PROBLEM The effect of thyroid autoimmunity (TAI) on the prevalence of recurrent miscarriage (RM) is highly debatable. No meta-analysis has been published in the past decade to investigate the impact of TAI on women with RM. METHOD OF STUDY Systemic literature search was conducted on PubMed, Embase, Cochrane, and Web of Science databases. English language literatures published between 1993 and 2019 were selected. We assessed the relationship between the prevalence of RM and thyroid peroxidase antibodies (TPO-Ab) or antithyroid antibodies (ATA) and evaluated the thyroid-stimulating hormone (TSH) level in TPO-Ab-positive women with RM. We also observed the treatment effect with levothyroxine (LT4) for RM. Review Manager 5.3 software was used to obtain the pooled odds ratios (OR). RESULTS Analysis of 22 eligible studies revealed significant association between TPO-Ab and the prevalence of RM (OR = 1.85; 95% CI, 1.38 to 2.49; P < .001)(n ≥ 3), (OR = 1.82; 95% CI, 1.13 to 2.92; P = .01) (n ≥ 3). Women with ATA + had higher risk of RM (OR = 2.36; 95% CI, 1.71 to 3.25; P < .00001)(n ≥ 3), (OR = 2.34; 95% CI, 1.70 to 3.22; P < .00001)(n ≥ 2). RM women with TPO-Ab had higher TSH level when compared with those negative for TPO-Ab (random-effect SMD = 0.60; 95% CI, 0.31 to 0.90; P < .0001). We also found beneficial effects of LT4 supplementation on the outcome of live birth rate (LBR) among pregnant women with TPO-Ab (OR = 3.04; 95% CI, 0.69 to 13.36; P = .14). CONCLUSION The presence of serum antithyroid antibodies does harms to women and can even lead to recurrent miscarriage; LT4 treatment may have beneficial to RM women.

中文翻译：

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抗甲状腺抗体对反复流产妇女的影响：一项荟萃分析。

问题甲状腺自身免疫（TAI）对反复流产（RM）患病率的影响值得商de。在过去的十年中，没有发表荟萃分析来研究TAI对患有RM的女性的影响。研究方法在PubMed，Embase，Cochrane和Web of Science数据库中进行系统文献检索。选择了1993年至2019年出版的英语文学。我们评估了RM的患病率与甲状腺过氧化物酶抗体（TPO-Ab）或抗甲状腺抗体（ATA）之间的关系，并评估了患有RM的TPO-Ab阳性女性的促甲状腺激素（TSH）水平。我们还观察到左旋甲状腺素（LT4）对RM的治疗效果。使用Review Manager 5.3软件来获得合并的优势比（OR）。结果对22项合格研究的分析表明，TPO-Ab与RM患病率之间存在显着相关性（OR = 1.85; 95％CI，1.38至2.49; P <.001）（n≥3），（OR = 1.82; 95％CI ，1.13至2.92； P = 0.01）（n≥3）。患有ATA +的女性患RM的风险更高（OR = 2.36; 95％CI，1.71至3.25; P <.00001）（n≥3），（OR = 2.34; 95％CI，1.70至3.22; P <.00001 ）（n≥2）。与TPO-Ab阴性的女性相比，患有TPO-Ab的RM女性的TSH水平更高（随机效应SMD = 0.60； 95％CI为0.31至0.90； P <.0001）。我们还发现补充LT4对TPO-Ab孕妇的活产率（LBR）有益（OR = 3.04； 95％CI，0.69至13.36； P = 0.14）。结论血清抗甲状腺抗体的存在确实对女性有害，甚至可能导致反复流产。