Subclinical Hypothyroidism in Women Planning Conception and During Pregnancy: Who Should Be Treated and How?

Journal of the Endocrine Society
Spyridoula MarakaDerek T O'Keeffe

Abstract

Subclinical hypothyroidism (SCH), a mild form of hypothyroidism defined as elevated TSH with normal free thyroxine levels, is a common diagnosis among women of reproductive age. In some, but not all, studies, it has been associated with infertility, an increased risk of adverse pregnancy and neonatal outcomes, and possibly with an increased risk of neurocognitive deficits in offspring. Despite well-established recommendations on treatment of overt hypothyroid pregnant women, a consensus has not yet been reached on whether to treat women with SCH. This review focuses on examining the evidence informing the clinical strategy for using levothyroxine (LT4) in women with SCH during pregnancy and those who are planning conception. A crucial first step is to accurately diagnose SCH using the appropriate population-based reference range. For pregnant women, if this is unavailable, the recommended TSH upper normal limit cutoff is 4.0 mIU/L. There is evidence supporting a decreased risk for pregnancy loss and preterm delivery for pregnant women with TSH > 4.0 mIU/L receiving LT4 therapy. LT4 treatment has been associated with better reproductive outcomes in women with SCH undergoing artificial reproductive techniques, but not in those wh...Continue Reading

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Citations

Oct 11, 2019·Journal of Obstetrics and Gynaecology of India·Suvarna Khadilkar
Nov 6, 2018·The Australian & New Zealand Journal of Obstetrics & Gynaecology·Hayden Anthony Homer
Feb 26, 2021·Journal of Human Reproductive Sciences·Leena WadhwaSarika Arora
Jun 15, 2021·Frontiers in Endocrinology·Chae Won ChungYoung Joo Park
Sep 17, 2021·Reviews in Endocrine & Metabolic Disorders·Kardalas EfstratiosMastorakos George

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Methods Mentioned

BETA
pregnancy test

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Scopus
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