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

Ya Min Qiu,1 Zheng Wen Qin,2 Jie Lin,1 Yi Yang3 1Department of Reproductive Health and Infertility, Zigong Maternal and Child Health Care Hospital, Zigong City, Sichuan Province, People’s Republic of China; 2Department of Obstetrics and Gynecology, Zigong Maternal and Child Health Care Hospital, Zigong City, Sichuan Province, People’s Republic of China; 3Department of Women’s Health Department, Zigong Maternal and Child Health Care Hospital, Zigong City, Sichuan Province, People’s Republic of ChinaCorrespondence: Ya Min Qiu, Department of Reproductive Health and Infertility, Zigong Maternal and Child Health Care Hospital, No. 49, Wong Tong Road, Longjing Street, Daan District, Zigong City, Sichuan Province, 643000, People’s Republic of China, Tel +86 13890022005, Email [email protected]: 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.Keywords: prednisone, levothyroxine, thyroid peroxidase antibodies, recurrent pregnancy loss, thyroid function tests