The Effect of Prednisone and Levothyroxine Sodium on Miscarriage Risk and Thyroid Function in Patients with High TPOAb Concentrations: A Retrospective Cohort Study

Objective: The potential benefit of immunomodulatory therapy in women with high TPOAb concentrations and TSH levels exceeding 2.5 mIU/L remains unclear. This study aimed to evaluate the effects of prednisone combined with levothyroxine sodium (LT4) on miscarriage risk, thyroid function, LT4 dosage and adverse events in this population. Methods: A retrospective cohort study was conducted, in which patients were divided into Group A (treated with levothyroxine sodium tablets alone) and Group B (treated with prednisone combined with levothyroxine sodium tablets). Statistical analyses included chi-square tests, independent sample t-tests, paired sample t-tests and repeated measures ANOVA. Results: Compared with levothyroxine sodium alone, combined treatment significantly reduced miscarriage risk in Group B (P=0.019). TPOAb concentrations in Group B decreased significantly during treatment (P<0.001), while TSH levels showed less fluctuation and remained relatively stable during pregnancy. In addition, Group B required a lower total dose of levothyroxine sodium (P<0.001) and had a lower incidence of adverse reactions. Conclusion: Prednisone combined with levothyroxine sodium was associated with a lower miscarriage rate, more stable thyroid function during pregnancy, and reduced LT4 requirements in patients with high TPOAb concentrations and TSH levels >2.5 mIU/L. These findings suggest that this combined regimen may be a useful option for improving early pregnancy management in this specific patient population.