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Thyroid autoimmunity and miscarriage.

Mark F Prummel1, Wilmar M Wiersinga

  • 1Department of Endocrinology and Metabolism, F5-171 Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. m.f.prummel@amc.uva.nl

European Journal of Endocrinology
|June 12, 2004
PubMed
Summary
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Thyroid autoimmunity, indicated by thyroid antibodies, is clearly associated with an increased risk of miscarriage. Further research is needed to understand this link and explore potential treatments like l-thyroxine.

Area of Science:

  • Reproductive Immunology
  • Endocrinology
  • Autoimmunity

Background:

  • Thyroid autoimmunity is increasingly recognized as a factor in reproductive health.
  • The association between thyroid antibodies and miscarriage has been noted since 1990.
  • Potential mechanisms linking thyroid autoimmunity to adverse pregnancy outcomes require elucidation.

Purpose of the Study:

  • To quantify the strength of the association between thyroid autoimmunity and miscarriage.
  • To review existing evidence from case-control and longitudinal studies.
  • To explore potential explanations for the observed association.

Main Methods:

  • A meta-analysis of case-control and longitudinal studies published since 1990.
  • Calculation of odds ratios (OR) and 95% confidence intervals (CI) for miscarriage in the presence of thyroid antibodies.

Related Experiment Videos

  • Analysis of potential confounding factors including maternal age and thyroid-stimulating hormone (TSH) levels.

    • Main Results:

    • A significant association was found between thyroid antibodies and miscarriage (OR 2.73 in case-control, OR 2.30 in longitudinal studies).
    • Maternal age was slightly higher in antibody-positive women (mean difference 0.7 years, P<0.001).
    • Antibody-positive, euthyroid women had higher TSH levels than antibody-negative women (difference 0.81 mU/l, P=0.005).

    Conclusions:

    • Thyroid autoimmunity is a significant risk factor for miscarriage.
    • The association may be linked to a heightened autoimmune state, advanced maternal age, or subclinical thyroid dysfunction.
    • Randomized trials of l-thyroxine and selenium are warranted to investigate therapeutic interventions.