Levothyroxine may not adequately prepare hypothyroid women for controlled ovarian hyperstimulation.

IF 1.4 4区医学 Q3 OBSTETRICS & GYNECOLOGY Australian & New Zealand Journal of Obstetrics & Gynaecology Pub Date : 2024-06-24 DOI:10.1111/ajo.13854

Rachel A Bradbury, Karen Byth, Howard C Smith

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Abstract

Background: Thyroid axis dysregulation during controlled ovarian hyperstimulation (COH) is more pronounced in hypothyroid-treated women. Whether or not this leads to compromised thyroid hormone levels within the ovarian follicular fluid is not known.

Aims: To determine whether ovarian follicular thyroid hormone levels are compromised in adequately replaced hypothyroid women undergoing controlled ovarian hyperstimulation (COH), and/or influence cycle/pregnancy outcomes.

Materials and methods: Prospective cohort study involving 46 euthyroid (anti-thyroid peroxidase antibody negative) and 16 levothyroxine-replaced women with baseline thyroid-stimulating hormone (TSH) <2.5 mIU/L attending their first COH cycle. Follicular fluid TSH, free triiodothyronine (T3) and free thyroxine (T4) were recorded at oocyte pick-up. Serum levels were measured at: (i) baseline; (ii) human chorionic gonadotropin trigger day; and (iii) cycle conclusion. The number of mature oocytes retrieved, fertilisation, early pregnancy loss and live birth rates were compared.

Results: Median serum TSH levels were similar at baseline (1.76 vs 1.24 mIU/L, P = 0.053), but free T3 levels were lower (4.5 vs 4.8 pmol/L, P = 0.029) in levothyroxine-replaced compared to euthyroid women, with serum TSH levels increasing across ovarian stimulation (P = 0.006) into pregnancy testing (P = 0.030). Follicular fluid free T3 levels were lower in levothyroxine-replaced women (median 4.3 vs 4.6 pmol/L, P = 0.032). Fertilisation rates were lower (52% vs 71%, P = 0.043) in women requiring levothyroxine replacement, but numbers of mature oocytes retrieved, early pregnancy loss and live births did not differ.

Conclusion: Adequately replaced hypothyroid women achieve lower ovarian follicular fluid free T3 levels and poorer fertilisation rates compared to euthyroid women undergoing COH. Optimising T3 levels may be pivotal in improving COH outcomes in hypothyroid women.

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左甲状腺素可能无法让甲状腺功能减退的女性为控制性卵巢过度刺激做好充分准备。

背景：在控制性卵巢过度刺激（COH）过程中，甲状腺轴失调在甲状腺功能减退的妇女中更为明显。目的：确定接受控制性卵巢过度刺激（COH）治疗的甲状腺功能减退妇女的卵巢滤泡甲状腺激素水平是否会受到影响，以及/或者是否会影响周期/妊娠结局：前瞻性队列研究，涉及 46 名甲状腺功能正常（抗甲状腺过氧化物酶抗体阴性）和 16 名左甲状腺素替代妇女，其基线促甲状腺激素（TSH）结果：中位血清促甲状腺激素基线水平相似（1.76 vs 1.24 mIU/L，P = 0.053），但与甲状腺功能正常的妇女相比，置换左甲状腺素的妇女的游离 T3 水平较低（4.5 vs 4.8 pmol/L，P = 0.029），血清促甲状腺激素水平在卵巢刺激（P = 0.006）和妊娠检测（P = 0.030）期间均有所上升。替换左甲状腺素的女性卵泡液游离 T3 水平较低（中位数为 4.3 vs 4.6 pmol/L，P = 0.032）。需要替换左甲状腺素的女性受精率较低（52% vs 71%，P = 0.043），但取回的成熟卵母细胞数量、早孕损失和活产率并无差异：结论：与接受 COH 的甲状腺功能正常的妇女相比，得到充分替代的甲状腺功能减退妇女的卵泡液游离 T3 水平较低，受精率较低。优化T3水平可能是改善甲减女性COH结果的关键。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Australian & New Zealand Journal of Obstetrics & Gynaecology 医学-妇产科学

CiteScore

3.40

自引率

11.80%

发文量

165

审稿时长

4-8 weeks

期刊介绍： The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.