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Semin Reprod Med 2024; 42(03): 178-192
DOI: 10.1055/s-0044-1795160
Review Article

A Review of Autoimmune Thyroid Diseases and Their Complex Interplay with Female Fertility

Lindsay Carafone    *
1   Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York
,
Alex J. Knutson    *
2   Department of Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, New York
,
Benjamin J. Gigliotti 
1   Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York
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Abstract

Hashimoto thyroiditis and Graves' disease are autoimmune thyroid disorders that are common in women of reproductive age and have a complex relationship with female fertility and health of the maternal–fetal dyad. Both hyperthyroidism and hypothyroidism, whether subclinical or overt in severity, directly or indirectly affect nearly every level of the hypothalamic–pituitary–ovary axis, uterine and ovarian function, as well as fetal development from implantation through delivery. Autoimmunity itself also appears to negatively impact both spontaneous and assisted fertility, as well as miscarriage risk, although the mechanism remains unclear, and the presence and magnitude of risk is variable in published literature. While treatment of overt hyperthyroidism and hypothyroidism is unequivocally recommended by professional societies, the impact of treatment on fertility outcomes, and the role of treatment in subclinical thyroid disease is more controversial. Unfortunately, levothyroxine has not been shown to abrogate the risk of subfertility and miscarriage observed in euthyroid thyroid autoantibody positive women.

Keywords

thyroid autoimmunity - female fertility - miscarriage - Hashimoto thyroiditis - Graves' disease

* Co-first authors.




Publication History

Article published online:
12 December 2024

© 2024. Thieme. All rights reserved.

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