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Evidence summaries

Thyroxine Replacement for Subfertile Women with Subclinical Hypothyroidism

In subfertility with subclinical hypothyroidism thyroxine replacement therapy may possibly improve live birth rate. Level of evidence: "D"

Comment: The quality of evidence is downgraded by imprecise results (one study, with few patients and wide confidence intervals).

Summary

A Cochrane review [Abstract] 1 included 4 studies with a total of 820 subjects. In one study of women with subclinical hypothyroidism (SCH) and positive or negative anti-TPO antibodies (autoimmune disease), thyroxine replacement improved live birth rate (RR 2.13, 95% CI 1.07 to 4.21; 1 RCT, n=64; low-quality evidence) compared with placebo or no treatment, and led to similar miscarriage rates. In women with normal thyroid function and thyroid autoimmunity (euthyroid autoimmune thyroid disease), treatment with thyroxine replacement compared with placebo or no treatment led to similar live birth rates (RR 1.04, 95% CI 0.83 to 1.29; 2 RCTs, n=686; I²=46%; low-quality evidence) and miscarriage rates (RR 0.83, 95% CI 0.47 to 1.46, 2 RCTs, n=686, I²=0%; low-quality evidence).

Clinical comments

Note

Date of latest search: 2019-12-30

    References

    • Akhtar MA, Agrawal R, Brown J et al. Thyroxine replacement for subfertile women with euthyroid autoimmune thyroid disease or subclinical hypothyroidism. Cochrane Database Syst Rev 2019;(6):CD011009. [PubMed]

Primary/Secondary Keywords