Sunday , January 24 2021

T4 does not prevent normal risk in anti-coronary women



NEW ORLEANS – Thyroid peroxidase (TPO), before the delivery of levothyroxine to normal women with normal thyroid function, as shown by new research, did not reduce the warning rate.

The findings were presented on March 23rd, ENDO 2019: Annual meeting of the Endocrino Association, Rima K. Dhillon-Smith, MB, ChB, PhD, clinical professor at the University of Birmingham, UK, and at the same time. New England Journal of Medicine.

Previous studies have shown that the abortion of women with positive TPO antibodies, which is approximately four times higher, increased risk of recurrent abdominal recurrence and infertility, and in selected populations.

TOMA with the study of antibody and, in general, thyroid function, women studied levothyroxin during pregnancy during pregnancy, as well as normal thyroid function.

The double-blind, double-blind, double-blind, controlled trials of placebo-controlled women with antibody-positive eutroid but positive thyroid peroxidase (TPO) antibody was positive.

The difference between the rates of life expectancy during pregnancy and the increase in the number of pregnancy rates during the pregnancy at the end of pregnancy was given between levothyroxina given during the 50 mg day or postpartum. Also, there were no differences in secondary outcomes, such as preventing pregnancy, previous birth or newborns.

"It is not beneficial that there is little sense, but it is very important that we really say that we would not use thyroxine for these women, and we would not say that it would be a fake hope." Dhillon-Smithe said Medscape Medicine News in a conversation.

And, during his presentation, the discovery also tests thyroid antibody tests in pregnant women, prior warning or infertility.

"You have to have a treatment or intervention that is one of the screening test conditions, which results or changes and we do not currently have this population, so instead of creating anxiety instead of helping?"

Licy L. Yanes Cardozo, MD, session curator, assistant medical instructor, was asked at the Mississippi Medical Center at Jackson University. Medscape Medicine News"An excellent study was a random and very large clinical trial, very powerful, with many patients … We should remember that the treatment was intended [thyroid stimulating hormone]. They did not really reduce TPO antibodies, which is related to abortion. "

Specifically, Michael T. McDermott's curator, the University of Colorado Medical and Clinical Pharmacy at the University of Aurora, and the Director of Endocrinology and Diabetes Practice explained that Aurora, in healthy pregnancies, increases the production of thyroid hormones from 30% to 50%. The fetus is provided, and the presence of antibody TPO affects this production.

But when the mechanism involves antibodies, effective intervention should be directed towards antibodies. "We do not know the mechanism of the shortcomings, so we might not correct it correctly," he said.

There are no differences in the results obtained during pregnancy, for more damages

In their article, Dhillon-Smith and colleagues have warned that the 2017 Thyroide Association (ATA) guidelines in 2017: levotyroxine TPO positive antibodies can be considered eutyroid videos that survive eutyroid pregnancy. risk ".

In fact, "the line of instructions has paid special attention to our ongoing trial," they added the trial of the thyroid antibodies and Levothyroxina (TABLET).

The results of that study are now taking place. The test was created to try to understand and avoid 952 women, standing or history of infertility, biochemically eutroids (within TSH-specified areas) and TPO antibodies were positive. Out of 476 participants, 266 women dared levothyroxine and 274 randomized pregnant women.

The proportion of those born after 34 weeks or more was almost identical: 37.4% of the levothyroxina group had a placebo of 37.9%.P = .74).

In the case of pregnant women, secondary effects were not observed between levothyroxine and placebo groups, the internal relation (28.2% vs. 29.6%); P = .95) or live birth in less than 34 weeks (3.8% vs. 3.6%; P = 1.02). And newborns, such as birth weight or Apgar score in 1 or 5 minutes, were similar between the two groups.

The proportion of those tested for the anomalous function of the thyroid woman extracted from the study did not differ between levotroxine and placebo groups (9.8% vs. 9.6%).

However, preeclampsia (from 5% to 3%) and gestational diabetes (11% vs. 9%) was higher in the group treated with levothyroxin, although the difference was not significant.

Cardozo says that the results suggest that these patients do not use levothyroxine. "Although this is not significant, it is still a concern. There is no benefit and it can be harmful."

McDermott said: "I do not believe in damage, but we do not use it if we do not do it."

What is the Antibody Targeting?

Dhillon-Smith has admitted that the TPO supports the idea of ​​targeting antibodies according to the hypothesis that the abortion caused by the general autoimmune imbalance. Some people recommend internal immunology using globulin or steroids, the current trial is investigating the use of the selenium supplement in autoimmune thyroiditis, even during pregnancy.

McDermott says this trial is difficult for pregnant women. "Pregnant women are hard to tolerate, even if they are a supplement paid by selenium, they can be given pregnant women with positive antibody levels, but there is little risk in them, but during pregnancy we do not know the risk. It may be one. "

Meanwhile, Dhillon-Smithe says one of the next steps in his group may be a consequence of the preconception levothyroxina supplementation in pregnancy results in women with subclinical hypothyroidism.

In addition, "we must go back to what is underlying the cause, and then think about how we can change it."

The study was ordered by the National Institute of Health Research of the United Kingdom. Dhillon-Smith, Cardozo and McDermott They did not have any financial relationship.

ENDED 2019. It was presented on March 23, 2019. Summary OR11-1.

N Engl J Med. Published online, March 23, 2019. Summary

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