{"title":"左旋甲状腺素治疗对亚临床甲状腺功能减退、甲状腺功能减退和甲状腺自身免疫孕妇妊娠期高血压和先兆子痫的影响：系统回顾和荟萃分析","authors":"Masoomeh Goodarzi-Khoigani, Ashraf Aminorroaya, Raziyeh Mohammadi","doi":"10.2174/011871529X324722250207072454","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Gestational hypertension (GH) and preeclampsia (PE) are two important complications of pregnancy. Considering the U-shaped association between thyroidstimulating hormone (TSH) and hypertensive disorders of pregnancy in some reports, we decided to investigate the effect of levothyroxine treatment on GH and PE in pregnant women with subclinical hypothyroidism (SGH), overt hypothyroidism (OH), and autoimmune thyroid diseases.</p><p><strong>Methods: </strong>Google Scholar and databases, such as ProQuest, Medline, Cochrane Library, ScienceDirect, and Scopus were searched electronically for clinical trials and observational studies using the following search terms: ((\"levothyroxine\" OR \"LT4\" OR \"thyroxine supplementation\") AND (\"subclinical hypothyroidism\" OR \"SCH\" OR \"thyroid peroxidase antibodies\" OR \"autoimmune thyroid disease\") AND (\"pregnancy outcomes\" OR \"preeclampsia\" OR \"gestational hypertension\" OR \"PIH\")). Further, we investigated the impact of levothyroxine on the incidence of GH and/or PE compared with control or placebo groups from April 4 to November 1, 2022.</p><p><strong>Results: </strong>After treatment with levothyroxine, the odd ratios (ORs) of GH and PE in subclinical [OR = 1.03, 95% CI: (0.85, 1.25), I<sup>2</sup> = 35.25%, P =0.78, OR = 1.02, 95% CI: (0.66,1.58), I<sup>2</sup> = 46.86%, P =0.94, respectively] and overt hypothyroidism [OR=1.10, 95% CI: (0.70,1.71), I<sup>2</sup> =38.44%, P =0.69, OR=1.32, 95% CI: (0.83, 2.09), I<sup>2</sup> =0.00%, P =0.24, respectively] were not different from controls. Furthermore, this result was observed in studies that recruited women with SCH and OH [OR=1.12, 95% CI: (0.58, 2.14), I<sup>2</sup>=92.74%, P =0.74, OR=0.51, 95% CI: (0.15, 1.72), I<sup>2</sup> =97.30%, P =0.28, respectively]. Also, these studies compared thyroperoxidase antibodies between TPOAb-positive participants with TPOAb-negative controls (OR=1.01, 95% CI: (0.80, 1.28), I<sup>2</sup> =0.00%, P =0.90). However, LT4 reduced the risk of GH in TPOAb+ women compared with untreated TPOAb+ (OR=0.43, 95% CI: (0.30, 0.62), I<sup>2</sup> =0.00%, P =0.00).</p><p><strong>Conclusion: </strong>After LT4 therapy, the incidence rates of GH and PE in any form of hypothyroidism were not significantly different from controls. However, the reduction of GH in women with TPOAb+ who used levothyroxine needs further consideration.</p>","PeriodicalId":93925,"journal":{"name":"Cardiovascular & hematological disorders drug targets","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effect of Levothyroxine Therapy on Gestational Hypertension and Pre-Eclampsia in Pregnant Women with Subclinical Hypothyroidism, Hypothyroidism, and Thyroid Autoimmunity: A Systematic Review and Meta-analysis.