McMaster Textbook of Internal Medicine

McMaster Textbook of Internal Medicine
Interviews
Endocrinology
Levothyroxine and pregnancy loss in TPOAb-positive patients

Levothyroxine and pregnancy loss in TPOAb-positive patients

2019-04-04

Leonard Wartofsky

Recorded at the 4th McMaster International Review Course in Internal Medicine (MIRCIM).

Clarification

Please note this video was recorded in 2018. Commentary is pending following new trial results published in March 2019.

Does levothyroxine therapy reduce the risk of pregnancy loss in thyroid peroxidase antibody (TPOAb)-positive euthyroid women who are newly pregnant?

Leonard Wartofsky, MD: I think there are clear data that thyroxine replacement in TPO-positive women will reduce the risk of miscarriage and fetal demise.

There are mixed data, controversial data, in regard to outcomes in other areas such as the cognitive ability or IQ of the offspring of such patients, with some studies showing better outcomes with thyroxine therapy and other studies not, which may relate to when during the pregnancy thyroxine therapy is initiated.

See also

Euthyroid women, TPO antibodies, and thyroid supplementation Dr Serena Gundy, assistant professor at McMaster University specializing in obstetric medicine, discusses the practical implications of the recent TABLET study.
Treatment of type 2 diabetes and shared decision-making A lecture by Dr Victor M. Montori, from Mayo Clinic, USA, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
Insulin regimens preferred in the elderly with diabetes Which insulin regimen should be preferred in the elderly with type 2 diabetes?
Levothyroxine in TPOAb-negative patients with subclinical hypothyroidism Is there ever a need for hormone replacement therapy with levothyroxine in thyroid peroxidase antibody (TPOAb)-negative patients with subclinical hypothyroidism?
Metformin in a patient with diabetes and AKI For how long does metformin have to be withdrawn in a patient with diabetes who develops acute kidney injury?
TPO antibodies in subclinical hypothyroidism and pregnancy Should management be the same in thyroid peroxidase antibody (TPOAb)-negative and TPOAb-positive women with subclinical hypothyroidism who are planning a pregnancy and who are newly pregnant?
Antihypertensive drugs and the diagnosis of hyperaldosteronism What antihypertensive drugs can be used in a patient undergoing a diagnostic workup of primary hyperaldosteronism?
Hashimoto thyroiditis and other autoimmune diseases of the thyroid gland A lecture by Prof. Luigi Bartalena, from University of Insubria, Italy, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2016.

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