Recurrent Pregnancy Loss in Women with Hashimoto's Thyroiditis with Concurrent Non-Endocrine Autoimmune Disorders

Miriam Cellini, Maria Giulia Santaguida, Ilaria Stramazzo, Silvia Capriello, Nunzia Brusca, Alessandro Antonelli, Poupak Fallahi, Lucilla Gargano, Marco Centanni, Camilla Virili
Thyroid : official journal of the American Thyroid Association · 2020 · vol. 30(3) , pp. 457–462 · doi:10.1089/thy.2019.0456 · PMID:31910128 · W3000724601
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Women with Hashimoto's thyroiditis and concurrent non-endocrine autoimmune disorders face a higher risk of recurrent pregnancy loss, although antiphospholipid syndrome explains only a fraction of this rate.

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Abstract

Background: An increased rate of recurrent miscarriage has been described in patients with autoimmune thyroid disease. However, there is a lack of studies that assess the rate of recurrent pregnancy loss (RPL) in patients with Hashimoto's thyroiditis (HT) isolated or with concurrent non-endocrine autoimmune disorders (NEAD). The objective of the study was to assess the rate of RPL in patients with HT isolated or accompanied with non-endocrine autoimmune diseases. Methods: This is a retrospective observational cohort study with a systematic review of the NEAD with concurrent HT in an outpatient Endocrinology Unit at a University Hospital. Among the 3480 consecutively examined women with HT, 87 patients met the criteria of RPL and represented the study group. Sixty-five of them had isolated HT and 22 women had HT+NEAD. Results: The rate of RPL in women with HT was 2.1% versus 5.64% observed in women with HT+NEAD (odds ratio = 2.78 [95% confidence interval 1.70-4.57]; p < 0.0001). On subdivision, this difference was still evident in euthyroid patients (p < 0.0001), while it disappeared in hypothyroid women (p = 0.21). The RPL did not correlate with the autoantibody concentrations nor in women with isolated HT nor in those with HT+NEAD. The presence of antiphospholipid syndrome (APS) explained RPL in 3 out of 22 (14%) patients with HT+NEAD, the remaining being related to different autoimmune disorders. Interestingly, even subtracting the patients with APS, RPL was more frequent in patients with poly-autoimmunity than in patients with isolated HT (p = 0.0013). Conclusions: The co-presence of NEAD is correlated with a higher risk of RPL in women with HT. The association with APS may explain only a fraction of RPL rate in patients with poly-autoimmunity.

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MeSH descriptors

Abortion, Habitual Autoimmune Diseases Autoimmunity Hashimoto Disease Abortion, Habitual Adult Autoimmune Diseases Autoimmunity Female Hashimoto Disease Humans Pregnancy Retrospective Studies

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