\",\"authors\":\"Masoomeh Goodarzi-Khoigani, Ashraf Aminorroaya, Raziyeh Mohammadi\",\"doi\":\"10.2174/011871529X324722250207072454\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Gestational hypertension (GH) and preeclampsia (PE) are two important complications of pregnancy. Considering the U-shaped association between thyroidstimulating hormone (TSH) and hypertensive disorders of pregnancy in some reports, we decided to investigate the effect of levothyroxine treatment on GH and PE in pregnant women with subclinical hypothyroidism (SGH), overt hypothyroidism (OH), and autoimmune thyroid diseases.</p><p><strong>Methods: </strong>Google Scholar and databases, such as ProQuest, Medline, Cochrane Library, ScienceDirect, and Scopus were searched electronically for clinical trials and observational studies using the following search terms: ((\\\"levothyroxine\\\" OR \\\"LT4\\\" OR \\\"thyroxine supplementation\\\") AND (\\\"subclinical hypothyroidism\\\" OR \\\"SCH\\\" OR \\\"thyroid peroxidase antibodies\\\" OR \\\"autoimmune thyroid disease\\\") AND (\\\"pregnancy outcomes\\\" OR \\\"preeclampsia\\\" OR \\\"gestational hypertension\\\" OR \\\"PIH\\\")). Further, we investigated the impact of levothyroxine on the incidence of GH and/or PE compared with control or placebo groups from April 4 to November 1, 2022.</p><p><strong>Results: </strong>After treatment with levothyroxine, the odd ratios (ORs) of GH and PE in subclinical [OR = 1.03, 95% CI: (0.85, 1.25), I<sup>2</sup> = 35.25%, P =0.78, OR = 1.02, 95% CI: (0.66,1.58), I<sup>2</sup> = 46.86%, P =0.94, respectively] and overt hypothyroidism [OR=1.10, 95% CI: (0.70,1.71), I<sup>2</sup> =38.44%, P =0.69, OR=1.32, 95% CI: (0.83, 2.09), I<sup>2</sup> =0.00%, P =0.24, respectively] were not different from controls. Furthermore, this result was observed in studies that recruited women with SCH and OH [OR=1.12, 95% CI: (0.58, 2.14), I<sup>2</sup>=92.74%, P =0.74, OR=0.51, 95% CI: (0.15, 1.72), I<sup>2</sup> =97.30%, P =0.28, respectively]. Also, these studies compared thyroperoxidase antibodies between TPOAb-positive participants with TPOAb-negative controls (OR=1.01, 95% CI: (0.80, 1.28), I<sup>2</sup> =0.00%, P =0.90). However, LT4 reduced the risk of GH in TPOAb+ women compared with untreated TPOAb+ (OR=0.43, 95% CI: (0.30, 0.62), I<sup>2</sup> =0.00%, P =0.00).</p><p><strong>Conclusion: </strong>After LT4 therapy, the incidence rates of GH and PE in any form of hypothyroidism were not significantly different from controls. However, the reduction of GH in women with TPOAb+ who used levothyroxine needs further consideration.</p>\",\"PeriodicalId\":93925,\"journal\":{\"name\":\"Cardiovascular & hematological disorders drug targets\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-02-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiovascular & hematological disorders drug targets\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2174/011871529X324722250207072454\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular & hematological disorders drug targets","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2174/011871529X324722250207072454","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景：妊娠期高血压（GH）和先兆子痫（PE）是妊娠期的两种重要并发症。考虑到在一些报道中促甲状腺激素（TSH）与妊娠高血压疾病之间存在u型关联，我们决定研究左旋甲状腺素治疗对亚临床甲状腺功能减退症（SGH）、显性甲状腺功能减退症（OH）和自身免疫性甲状腺疾病孕妇GH和PE的影响。方法：以电子方式检索谷歌学者和数据库，如ProQuest、Medline、Cochrane Library、ScienceDirect和Scopus，使用以下搜索词检索临床试验和观察性研究：（“左旋甲状腺素”或“LT4”或“甲状腺素补充剂”）和（“亚临床甲状腺功能减退症”或“SCH”或“甲状腺过氧化酶抗体”或“自身免疫性甲状腺疾病”）和（“妊娠结局”或“先兆子痫”或“妊娠高血压”或“PIH”）。