Мини-тироксин не помогает выносить ЭКО беременность женщинам с АТ к ЩЖ

[Dr.Vad]

Effect of Levothyroxine on Miscarriage Among Women With Normal Thyroid Function and Thyroid Autoimmunity Undergoing In Vitro Fertilization and Embryo Transfer
A Randomized Clinical Trial

Haining Wang, MD1; и соавторы
JAMA. 2017;318(22):2190-2198.

Question Does levothyroxine treatment improve outcomes following in vitro fertilization and embryo transfer in women who have tested positive for thyroid autoantibodies but otherwise have normal thyroid function?

Findings In this randomized clinical trial involving 600 women undergoing in vitro fertilization and embryo transfer who tested positive for antithyroperoxidase antibodies but who had a normal thyroid function, the miscarriage rate before 28 weeks’ gestation was 10.3% among women who received and 10.6% among those who did not receive levothyroxine, a nonsignificant difference.

Meaning Levothyroxine treatment did not appear to improve pregnancy outcomes among women with thyroid autoantibodies undergoing in vitro fertilization and embryo transfer.

Importance Presence of thyroid autoantibodies in women with normal thyroid function is associated with increased risk of miscarriage. Whether levothyroxine treatment improves pregnancy outcomes among women undergoing in vitro fertilization and embryo transfer (IVF-ET) is unknown.

Objective To determine the effect of levothyroxine on miscarriage among women undergoing IVF-ET who had normal thyroid function and tested positive for thyroid autoantibodies.

Design, Setting, and Participants An open-label, randomized clinical trial involving 600 women who tested positive for the antithyroperoxidase antibody and were being treated for infertility at Peking University Third Hospital from September 2012 to March 2017.

Interventions The intervention group (n = 300) received either a 25-μg/d or 50-μg/d dose of levothyroxine at study initiation that was titrated according to the level of thyroid-stimulating hormone during pregnancy. The women in the control group (n = 300) did not receive levothyroxine. All participants received the same IVF-ET and follow-up protocols.

Main Outcomes and Measures The primary outcome was the miscarriage rate (pregnancy loss before 28 weeks of gestation, which was calculated among women who became pregnant). The secondary outcomes were clinical intrauterine pregnancy rate (fetal cardiac activity seen at sonography observation on the 30th day after the embryo transfer), and live-birth rate (at least 1 live birth after 28 weeks of gestation).

Results Among the 600 women (mean [SD] age, 31.6 [3.8] years) randomized in this trial, 567 women (94.5%) underwent IVF-ET and 565 (94.2%) completed the study. Miscarriage rates were 10.3% (11 of 107) in the intervention group and 10.6% (12 of 113) in the control group, with the absolute rate difference (RD) of −0.34% (95% CI, −8.65% to 8.12%) over the 4.5-year study period. Clinical intrauterine pregnancy rates were 35.7% (107 of 300) in the intervention group and 37.7% (113 of 300) in the control group, with an absolute RD of −2.00% (95% CI, −9.65% to 5.69%). Live-birth rates were 31.7% (95 of 300) in the intervention group and 32.3% (97 of 300) in the control group, with an absolute RD of −0.67% (95% CI, −8.09% to 6.77%).

Conclusions and Relevance Among women in China who had intact thyroid function and tested positive for antithyroperoxidase antibodies and were undergoing IVF-ET, treatment with levothyroxine, compared with no levothyroxine treatment, did not reduce miscarriage rates or increase live-birth rates.

[Melnichenko]

Честно говоря, во всех гайдах подчеркивалось, что успехи тироксна при референсном ТТГ и АТТРО связаны только с имененм Pop и Glinoer.
Мы не знаем, почему выкидыша чаще при наличии АТТРО ( кстати,при анализе многих работ на эту тему у нас с В.В.Фадеевым и еще у одного немца только не получилось такой закономерности, у остальных примерно 8 групп получилось.
Словом, обычная ситуаци - ясно, что при наличии этого паратметра плохо - но попытка предотвраться могущее буть следствием этого параметра ситуацию не исправляет.