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Thyroid screening may benefit women with fertility problems
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Screening for thyroid disease should be considered in women with fertility problems and recurrent early pregnancy loss, according to a review published in The Obstetrician & Gynaecologist.
“Abnormalities in thyroid function can have an adverse effect on reproductive health and result in reduced rates of conception, increased miscarriage risk and adverse pregnancy and neonatal outcomes,” Amanda Jefferys, BMBS, BMedSci, MRCOG, of the Bristol Center for Reproductive Medicine at Southmead Hospital in the United Kingdom, said in a press release. “However, with appropriate screening and prompt management, these risks can be significantly reduced.”
Jefferys and colleagues conducted the review to gather information on the effect of thyroid disorders on reproductive health. The researchers also sought to gather information on how to optimize thyroid function in order to improve reproductive outcomes.
There can be adverse effects on reproductive health, decreased conception rates, increased early pregnancy loss, and adverse pregnancy and neonatal outcomes with abnormalities in thyroid function, including hyperthyroidism and hypothyroidism.
Compared with 1.5% of women in the general population, 2.3% with fertility problems have hyperthyroidism. Menstrual irregularity has been linked to hyperthyroidism. Preterm delivery, preeclampsia, growth restriction, heart failure and stillbirth are all possible adverse outcomes of pregnancy in women with hyperthyroidism.
Less than 1% of women of reproductive age have hypothyroidism, which can cause a delay in reaching sexual maturity during childhood and adolescence as well as menstrual problems in adulthood.
Currently, national guidelines do not recommend screening for asymptomatic women with problems conceiving.
“Thyroid disease can have significant effects on reproduction from conception to birth; however, with appropriate screening, a high index of suspicion and prompt management, risks can be significantly reduced if not ameliorated,” the researchers wrote. “The benefits of [levothyroxine] replacement in euthyroid women and with [autoimmune thyroid disease] both preconceptually and during pregnancy remain a grey area and further research is needed to confirm benefit.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Alan Copperman, MD
This paper makes a strong case for universal thyroid screening in women of reproductive age women. Thyroid disorders can clearly affect fertility and pregnancy, and with appropriate screening and treatment, the chance of having a healthy baby can be dramatically increased. It is great to have evidence that supports current practice and that establishes a data-driven and evidence-based standard of care. Recognizing and treating even mild hypothyroidism can prevent miscarriages, improve neonatal brain development, and promote healthy family building.
Thyroid dysfunction is the most common endocrine condition affecting reproductive-aged women. Both overactive and underactive thyroid can have significant effects on reproductive function. While it has been known for years that thyroid disease can impact fertility, the authors make a strong case for routine measurement of thyroid function with a simple blood test in asymptomatic women presenting with problems conceiving. Treating even minor disease may improve the chance of pregnancy, may decrease the miscarriage risk, and may improve the health of the baby.
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