Mild thyroid abnormalities and recurrent spontaneous abortion: diagnostic and therapeutical approach.
OBJECTIVE
The aim of this study is to evaluate the role of mild thyroid abnormalities in recurrent spontaneous abortion, and to assess the effects of two different therapeutical protocols.


METHODS
A prospective study in the population of recurrent aborters with mild thyroid abnormalities, evaluating the obstetric outcome in 42 patients. Sixteen thyroid autoantibodies positive patients were treated with thyroid replacement therapy, while 11 patients received intravenous immunoglobulins (IVIG). Fifteen patients, characterized by negative antithyroid antibodies, and having underlying thyroid pathology, were treated with thyroid replacement therapy.


RESULTS
Among patients with thyroid antibodies, 6 out of the 11 pregnancies (54.5%) treated with IVIG ended in live birth. In the thyroid supplementation group, 13 out of 16 pregnancies (81.2%) ended in live birth. Only one pregnancy loss occurred among patients with a mild underlying thyroid pathology treated with thyroid replacement therapy.


CONCLUSIONS
Mild thyroid abnormalities are associated with an increased rate of miscarriage. This poor obstetrical prognosis seems to be related to an impaired thyroid adaptation to pregnancy. Thyroid replacement therapy appears to be more effective than IVIG in preventing a new miscarriage.
Vaquero
E
E
Department of Obstetric and Gynecology, University of Rome, Tor Vergata, Italy.
Lazzarin
N
N
De Carolis
C
C
Valensise
H
H
Moretti
C
C
Ramanini
C
C
D000026:Abortion, Habitual / Q000453:epidemiology / Q000209:etiology*; D000022:Abortion, Spontaneous / Q000517:prevention & control*; D000328:Adult; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D018828:Immunoglobulins, Thyroid-Stimulating; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000628:therapy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D011989:Receptors, Thyrotropin / Q000097:blood; D013959:Thyroid Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy; D013963:Thyroid Hormones / Q000627:therapeutic use; D013967:Thyroiditis, Autoimmune / Q000150:complications / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D013973:Thyrotropin-Releasing Hormone
D001323:Autoantibodies; D016756:Immunoglobulins, Intravenous; D018828:Immunoglobulins, Thyroid-Stimulating; D011989:Receptors, Thyrotropin; D013963:Thyroid Hormones; C056626:thyroid microsomal antibodies; C094372:thyrotropin-binding inhibitory immunoglobulin; D013973:Thyrotropin-Releasing Hormone