此外，我们研究了在2022年4月4日至11月1日期间，与对照组或安慰剂组相比，左旋甲状腺素对GH和/或PE发病率的影响。结果：左旋甲状腺素治疗后，亚临床[OR= 1.03, 95% CI: (0.85, 1.25), I2 = 35.25%, P =0.78， OR= 1.02, 95% CI: (0.66,1.58), I2 = 46.86%, P =0.94]和明显甲状腺功能减退[OR=1.10, 95% CI: (0.70,1.71), I2 =38.44%, P =0.69， OR=1.32, 95% CI: (0.83, 2.09), I2 =0.00%, P =0.24]中GH和PE的奇比(OR = 1.03, 95% CI: (0.85, 1.25), I2 = 35.25%, P =0.78， OR= 1.02, P =0.94]与对照组比较无差异。此外，在招募SCH和OH女性的研究中也观察到这一结果[OR=1.12, 95% CI: (0.58, 2.14), I2=92.74%, P =0.74， OR=0.51, 95% CI: (0.15, 1.72), I2= 97.30%, P =0.28]。此外，这些研究比较了tpoab阳性受试者与tpoab阴性对照之间的甲状腺过氧化物酶抗体（OR=1.01, 95% CI:(0.80, 1.28), I2 =0.00%, P =0.90）。然而，与未治疗的TPOAb+妇女相比，LT4降低了TPOAb+妇女生长激素的风险（OR=0.43, 95% CI:(0.30, 0.62), I2 =0.00%, P =0.00）。结论：LT4治疗后，任何形式甲状腺功能减退患者GH和PE的发生率与对照组无显著差异。然而，使用左旋甲状腺素的TPOAb+妇女GH的降低需要进一步考虑。
Effect of Levothyroxine Therapy on Gestational Hypertension and Pre-Eclampsia in Pregnant Women with Subclinical Hypothyroidism, Hypothyroidism, and Thyroid Autoimmunity: A Systematic Review and Meta-analysis.
Background: Gestational hypertension (GH) and preeclampsia (PE) are two important complications of pregnancy. Considering the U-shaped association between thyroidstimulating hormone (TSH) and hypertensive disorders of pregnancy in some reports, we decided to investigate the effect of levothyroxine treatment on GH and PE in pregnant women with subclinical hypothyroidism (SGH), overt hypothyroidism (OH), and autoimmune thyroid diseases.
Methods: Google Scholar and databases, such as ProQuest, Medline, Cochrane Library, ScienceDirect, and Scopus were searched electronically for clinical trials and observational studies using the following search terms: (("levothyroxine" OR "LT4" OR "thyroxine supplementation") AND ("subclinical hypothyroidism" OR "SCH" OR "thyroid peroxidase antibodies" OR "autoimmune thyroid disease") AND ("pregnancy outcomes" OR "preeclampsia" OR "gestational hypertension" OR "PIH")). Further, we investigated the impact of levothyroxine on the incidence of GH and/or PE compared with control or placebo groups from April 4 to November 1, 2022.
Results: After treatment with levothyroxine, the odd ratios (ORs) of GH and PE in subclinical [OR = 1.03, 95% CI: (0.85, 1.25), I2 = 35.25%, P =0.78, OR = 1.02, 95% CI: (0.66,1.58), I2 = 46.86%, P =0.94, respectively] and overt hypothyroidism [OR=1.10, 95% CI: (0.70,1.71), I2 =38.44%, P =0.69, OR=1.32, 95% CI: (0.83, 2.09), I2 =0.00%, P =0.24, respectively] were not different from controls. Furthermore, this result was observed in studies that recruited women with SCH and OH [OR=1.12, 95% CI: (0.58, 2.14), I2=92.74%, P =0.74, OR=0.51, 95% CI: (0.15, 1.72), I2 =97.30%, P =0.28, respectively]. Also, these studies compared thyroperoxidase antibodies between TPOAb-positive participants with TPOAb-negative controls (OR=1.01, 95% CI: (0.80, 1.28), I2 =0.00%, P =0.90). However, LT4 reduced the risk of GH in TPOAb+ women compared with untreated TPOAb+ (OR=0.43, 95% CI: (0.30, 0.62), I2 =0.00%, P =0.00).
Conclusion: After LT4 therapy, the incidence rates of GH and PE in any form of hypothyroidism were not significantly different from controls. However, the reduction of GH in women with TPOAb+ who used levothyroxine needs further consideration.
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