Conference Thyroid Function and Conception 13.8.1398
Thyroid Function and Conception
CLINICAL DECISIONS
The NEW ENGLAND JOURNAL of MEDICINE
A Woman Trying to Conceive
- Mrs. Thompson is a 31 y/o woman who has been trying to conceive for the past 12 months and comes to see you, her primary care physician. One month ago, she had a miscarriage at 7 weeks of gestation.
- She has not had any other pregnancies. Ms. Thompson has always been healthy; she has no significant medical history. Her only regular medication is a prenatal multivitamin, which she has been taking regularly for the past 12 months.
- Before that, she had used the combined estrogen–progesterone oral contraceptive pill for several years. Since she discontinued the contraceptive pill, her menses have been regular, with a 28-day cycle.
- Her family history is significant for autoimmune disease. Her brother has type 1 diabetes mellitus, and a maternal uncle has Hashimoto’s thyroiditis.
- Mrs. Thompson has no personal history of thyroid disease and reports no symptoms suggestive of hyperthyroidism or hypothyroidism, nor does she have any localized neck discomfort or swelling.
- TSH: 3.2 mIU /l (0.5 to 4.0)
- free T4: 1.1 ng /dl (0.86 to 1.9 )
- thyroid peroxidase antibodies is positive (78 IU/ml [normal <35])
- Ms. Thompson has read that changes in thyroid function can affect a woman’s chances of having a successful pregnancy.
- Given the results of her tests, she is interested in your recommendation as to whether she should begin treatment with levothyroxine to increase her chances of conceiving.
