TSH doesn't span the same as SPAM - otherwise I'd be putting this paper to the tune of Monty Python's famous ditty. It is repeated enough to have to play the tune ad nauseam.
When, O when, will we see proper understanding and measuring and reporting of thyroid hormones rather than TSH?
(Wouldn't it be grand if "they" insisted on TSH, FT4 and FT3 all being measured and reported in all papers - as a requirement for a) ethical approval; b) consideration for publication?)
It looks like we should be preparing to see the TSH limit go up to 4.0 - rather than 2.5.
Does anyone ever consider T3 (Free, Total or as Liothyronine/desiccated thyroid) at all?
Does anyone look at the most obvious "other" issues such as iron, B12, D, etc.? (They might be looked at individually, but in conjunction with thyroid is my point.)
BMJ. 2017 Jan 25;356:i6865. doi: 10.1136/bmj.i6865.
Thyroid hormone treatment among pregnant women with subclinical hypothyroidism: US national assessment.
Maraka S1,2, Mwangi R3, McCoy RG4,5, Yao X3,6, Sangaralingham LR3,7, Singh Ospina NM2,8, O'Keeffe DT9,10, De Ycaza AE10, Rodriguez-Gutierrez R2,11, Coddington CC 3rd12, Stan MN10, Brito JP2,10, Montori VM2,10.
To estimate the effectiveness and safety of thyroid hormone treatment among pregnant women with subclinical hypothyroidism.
Retrospective cohort study.
Large US administrative database between 1 January 2010 and 31 December 2014.
5405 pregnant women with subclinical hypothyroidism, defined as untreated thyroid stimulating hormone (TSH) concentration 2.5-10 mIU/L.
Thyroid hormone therapy.
MAIN OUTCOME MEASURE:
Pregnancy loss and other pre-specified maternal and fetal pregnancy related adverse outcomes.
Among 5405 pregnant women with subclinical hypothyroidism, 843 with a mean pre-treatment TSH concentration of 4.8 (SD 1.7) mIU/L were treated with thyroid hormone and 4562 with a mean baseline TSH concentration of 3.3 (SD 0.9) mIU/L were not treated (P<0.01). Pregnancy loss was significantly less common among treated women (n=89; 10.6%) than among untreated women (n=614; 13.5%) (P<0.01). Compared with the untreated group, treated women had lower adjusted odds of pregnancy loss (odds ratio 0.62, 95% confidence interval 0.48 to 0.82) but higher odds of preterm delivery (1.60, 1.14 to 2.24), gestational diabetes (1.37, 1.05 to 1.79), and pre-eclampsia (1.61, 1.10 to 2.37); other pregnancy related adverse outcomes were similar between the two groups. The adjusted odds of pregnancy loss were lower in treated women than in untreated women if their pre-treatment TSH concentration was 4.1-10 mIU/L (odds ratio 0.45, 0.30 to 0.65) but not if it was 2.5-4.0 mIU/L (0.91, 0.65 to 1.23) (P<0.01).
Thyroid hormone treatment was associated with decreased risk of pregnancy loss among women with subclinical hypothyroidism, especially those with pre-treatment TSH concentrations of 4.1-10 mIU/L. However, the increased risk of other pregnancy related adverse outcomes calls for additional studies evaluating the safety of thyroid hormone treatment in this patient population.
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