Thyroid Dysfunction and Infertility
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Recommendations Table 5. Overt Hypothyroidism in Women
With Infertility
Strength
*
Level
#
In women with newly diagnosed or uncontrolled overt
hypothyroidism, fertility treatment should be delayed until
euthyroidism is restored.
Good Practice Statement
Women with overt hypothyroidism who are planning
pregnancy should be treated with levothyroxine (LT4 ).
Strong Moderate
yroid preparations other than levothyroxine (LT4 ), such
as liothyronine (LT3) or desiccated thyroid extract, should
not be used in women planning pregnancy.
Strong Low
* Strength of Recommendation;
#
Level of Evidence; Good Practice Statement.
Recommendations Table 6. Subclinical Hypothyroidism in
Women With Infertility
Strength
*
Level
#
In women with newly diagnosed or uncontrolled subclinical
hypothyroidism, fertility treatment may be delayed until the
spontaneous restoration or therapy-induced restoration of
euthyroidism.
Conditional Low
Subclinical hypothyroidism with a TSH >10 mU/L should
be treated with levothyroxine.
Good Practice Statement
For all women with newly diagnosed subclinical
hypothyroidism, diagnostic confirmation with rechecking
TSH and FT4 may be done in 4–6 weeks.
If the TSH concentration normalizes upon repeat
measurement:
1. TPOAb negative women do not require biochemical
follow-up and may be advised to seek medical evaluation
upon the development of hypothyroid symptoms.
2. TPOAb positive women may be followed-up with TSH
testing every 3–6 months when planning pregnancy, and
once pregnant, every 4–6 weeks during the first half of
pregnancy, at least once in the third trimester, and 4–6
weeks after any dose adjustment.
If subclinical hypothyroidism is persistent upon repeat testing :
1. Low dose (25–75 mcg/day) levothyroxine may be started,
with a TSH measurement aer 4–6 weeks and levothyroxine
dose titrated to a target TSH between 0.5–2.5 mU/L.
Conditional Moderate
Conditional Low
* Strength of Recommendation;
#
Level of Evidence; Good Practice Statement.
