Scientific publications
Use of levothyroxine for euthyroid, thyroid antibody positive women with infertility: Analyses of aggregate data from a survey of European thyroid specialists (Treatment of Hypothyroidism in Europe by Specialists: An International Survey)
Roberto Negro 1 , Miloš Žarković 2 , Roberto Attanasio 3 , Laszlo Hegedüs 4 , Endre V Nagy 5 , Enrico Papini 6 , Ersin Akarsu 7 , Maria Alevizaki 8 , Göksun Ayvaz 9 , Tomasz Bednarczuk 10 , Biljana Nedeljković Beleslin 2 , Eszter Berta 5 , Miklos Bodor 5 , Anna Maria Borissova 11 , Mihail Boyanov 12 , Camille Buffet 13 , Maria-Cristina Burlacu 14 , Jamina Ćirić 2 , Chagit Adler Cohen 15 , Juan J Díez 16 17 18 , Harald Dobnig 19 , Valentin Fadeyev 20 , Benjamin C T Field 21 , Eric Fliers 22 , Dagmar Führer 23 , Juan C Galofré 24 , Tommi Hakala 25 , Jiskra Jan 26 , Peter Kopp 27 , Michael Krebs 28 , Michal Kršek 26 , Martin Kužma 29 , Laurence Leenhardt 13 , Vitaliy Luchytskiy 30 , Francisca Marques Puga 31 , Anne McGowan 32 , Miguel Melo 33 , Saara Metso 34 , Carla Moran 35 36 37 , Tatyana Morgunova 20 , Dan Alexandru Niculescu 38 , Božidar Perić 39 , Tereza Planck 40 , Catalina Poiana 38 , Eyal Robenshtok 41 , Patrick Olivier Rosselet 42 , Marek Ruchala 43 , Kamilla Ryom Riis 4 , Alla Shepelkevich 44 , Mykola Tronko 45 , David Unuane 46 , Irfan Vardarli 47 48 , Edward Visser 49 , Andromachi Vryonidou 50 , Younes R Younes 51 , Petros Perros 52
Objectives: The use of levothyroxine (LT4) treatment aiming to improve fertility in euthyroid women with positive thyroid peroxidase antibodies (TPOAb) is not supported by the available evidence. The aim of the study was to document the use of LT4 by European thyroid specialists in such patients.
Design: The data presented derive from Treatment of Hypothyroidism in Europe by Specialists, an International Survey (THESIS), a questionnaire conducted between 2019 and 2021 to document the management of hypothyroidism by European thyroid specialists. Here, we report the aggregate results on the use of LT4 in infertile, euthyroid women with positive TPOAb.
Results: A total of 2316/5406 (42.8%) respondents stated that LT4 may be indicated in TPOAb positive euthyroid women with infertility. The proportion of those replying positively to this question varied widely across different countries (median 39.4, range 22.9%-83.7%). In multivariate analyses males (OR: 0.8; CI: 0.7-0.9) and respondents >60 years (OR: 0.7; 0.6-0.8) were the least inclined to consider LT4 for this indication. Conversely, respondents managing many thyroid patients ("weekly" [OR: 1.4; CI: 1.0-1.9], "daily" [OR: 1.8; CI: 1.3-2.4]) and practicing in Eastern Europe (OR: 1.5; CI: 1.3-1.9) were most likely to consider LT4.
Conclusions: A remarkably high number of respondents surveyed between 2019 and 2021, would consider LT4 treatment in TPOAb positive euthyroid women with infertility. This view varied widely across countries and correlated with sex, age and workload, potentially influencing patient management. These results raise concerns about potential risks of overtreatment.
CITATION Clin Endocrinol (Oxf). 2024 Jun 10. doi: 10.1111/cen.15099
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