SynthesisBMJ open2021
Impact of levothyroxine in women with positive thyroid antibodies on pregnancy outcomes: a systematic review and meta-analysis of randomised controlled trials.
Synthesis in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Levothyroxine in euthyroid pregnant women with thyroid peroxidase antibody: a systematic review and meta-analysis of randomized controlled trials.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2025Pooled it
- The impact of levothyroxine therapy on pregnancy and neonatal outcomes in euthyroid pregnant women with thyroid autoimmunity: A systematic review, meta-analysis and trial sequential analysis.Frontiers in pharmacology · 2023Pooled it
- Effect of Levothyroxine on Pregnancy Outcomes in Pregnant Women With Hypothyroxinemia: An Interventional Study.Frontiers in endocrinology · 2022Trial
- Canadian Endocrinologists' Perspectives on Treatment With Thyroid Hormone Substitutions in Euthyroid and Hypothyroid Patients: A 2023 THESIS Questionnaire Survey.Clinical endocrinology · 2025Article
- Overview of thyroid disorders in pregnancy.Maternal health, neonatology and perinatology · 2025Review
- Levothyroxine supplementation and pregnancy outcomes in women with thyroid disorders: an umbrella review of systematic reviews and meta-analyses of randomized controlled trials.Human reproduction open · 2025Review
- Update on therapeutic use of levothyroxine for the management of hypothyroidism during pregnancy.Endocrine connections · 2024Review
- Preconception Counseling in Patients with Hypothyroidism and/or Thyroid Autoimmunity.Medicina (Kaunas, Lithuania) · 2022Review
- Hashimoto thyroiditis: an evidence-based guide to etiology, diagnosis and treatment.Polish archives of internal medicine · 2022Article
- Assessment and treatment of thyroid disorders in pregnancy and the postpartum period.Nature reviews. Endocrinology · 2022Review
- Thyroid autoimmunity and its negative impact on female fertility and maternal pregnancy outcomes.Frontiers in endocrinology · 2022Review
- Effect of Bisphenol A-Mediated RBP-4 on Pregnancy Outcomes in Nonobese Pregnant Female with Subclinical Hypothyroidism.Contrast media & molecular imaging · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo evaluate the effect of levothyroxine therapy on pregnancy outcomes compared with placebo or no treatment in women without overt hypothyroidism with presence of thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies (TgAb).
designSystematic review and meta-analysis of randomised controlled trials STUDY ELIGIBILITY CRITERIA: Prespecified criteria for inclusion were: randomised trials of levothyroxine versus control (placebo or no treatment) among women with positive TPOAb or TgAb who were pregnant or considering conception. DATA SOURCES: Ovid MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched from 1980 to 5 November 2020. OUTCOME MEASURES: Prespecified data elements were extracted and where appropriate, meta-analyses were conducted. Main outcomes include pregnancy achieved, miscarriage, preterm delivery and live birth. RISK OF BIAS ASSESSMENT: Cochrane Risk of Bias Tool for Quality Assessment of Randomised Controlled Trials.
resultsFrom 3023 citations, 79 citations were identified for full-text review. Of these, six trials (total of 2263 women) were included for qualitative and quantitative analyses. Risk of bias was deemed low for only one trial. There was no significant difference in the relative risk (RR) of pregnancy achieved (RR 1.03; 95% CI 0.93 to 1.13), miscarriage (RR 0.93; 95% CI 0.76 to 1.14), preterm delivery (RR 0.66; 95% CI 0.39 to 1.10) or live births (RR 1.01; 95% CI 0.89 to 1.16) in thyroid autoimmune women treated with levothyroxine compared with controls. Sensitivity analyses of preterm birth identified study quality and timing of levothyroxine initiation as sources of heterogeneity.
conclusionsAmong pregnant women or women planning conception, with thyroid autoimmunity, there is a lack of evidence of benefit for levothyroxine use (moderate to high Grading of Recommendations, Assessment, Development and Evaluations). Recommendations to use levothyroxine in this setting need to be reconsidered. PROSPERO REGISTRATION NUMBER: CRD42019130459.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.