Implications of thyroid autoimmunity in infertile women with subclinical hypothyroidism in the absence of both goiter and anti-thyroid antibodies: lessons from three cases

Abstract

There is a great deal of research interest regarding the underlying causes of slightly elevated TSH values in patients with subclinical hypothyroidism (SH) without abnormal findings on ultrasonography or anti-thyroid antibodies. Twelve infertile women with thyroglobulin antibody (TGAb) and thyroid peroxidase antibody (TPOAb)-negative nongoitrous SH were referred to our department of endocrinology between September 2007 and September 2015. None had been diagnosed with autoimmune thyroid disease or had any possible causes of SH. In all cases, LT4 was prescribed to bring TSH value below 2.5 mIU/L. Among those with infertility treatments, six (50%) became pregnant and gave birth to infants. Here, we report three of these six women who successfully became pregnant with infertility treatments and were found to have thyroid autoimmunity on data obtained during the postpartum period. Two developed postpartum thyroiditis, and the remaining one woman was temporarily weakly positive for TPOAb at 9 months postpartum. We describe three infertile subclinically hypothyroid women without goiter or anti-thyroid antibodies with potential thyroid autoimmunity. Thyroid autoimmunity is one of the most important issues for management of pregnant women, and thus, our findings are noteworthy for the care of infertile women with SH. This report provides valuable insights into the presence of autoimmunity in nongoitrous thyroidassociated antibody-negative SH patients.

Association between gestational blood lipids and TSH levels and pregnancy outcome of patients with subclinical hypothyroidism

“…Studies have shown that the probability of premature delivery caused by SCH during pregnancy is two times larger than that in pregnant women without it. 25 Our study showed that the incidences of premature delivery, abortion and neonatal growth re- striction in the SCH poorly controlled patients were significantly higher than those in the SCH poorly controlled patients and patients without SCH. Yang J et al showed that the incidence of adverse pregnancy outcomes (early pregnancy abortion, premature delivery, pregnancyinduced hypertension, gestational diabetes mellitus, fetal growth restriction and low birth weight infants) in patients with SCH was significantly higher than that in pregnant women with normal thyroid function.…”

Subclinical Hypothyroidism: Prevalence, Health Impact, and Treatment Landscape

“…On physical examination, the presence of goiter could be a clue suggesting CAT, although CAT may also present without goiter [ 71 ]. To rule out other causes, it is recommended to measure serum TPOAb and check the history of the goiter, its size, and the co-occurrence of symptoms (e.g., pain).…”

Comparison of thyroid hormone profile (T3, T4, TSH, ANTI TPOAB, & TBG) among fertile and infertile females.

“…13 Untreated and undetected thyroid disease may play a role in infertility; thus, awareness of thyroid condition in infertile couples is critical, because of its significant, recurring, and frequently preventable or reversible effect on infertility. 14 A review of the available literature reveals that although there are numerous foreign studies on the subject, not really enough research has been carried out at the local level. The current study is proposed with the rationale of evaluating the association of thyroid dysfunction as well as thyroid autoimmunity with unexplained infertility, which will assist in the creation of appropriate interventions to reduce the incidence of infertility caused by undiagnosed or untreated thyroid dysfunction.…”