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Chapter 10 - Thyroid Treatment Trials

Published online by Cambridge University Press:  16 April 2025

By
Anne H. van der Spek and
Peter H. Bisschop
Edited by
Roy G. Farquharson,
Mary D. Stephenson and
Mariëtte Goddijn
Roy G. Farquharson
Affiliation:
Liverpool Women’s Hospital
Mary D. Stephenson
Affiliation:
University of Illinois, Chicago
Mariëtte Goddijn
Affiliation:
Amsterdam University Medical Centers
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Summary

Thyroid dysfunction and autoimmunity during pregnancy have been consistently associated with poor maternal and fetal outcomes. Treatment for overt hypo- and hyperthyroidism in pregnant women and women attempting pregnancy is therefore universally recommended. In women with subclinical hypothyroidism, levothyroxine treatment is thought to reduce pregnancy loss, preterm delivery and gestational hypertension although several large trials have failed to demonstrate an effect on child cognition and neurodevelopment. Levothyroxine treatment has also been shown to improve the outcome of fertility treatment in women with subclinical hypothyroidism. However there is currently insufficient evidence to recommend levothyroxine treatment in euthyroid women with thyroid auto-immunity attempting pregnancy as several high-quality randomized trials have failed to demonstrate a beneficial effect of levothyroxine treatment on life birth, miscarriage rate or the outcomes of assisted reproductive therapy.

Keywords

thyroid dysfunctionthyroid autoimmunitypregnancy complicationssubfertilityassisted reproductive technologylevothyroxine

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Early Pregnancy , pp. 89 - 95
Publisher: Cambridge University Press
Print publication year: 2025

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