Long-term hypothyroidism in patients started on levothyroxine during pregnancy

Author:

Demartin Sophie1,Constantinescu Stefan Matei1ORCID,Poppe Kris G2ORCID,Maiter Dominique1ORCID,Furnica Raluca Maria1,Alexopoulou Orsalia1,Daumerie Chantal1,Debiève Frederic3,Burlacu Maria-Cristina1ORCID

Affiliation:

1. Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

2. Endocrine Unit, Centre Hospitalier Universitaire Saint Pierre, Université Libre de Bruxelles (ULB), Rue Haute, Brussels, Belgium

3. Department of Obstetrics, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

Abstract

Background Current guidelines recommend different postpartum approaches for patients started on levothyroxine (LT4) during pregnancy. Objective We studied the postpartum management of these patients and determined factors associated with long-term hypothyroidism. Methods A retrospective study was conducted at a tertiary center between 2014 and 2020, with LT4 initiation according to 2014 ETA recommendations. We performed multivariate logistic regression (MVR) and a receiver operating characteristic curve analysis to determine variables associated with long-term hypothyroidism and their optimal cutoffs. Results LT4 was initiated in 177 pregnant women, and 106/177 (60%) were followed at long-term (at least 6 months post partum) (28.5 (9.0–81.9) months). LT4 could have been stopped in 45% of patients who continued it immediately after delivery. Thirty-six out of 106 (34%) patients were long-term hypothyroid. In them, LT4 was initiated earlier during pregnancy than in euthyroid women (11.7 ± 4.7 vs 13.7 ± 6.5 weeks, P = 0.077), at a higher thyroid-stimulating hormone (TSH) level (4.1 (2.2–10.1) vs 3.5 (0.9–6.9) mU/L, P = 0.005), and reached a higher dose during pregnancy (62.8 ± 22.2 vs 50.7 ± 13.9 µg/day, P = 0.005). In the MVR, only the maximal LT4 dose during pregnancy was associated with long-term hypothyroidism (odds ratio (OR) = 1.03, 95% CI: 1.00–1.05, P = 0.003). The optimal cutoffs for predicting long-term hypothyroidism were an LT4 dose of 68.75 µg/day (87% specificity, 42% sensitivity; P = 0.013) and a TSH level ≥ 3.8 mU/L (68.5% specificity, 77% sensitivity; P = 0.019). Conclusion One-third of the patients who started on LT4 during pregnancy had long-term hypothyroidism. The TSH level at treatment initiation and the LT4 dose during pregnancy could guide the decision for continuing long-term LT4.

Publisher

Bioscientifica

Reference26 articles.

1. Hypothyroidism in pregnancy;Taylor,2019

2. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children;Lazarus,2014

3. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum;Alexander,2017

4. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence;Thangaratinam,2011

5. 2021 European Thyroid Association guideline on thyroid disorders prior to and during assisted reproduction;Poppe,2021

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