The Journal of clinical endocrinology and metabolism · 2026
Gestational hypothyroidism and pregnancy outcomes following hemithyroidectomy: a nationwide matched cohort study.
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Atias Dor, Allon Raviv, Ben-Basat Nofar, Kovo Michal, Melamed Guy, Saciuk Yaki, Patalon Tal
Аннотация
BACKGROUND: Hemithyroidectomy is increasingly performed in women of reproductive age, but its implications for thyroid function during pregnancy and obstetric outcomes remain unclear.
OBJECTIVE: To assess gestational hypothyroidism and the risks of preterm birth and pregnancy loss among pregnancies in women with prior hemithyroidectomy vs matched pregnancies in women without thyroid surgery.
METHODS: We conducted a retrospective matched cohort study using anonymized electronic medical records from Maccabi Healthcare Services, Israel, from 2002 to 2023. Pregnancies with at least one thyroid-stimulating hormone (TSH) measurement were included. Pregnancies after hemithyroidectomy were matched to pregnancies without thyroid surgery using exact matching on maternal age, gravidity, and pregnancy year, followed by propensity-score matching on sociodemographic and clinical covariates. Gestational hypothyroidism was defined as TSH >4.0 mIU/L or levothyroxine initiation during pregnancy and analyzed using generalized estimating equations. Pregnancy loss and preterm birth were analyzed using a weighted time-varying Cox model with gestational age as the time scale, incorporating thyroid status and levothyroxine treatment as time-varying covariates and a hemithyroidectomy-by-trimester interaction.
RESULTS: The matched cohort included 463 pregnancies after hemithyroidectomy and 2293 matched controls. Prior hemithyroidectomy was associated with higher odds of gestational hypothyroidism (adjusted odds ratio, 4.2; 95% CI, 2.9-6.3; P < .01). In the time-varying outcome analysis, hemithyroidectomy was not associated with increased first-trimester pregnancy loss (hazard ratio [HR], 0.9; 95% CI, 0.7-1.1; P = .29), but was associated with higher hazard of preterm birth or pregnancy loss during the second and third trimesters (HR, 1.6; 95% CI, 1.3-2.0; P < .01).
CONCLUSION: Prior hemithyroidectomy was associated with gestational hypothyroidism and modestly higher later-gestation hazard of preterm birth or pregnancy loss, supporting enhanced thyroid surveillance during pregnancy.
OBJECTIVE: To assess gestational hypothyroidism and the risks of preterm birth and pregnancy loss among pregnancies in women with prior hemithyroidectomy vs matched pregnancies in women without thyroid surgery.
METHODS: We conducted a retrospective matched cohort study using anonymized electronic medical records from Maccabi Healthcare Services, Israel, from 2002 to 2023. Pregnancies with at least one thyroid-stimulating hormone (TSH) measurement were included. Pregnancies after hemithyroidectomy were matched to pregnancies without thyroid surgery using exact matching on maternal age, gravidity, and pregnancy year, followed by propensity-score matching on sociodemographic and clinical covariates. Gestational hypothyroidism was defined as TSH >4.0 mIU/L or levothyroxine initiation during pregnancy and analyzed using generalized estimating equations. Pregnancy loss and preterm birth were analyzed using a weighted time-varying Cox model with gestational age as the time scale, incorporating thyroid status and levothyroxine treatment as time-varying covariates and a hemithyroidectomy-by-trimester interaction.
RESULTS: The matched cohort included 463 pregnancies after hemithyroidectomy and 2293 matched controls. Prior hemithyroidectomy was associated with higher odds of gestational hypothyroidism (adjusted odds ratio, 4.2; 95% CI, 2.9-6.3; P < .01). In the time-varying outcome analysis, hemithyroidectomy was not associated with increased first-trimester pregnancy loss (hazard ratio [HR], 0.9; 95% CI, 0.7-1.1; P = .29), but was associated with higher hazard of preterm birth or pregnancy loss during the second and third trimesters (HR, 1.6; 95% CI, 1.3-2.0; P < .01).
CONCLUSION: Prior hemithyroidectomy was associated with gestational hypothyroidism and modestly higher later-gestation hazard of preterm birth or pregnancy loss, supporting enhanced thyroid surveillance during pregnancy.