ASSESSMENT OF THYROID DYSFUNCTION AND AUTOIMMUNE DISORDERS IN WOMEN WITH RECURRENT PREGNANCY LOSS
Main Article Content
Keywords
Pregnancy Loss, Thyroid Dysfunction, Autoimmune Thyroiditis, Women’s Health
Abstract
Introduction: Recurrent pregnancy loss (RPL) is a significant reproductive health issue affecting many women worldwide. Endocrine and immune factors, especially thyroid dysfunction and thyroid autoimmunity, are increasingly recognized as potential contributors to pregnancy loss. However, there is limited regional data in Pakistan, particularly among the female population of Lahore.
Aims & Objectives: The aim of this study was to assess the prevalence of thyroid dysfunction and autoimmune thyroid disorders in women with a history of RPL. The study also aimed to explore the association of thyroid abnormalities with clinical risk factors such as body mass index (BMI) and parity.
Methodology: A cross-sectional observational study was conducted at five tertiary care hospitals in Lahore. A total of 173 women aged 20 to 42 years, with a history of two or more consecutive miscarriages, were enrolled. Blood samples were analyzed for thyroid-stimulating hormone (TSH), free thyroxine (fT4), and thyroid peroxidase antibodies (TPOAb). Thyroid status was categorized into euthyroid, subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism based on established guidelines. Statistical analysis included descriptive measures and logistic regression to identify associated factors.
Results & Findings: Among the 173 women, 61.8% (n = 107) were found to be euthyroid, while 38.2% (n = 66) had thyroid dysfunction. Subclinical hypothyroidism was the most frequent abnormality, seen in 21.4% (n = 37) of participants using a TSH threshold of >2.5 mIU/L. Overt hypothyroidism was observed in 4.6% (n = 8), while subclinical hyperthyroidism and overt hyperthyroidism were found in 2.9% (n = 5) and 2.3% (n = 4), respectively. TPOAb positivity, indicating autoimmune thyroid disease, was detected in 16.8% (n = 29) of the women, with a strong link to subclinical or overt hypothyroidism (p < 0.01). Higher BMI and history of consanguinity were significantly associated with thyroid autoimmunity and dysfunction.
Conclusion: Thyroid dysfunction, particularly subclinical hypothyroidism and thyroid autoimmunity, is common in women with recurrent pregnancy loss in the Lahore population. These findings support the need for routine thyroid function and antibody screening in women with RPL. Early identification and management may help improve reproductive outcomes and reduce the risk of further pregnancy losses.
References
2. Qureshi RN, Sheikh S, Khowaja AR, et al. Maternal and perinatal health in Pakistan: Trends and determinants. Lancet Glob Health. 2022;10(1):e42–e50.
3. Di Pasquo E, Makieva S, Simopoulou M, et al. RPL: An update on etiology and future perspectives. Hum Reprod Update. 2023;29(1):58–80.
4. De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: An Endocrine Society Clinical Practice Guideline update. J Clin Endocrinol Metab. 2021;106(10):3025–3045.
5. Poppe K, Glinoer D. Thyroid autoimmunity and hypothyroidism before and during pregnancy. Nat Rev Endocrinol. 2022;18(3):158–171.
6. Korevaar TIM, Derakhshan A, Taylor PN. Maternal thyroid function and child neurodevelopment: An updated systematic review. Lancet Diabetes Endocrinol. 2022;10(5):362–374.
7. Wang H, Gao H, Chi H, et al. Effect of subclinical hypothyroidism on pregnancy outcomes: A meta-analysis. Reprod Biol Endocrinol. 2021;19(1):1–10.
8. Alexander EK, Pearce EN, Brent GA, et al. 2023 ATA guidelines for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2023;33(1):1–66.
9. Derakhshan A, Korevaar TIM, Taylor PN. Association of maternal thyroid function and thyroid autoimmunity with adverse pregnancy outcomes. BMJ. 2022;376:e068342.
10. Yang Y, Li Q, Wang L, et al. Prevalence of thyroid autoimmunity in euthyroid women with RPL: A meta-analysis. J Reprod Immunol. 2021;143:103249.
11. Korevaar TIM, Medici M, Visser TJ, Peeters RP. Thyroid disease and pregnancy: Clinical guidelines and gaps in evidence. Nat Rev Endocrinol. 2022;18(6):348–361.
12. Zhao L, Zhao Y, Zhang Y. Immunological pathways linking thyroid autoimmunity and reproductive failure: Current knowledge and future directions. Front Immunol. 2023;14:1074326.
13. Ebrahimi N, Behboudi-Gandevani S, Amiri M, et al. Impact of TPOAb positivity on miscarriage risk: Updated systematic review. Endocrine. 2021;72(3):647–655.
14. Abalovich M, Amino N, Barbour LA, et al. TPO antibodies and pregnancy complications: Revisited. J Clin Endocrinol Metab. 2023;108(5):1349–1359.
15. Yousafzai MT, Ahmed Z, Hussain H, et al. The impact of consanguinity on autoimmune and genetic disorders in Pakistani populations. BMC Med Genet. 2022;23(1):77.
16. Malik A, Baig M, Hashmi R, et al. Thyroid function assessment in RPL: An overlooked domain in Pakistan. J Pak Med Assoc. 2023;73(3):615–620.
