scholarly journals Functional Ovarian Reserve in Women With Infertility and Euthyroidism: What Is the Role of Thyroid Autoimmunity?

2021 ◽  
Author(s):  
Diana Festas Silva ◽  
Tânia Carvalho ◽  
Leonor Gomes ◽  
Isabel Paiva ◽  
Paulo Cortesão ◽  
...  
Keyword(s):  
Ovarian Reserve ◽  
Polycystic Ovary ◽  
Thyroid Autoimmunity ◽  
Univariate Analysis ◽  
Human Reproduction ◽  
Thyroid Peroxidase ◽  
Childbearing Age ◽  
Autoimmune Pathology ◽  
Cervical Surgery ◽  
Tsh Levels

Abstract Background: Thyroid dysfunction is the most common endocrine disorder in women of childbearing age, and is associated with menstrual irregularities, anovulation and infertility. Whether it is thyroid function, thyroid autoimmunity (AI) or both that affects functional ovarian reserve remains to be clarified. The aim of this study was to evaluate the association between functional ovarian reserve and thyroid AI in women with infertility in euthyroidism.Methods: retrospective study of women with infertility, in euthyroidism, followed in a Human Reproduction Department, between May 2016 and January 2020. TSH, anti-thyroid peroxidase (TPO) antibodies, anti-thyroglobulin (TG) antibodies were measured. Functional ovarian reserve was assessed by anti-Müllerian hormone (AMH) levels with antral follicle count (AFC) performed by endovaginal ultrasound. Women with at least one of the following criteria were excluded: prior thyroidectomy, radioactive iodine treatment, cervical surgery/radiotherapy, oophorectomy, malignant/autoimmune pathology, chronic kidney disease, liver disease, polycystic ovary syndrome, current pregnancy and current medication with levothyroxine, methimazole or propylthiouracil. Results with p<0.05 were considered statistically significant.Results: 730 women were evaluated, with mean age of 34.9±3.9 years, with positive thyroid AI (≥ 1 positive antibody) present in 14.8% of cases. Anti-TPO antibodies were positive in 11.0% of patients and anti-TG antibodies in 7.0%. Mean TSH level was 1.6±0.7 µIU/mL (NR: 0.4-4.0). Median body mass index (BMI) was 22.8 kg/m2 (IQR 5.1). Median AMH was 1.7ng/mL (IQR 2.1), and mean AFC was 10.2±6.3. Patients with positive and negative thyroid AI did not differ significantly with age (p=0.133), BMI (p=0.784], AFC (p=0.508) and AMH (p=0.825). TSH levels were significantly higher in the positive AI group (2.0±0.8 vs 1.5±0.7µIU/mL; p<0.001).In the univariate and multivariate analysis, only patient's age and AFC were predictive of AMH levels (p<0.001; p<0.001, respectively). TSH levels, BMI and thyroid AI were not predictive of AMH levels.In regard to AFC, in the univariate analysis, only age was predictive (p<0.001). TSH levels, BMI and thyroid AI were not predictive of AFC.Conclusions: In this study we found that thyroid autoimmunity, in women with infertility and TSH levels in the normal range, apparently, do not have a predictive role for functional ovarian reserve.

scholarly journals Link between autoimmune hypothyroidism and polycystic ovary syndrome.

2020 ◽  
Vol 27 (09) ◽  
pp. 1804-1808
Author(s):  
Anam Rehman ◽  
Shireen Jawed ◽  
Amna Rashid Tariq
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Thyroid Function ◽  
Polycystic Ovary ◽  
Thyroid Autoimmunity ◽  
Study Groups ◽  
Thyroid Peroxidase ◽  
Ovary Syndrome ◽  
Cross Sectional ◽  
Autoimmune Hypothyroidism ◽  
Thyroid Peroxidase Antibody

