Thyroid Autoimmunity: The Treatment of Hashimoto's Disease, or the Presence of Antithyroid Antibodies Alone, in Pregnancy
Jonathan Scher, Carmen Dabao, Caitlin E. Rukat
Abstract
PROBLEM: Hashimoto's disease is the commonest autoimmune disease of pregnancy. The presence of Anti-Thyroid antibodies (ATAs) alone [subclinical hypothyroidism] has also been shown to have adverse pregnancy effects. These can result in failure to conceive, recurrent miscarriages, anemia, preeclampsia, and abruption. Hashimoto's disease in reproduction can cause difficulty in conception through hormonal interference. It can also cause miscarriages, growth retardation, and preterm birth. The current recommended treatment is the administration of levothyroxine. This corrects the thyroid balance and may relieve the patient's hypothyroid symptoms. However, repeated recent studies have shown that it is no more effective than a placebo in correcting obstetric complications. METHOD OF STUDY: As a result, we decided to use an anti-autoimmune-directed treatment for this disorder. We selected to use IVIG for both its known powerful anti-inflammatory and anti-autoimmune benefits. There are several studies and observational reports in the literature on the use of IVIG in pregnancy for treating recurrent miscarriages and repeated failed IVF. However, there are no reports in the literature on using IVIG to treat Hashimoto's disease, or the presence of ATAs alone, in pregnancy. RESULTS: This study showed an increase in live births in the IVIG-treated group versus the non-IVIG-treated group after adjustment for maternal age at delivery (OR = 4.6, 95% CI (1.1, 18.1)). There were no adverse effects in the patients who received IVIG. CONCLUSION: IVIG is effective in significantly improving the obstetric outcome in patients with Hashimoto's disease, or the presence of ATAs alone.