17. Khokhar A, Asif N, Saleem A, et al. Thyroid disorders and reproductive outcomes in Pakistani women: A cross-sectional study. BMC Womens Health. 2021;21(1):191.
18. Raza A, Shahid R, Saeed F, et al. Consanguinity, obesity, and endocrine disorders: A population-based study in Lahore. Pak J Med Sci. 2024;40(1):22–28.
19. Bhattacharjee S, Saha S, Ghosh S. Subclinical hypothyroidism and its association with recurrent pregnancy loss: A cross-sectional study. J Obstet Gynaecol India. 2021;71(5):465-70.
20. Rizwan S, Hussain Z, Younas M. Thyroid dysfunction in recurrent pregnancy loss: a tertiary care experience. Pak J Med Sci. 2021;37(2):421-5.
21. Kiran Z, Masood Q, Jamil B. Association of thyroid dysfunction with recurrent pregnancy loss. J Coll Physicians Surg Pak. 2022;32(4):482-6.
22. Patel S, Ahmed T, Zuberi N. Thyroid hormone and endometrial receptivity: implications for recurrent miscarriage. Front Endocrinol. 2022;13:902423.
23. Li Y, Sun X, Yu M. Effect of thyroid hormones on placental development in women with miscarriage. BMC Pregnancy Childbirth. 2023;23(1):122.
24. Zhang H, Liang J, Zhang J. Low-normal free thyroxine is associated with miscarriage risk in euthyroid women. Reprod Biol Endocrinol. 2022;20(1):114.
25. Singh A, Chauhan V, Tripathi R. Anti-thyroid antibodies and pregnancy outcome in euthyroid women: a prospective cohort study. J Matern Fetal Neonatal Med. 2023;36(2):348-52.
26. Stagnaro-Green A, Pearce EN. Thyroid autoimmunity and miscarriage: unanswered questions. Trends Endocrinol Metab. 2021;32(3):177-85.
27. Wang Y, Zhao X, Liu X. Role of anti-TPO antibodies in unexplained recurrent miscarriage: observational data. Clin Endocrinol (Oxf). 2022;97(1):34-9.
28. Ibrahim M, Hameed A, Nafees M. Association of anti-thyroid peroxidase antibodies with pregnancy outcomes: a systematic review. Horm Mol Biol Clin Investig. 2022;43(3):e20220021.
29. Al-Harbi K, Al-Rowaily M. Thyroid autoimmunity and risk of progression to hypothyroidism during pregnancy. Saudi Med J. 2021;42(6):653-8.
30. Chauhan G, Tyagi R, Sharma M. Thyroid screening in RPL: necessity or overuse? Int J Reprod Contracept Obstet Gynecol. 2023;12(1):45-50.
31. Ali M, Javed R. Effect of maternal age on thyroid dysfunction in women with RPL. Cureus. 2021;13(12):e20035.
32. Qureshi Z, Aslam M, Shahid R. Age-associated thyroid dysfunction and miscarriage frequency. Pak J Endocrinol Metab. 2022;11(3):19-24.
33. Chen Y, Liu H, Zhou Q. Impact of obesity on thyroid function and miscarriage risk. J Clin Endocrinol Metab. 2023;108(2):567-75.
34. Khalid S, Rahim R, Faryal S. Awareness of thyroid dysfunction in women with reproductive failures. Int J Med Sci Public Health. 2022;11(2):123-6.
35. Alotaibi S, AlKhaldi H. Low screening rates for thyroid disease among Saudi women with infertility and miscarriage. Middle East Fertil Soc J. 2021;26(1):4.
36. Wang Y, Hu C, Lin J. Correlation of thyroid markers with miscarriage frequency in RPL: a retrospective analysis. Eur J Obstet Gynecol Reprod Biol. 2023;284:43-9.
37. Alexander EK, Pearce EN, Brent GA, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy. Thyroid. 2021;31(3):1-22.
38. ACOG Practice Bulletin No. 223: Thyroid Disease in Pregnancy. Obstet Gynecol. 2021;137(5):e213-26.
39. Rao P, Jaleel R, Fatima M. Effectiveness of levothyroxine in improving outcomes in TPOAb-positive women with RPL: a randomized controlled trial. J Clin Gynecol Obstet. 2024;13(2):81-8.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Amna Hussain
Associate Professor Pathology, Jinnah Medical & Dental College, Karachi. Pakistan
Rameen Qazi
Women Medical Officer, Hameed Hospital, Rahim Yar Khan, Pakistan
Sana Zameer
Lecturer Biochemistry, Liaquat Institute of Medical & Health Sciences, Thatta, Pakistan
Muhammad Younus Jamal Siddiqi
Assistant Professor Pathology, Jinnah Medical & Dental College Karachi, Pakistan
Sadia Ashraf
Lecturer Biochemistry, Liaquat Institute of Medical & Health Sciences, Thatta, Pakistan
Muhammad Hamid Iqbal
Student, Fatima Memorial College of Medicine & Dentistry, Lahore, Pakistan
Arshi Naz
Assistant Professor Pathology, Liaquat University of Medical Health Sciences, Jamshoro. Pakistan
Abdul Rehman Khalil Shaikh
Assistant Professor Pathology, Liaquat University of Medical Health Sciences, Jamshoro. Pakistan