprod Contracept Obstetr Gynecol 3(2):321–324CrossRef
33.
go back to reference Sheehan PM, Nankervis A, Araujo Junior E, Da Silva Costa F (2015) Maternal thyroid disease and preterm birth: systematic review and meta-analysis. J Clin Endocrinol Metab 100(11):4325–4331PubMedCrossRef Sheehan PM, Nankervis A, Araujo Junior E, Da Silva Costa F (2015) Maternal thyroid disease and preterm birth: systematic review and meta-analysis. J Clin Endocrinol Metab 100(11):4325–4331PubMedCrossRef
34.
go back to reference Wang H, Gao H, Chi H, Zeng L, Xiao W, Wang Y, Li R, Liu P, Wang C, Tian Q, Zhou Z, Yang J, Liu Y, Wei R, Mol BWJ, Hong T, Qiao J (2017) Effect of levothyroxine on miscarriage among women with normal thyroid function and thyroid autoimmunity undergoing in vitro fertilization and embryo transfer: a randomized clinical trial. JAMA 318(22):2190–2198PubMedCrossRef Wang H, Gao H, Chi H, Zeng L, Xiao W, Wang Y, Li R, Liu P, Wang C, Tian Q, Zhou Z, Yang J, Liu Y, Wei R, Mol BWJ, Hong T, Qiao J (2017) Effect of levothyroxine on miscarriage among women with normal thyroid function and thyroid autoimmunity undergoing in vitro fertilization and embryo transfer: a randomized clinical trial. JAMA 318(22):2190–2198PubMedCrossRef
35.
go back to reference Khatiwada S, Sah SK, Kc R, Baral N, Lamsal M (2016) Thyroid dysfunction in metabolic syndrome patients and its relationship with components of metabolic syndrome. Clin Diabetes Endocrinol 2(1):3PubMedPubMedCentralCrossRef Khatiwada S, Sah SK, Kc R, Baral N, Lamsal M (2016) Thyroid dysfunction in metabolic syndrome patients and its relationship with components of metabolic syndrome. Clin Diabetes Endocrinol 2(1):3PubMedPubMedCentralCrossRef
36.
go back to reference Rao M, Zeng Z, Zhou F, Wang H, Liu J, Wang R, Wen Y, Yang Z, Su C, Su Z, Zhao S, Tang L (2019) Effect of levothyroxine supplementation on pregnancy loss and preterm birth in women with subclinical hypothyroidism and thyroid autoimmunity: a systematic review and meta-analysis. Hum Reprod Update 25(3):344–361PubMedCrossRef Rao M, Zeng Z, Zhou F, Wang H, Liu J, Wang R, Wen Y, Yang Z, Su C, Su Z, Zhao S, Tang L (2019) Effect of levothyroxine supplementation on pregnancy loss and preterm birth in women with subclinical hypothyroidism and thyroid autoimmunity: a systematic review and meta-analysis. Hum Reprod Update 25(3):344–361PubMedCrossRef
37.
go back to reference Duan Y, Peng W, Wang X, Tang W, Liu X, Xu S, Mao X, Feng S, Feng Y, Qin Y, Xu K, Liu C, Liu C (2009) Community-based study of the association of subclinical thyroid dysfunction with blood pressure. Endocrine 35(2):136–142PubMedCrossRef Duan Y, Peng W, Wang X, Tang W, Liu X, Xu S, Mao X, Feng S, Feng Y, Qin Y, Xu K, Liu C, Liu C (2009) Community-based study of the association of subclinical thyroid dysfunction with blood pressure. Endocrine 35(2):136–142PubMedCrossRef
38.
go back to reference Breathnach FM, Donnelly J, Cooley SM, Geary M, Malone FD (2013) Subclinical hypothyroidism as a risk factor for placental abruption: evidence from a low-risk primigravid population. Aust N Z J Obstet Gynaecol 53(6):553–560PubMedCrossRef Breathnach FM, Donnelly J, Cooley SM, Geary M, Malone FD (2013) Subclinical hypothyroidism as a risk factor for placental abruption: evidence from a low-risk primigravid population. Aust N Z J Obstet Gynaecol 53(6):553–560PubMedCrossRef
39.
go back to reference Debieve F, Duliere S, Bernard P, Hubinont C, De Nayer P, Daumerie C (2009) To treat or not to treat euthyroid autoimmune disorder during pregnancy? Gynecol Obstet Invest 67(3):178–182PubMedCrossRef Debieve F, Duliere S, Bernard P, Hubinont C, De Nayer P, Daumerie C (2009) To treat or not to treat euthyroid autoimmune disorder during pregnancy? Gynecol Obstet Invest 67(3):178–182PubMedCrossRef
40.
go back to reference He X, Wang P, Wang Z, He X, Xu D, Wang B (2012) Thyroid antibodies and risk of preterm delivery: a meta-analysis of prospective cohort studies. Eur J Endocrinol 167(4):455–464PubMedCrossRef He X, Wang P, Wang Z, He X, Xu D, Wang B (2012) Thyroid antibodies and risk of preterm delivery: a meta-analysis of prospective cohort studies. Eur J Endocrinol 167(4):455–464PubMedCrossRef
41.
go back to reference Triggianese P, Perricone C, Conigliaro P, Chimenti MS, Perricone R, De Carolis C (2016) Peripheral blood natural killer cells and mild thyroid abnormalities in women with reproductive failure. Int J Immunopathol Pharmacol 29(1):65–75PubMedCrossRef Triggianese P, Perricone C, Conigliaro P, Chimenti MS, Perricone R, De Carolis C (2016) Peripheral blood natural killer cells and mild thyroid abnormalities in women with reproductive failure. Int J Immunopathol Pharmacol 29(1):65–75PubMedCrossRef
42.
go back to reference Zhao L, Jiang G, Tian X, Zhang X, Zhu T, Chen B, Wang Y, Ma Q (2018) Initiation timing effect of levothyroxine treatment on subclinical hypothyroidism in pregnancy. Gynecol Endocrinol 34(10):845–848PubMedCrossRef Zhao L, Jiang G, Tian X, Zhang X, Zhu T, Chen B, Wang Y, Ma Q (2018) Initiation timing effect of levothyroxine treatment on subclinical hypothyroidism in pregnancy. Gynecol Endocrinol 34(10):845–848PubMedCrossRef
43.
go back to reference Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, Nixon A, Pearce EN, Soldin OP, Sullivan S, Wiersinga W, American Thyroid Association Taskforce on Thyroid Disease During P, Postpartum (2011) Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 21(10):1081–1125PubMedPubMedCentralCrossRef Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, Nixon A, Pearce EN, Soldin OP, Sullivan S, Wiersinga W, American Thyroid Association Taskforce on Thyroid Disease During P, Postpartum (2011) Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 21(10):1081–1125PubMedPubMedCentralCrossRef
Metadata
Title
Levothyroxine treatment and pregnancy outcomes in women with subclinical hypothyroidism: a systematic review and meta-analysis
Authors
Sima Nazarpour
Fahimeh Ramezani Tehrani
Mina Amiri
Razieh Bidhendi Yarandi
Fereidoun Azizi
Publication date
01-10-2019
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 4/2019
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-019-05245-2

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