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BMC Medicine
Published in: BMC Medicine 1/2019

Open Access 01-12-2019 | Infertility | Commentary

The TABLET trial: limitations and implications

Authors: Chrysoula Dosiou, Alex Stagnaro-Green

Published in: BMC Medicine | Issue 1/2019

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Excerpt

The link between thyroid antibodies and spontaneous pregnancy loss was published in a seminal paper in 1990. In this study of a prospective cohort of unselected women, the rate of miscarriage was twice as high in euthyroid thyroid antibody-positive women than in euthyroid thyroid antibody-negative women [1]. A 2011 meta-analysis of cohort studies replicating this finding reported the odds of pregnancy loss to be over three times higher in euthyroid thyroid antibody-positive women [2]. A critical question remains: what is the impact of intervention with levothyroxine on the rate of miscarriage in euthyroid thyroid antibody-positive women? In 2006, the first randomized controlled trial (RCT) reported a significant decrease in the miscarriage rate (from 13.8 to 3.5%, P < 0.05) in unselected euthyroid women with thyroid autoimmunity treated with levothyroxine compared with the untreated group [3]. …
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Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association between thyroid antibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ. 2011;342:d2616.CrossRef
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Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab. 2006;91:2587–91.CrossRef
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Wang H, Gao H, Chi H, Zeng L, Xiao W, Wang Y, et al. 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. 2017;318:2190–8.CrossRef
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Metadata
Title
The TABLET trial: limitations and implications
Authors
Chrysoula Dosiou
Alex Stagnaro-Green
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2019
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-019-1365-y

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