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dc.contributor.authorTaylor, P. N.en
dc.contributor.authorMinassian, C.en
dc.contributor.authorRehman, A.en
dc.contributor.authorIqbal, A.en
dc.contributor.authorDraman, M. S.en
dc.contributor.authorHamilton, W.en
dc.contributor.authorDunlop, D.en
dc.contributor.authorRobinson, A.en
dc.contributor.authorVaidya, Bijayen
dc.contributor.authorLazarus, J. H.en
dc.contributor.authorThomas, S.en
dc.contributor.authorDayan, C. M.en
dc.contributor.authorOkosieme, O. E.en
dc.date.accessioned2016-01-19T12:35:25Zen
dc.date.available2016-01-19T12:35:25Zen
dc.date.issued2014-10-01en
dc.identifier.citationJ Clin Endocrinol Metab. 2014 Oct;99(10):3895-902.en
dc.identifier.issn1945-7197en
dc.identifier.pmid25057882en
dc.identifier.doi10.1210/jc.2014-1954en
dc.identifier.urihttp://hdl.handle.net/11287/593824en
dc.description.abstractCONTEXT: Thyroid dysfunction is associated with adverse obstetric outcomes, but there is limited information on pregnancy outcomes in women established on levothyroxine. OBJECTIVE: The objective of the study was to determine the relationship between TSH levels and pregnancy outcomes in levothyroxine-treated women in a large community-based database. DESIGN: This was a historical cohort analysis. PATIENTS: Individuals with a first prescription of levothyroxine from 2001 through 2009 (n = 55 501) were identified from the UK General Practice Research Database (population 5 million). Of these, we identified 7978 women of child-bearing age (18-45 y) and 1013 pregnancies in which levothyroxine had been initiated at least 6 months before conception. MAIN OUTCOME MEASURES: TSH, miscarriage/delivery status, and obstetric outcomes were measured. RESULTS: Forty-six percent of levothyroxine-treated women aged 18-45 years had a TSH level greater than 2.5 mU/L (recommended upper level in the first trimester). Among pregnant women who had their TSH measured in the first trimester, 62.8% had a TSH level greater than 2.5 mU/L, with 7.4% greater than 10 mU/L. Women with TSH greater than 2.5 mU/L in the first trimester had an increased risk of miscarriage compared with women with TSH 0.2-2.5 mU/L after adjusting for age, year of pregnancy, diabetes, and social class (P = .008). The risk of miscarriage was increased in women with TSH 4.51-10 mU/L [odds ratio (OR) 1.80, 95% confidence interval (CI) 1.03, 3.14)] and TSH greater than 10 mU/L (OR 3.95, 95% CI 1.87, 8.37) but not with TSH 2.51-4.5 mU/L (OR 1.09, 95% CI 0.61, 1.93). CONCLUSIONS: The majority of levothyroxine-treated women have early gestational TSH levels above the recommended targets (>2.5 mU/L) with a strong risk of miscarriage at levels exceeding 4.5 mU/L. There is an urgent need to improve the adequacy of thyroid hormone replacement in early pregnancy.en
dc.language.isoengen
dc.publisherEndocrine Societyen
dc.relation.urlhttp://press.endocrine.org/doi/10.1210/jc.2014-1954?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmeden
dc.titleTSH levels and risk of miscarriage in women on long-term levothyroxine: a community-based studyen
dc.typeJournal Articleen
dc.typeResearch Support, Non-U.S. Gov'ten
dc.identifier.journalThe Journal of clinical endocrinology and metabolismen


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