Objectives: Polycystic ovary syndrome (PCOS) is a rampant endocrine disorder distressing women of child bearing age worldwide. Many current researches have detected the presence of some organ specific and non-specific autoantibodies in females with PCOS. Study Design: Cross Sectional study. Setting:  Aziz Fatimah Hospital, Faisalabad, Pakistan. Period: April to September 2017. Material & Methods: This study comprised of 88 female subjects of 17-35 years old. Participants were divided into four group’s i.e PCOS obese females, PCOS non-obese, obese females without PCOS and age matched controls. Thyroid function was evaluated by the measurement of serum TSH, FT3 and FT4 levels. Thyroid peroxidase antibody was detected as an indicator of thyroid autoimmunity. All parameters were measured by chemiluminescence immunoassay technique (CLIA). SPSS version 22 was used for the statistical analysis of the data. Results: Out of total 88 female participants, 38.6% were hypothyroid and 61.4% were euthyroid females. While on comparing the percentages of hypothyroidism among the study groups PCOS, non-PCOS patients and obese we found higher percentages of hypothyroidism among non-obese PCOS. Thyroid peroxidase antibody levels were higher in PCOS obese subjects. PCOS patients have 15 times more risk for hypothyroidism as compared to non-PCOS patients. Conclusion: Hypothyroidism was commonly found in PCOS patients with high levels of TPO-Antibody indicating that PCOS is an independent risk factor for hypothyroidism which suggests that evaluation of thyroid function and autoimmunity must be deliberated in PCOS patients.

scholarly journals Postpartum Thyroiditis and Autoimmune Thyroiditis in Women of Childbearing Age: Recent Insights and Consequences for Antenatal and Postnatal Care

2001 ◽  
Vol 22 (5) ◽  
pp. 605-630 ◽  
Author(s):  
Alex F. Muller ◽  
Hemmo A. Drexhage ◽  
Arie Berghout
Keyword(s):  
Autoimmune Thyroiditis ◽  
Thyroid Autoimmunity ◽  
Fetal Loss ◽  
First Year ◽  
Thyroid Peroxidase ◽  
Childbearing Age ◽  
Activated T Cells ◽  
Postpartum Thyroiditis ◽  
Autoimmune Thyroid ◽  
Significant Impairment

Abstract Postpartum thyroiditis is a syndrome of transient or permanent thyroid dysfunction occurring in the first year after delivery and based on an autoimmune inflammation of the thyroid. The prevalence ranges from 5–7%. We discuss the role of antibodies (especially thyroid peroxidase antibodies), complement, activated T cells, and apoptosis in the outbreak of postpartum thyroiditis. Postpartum thyroiditis is conceptualized as an acute phase of autoimmune thyroid destruction in the context of an existing and ongoing process of thyroid autosensitization. From pregnancy an enhanced state of immune tolerance ensues. A rebound reaction to this pregnancy-associated immune suppression after delivery explains the aggravation of autoimmune syndromes in the puerperal period, e.g., the occurrence of clinically overt postpartum thyroiditis. Low thyroid reserve due to autoimmune thyroiditis is increasingly recognized as a serious health problem. 1) Thyroid autoimmunity increases the probability of spontaneous fetal loss. 2) Thyroid failure due to autoimmune thyroiditis—often mild and subclinical—can lead to permanent and significant impairment in neuropsychological performance of the offspring. 3) Evidence is emerging that as women age subclinical hypothyroidism—as a sequel of postpartum thyroiditis—predisposes them to cardiovascular disease. Hence, postpartum thyroiditis is no longer considered a mild and transient disorder. Screening is considered.

scholarly journals Pregnancy outcomes are not altered by variation in thyroid function within the normal range in women free of thyroid disease

2018 ◽  
Vol 178 (2) ◽  
pp. 189-197 ◽  
Author(s):  
Flora Veltri ◽  
Pierre Kleynen ◽  
Lidia Grabczan ◽  
Alexandra Salajan ◽  
Serge Rozenberg ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Thyroid Function ◽  
Pregnancy Outcomes ◽  
Thyroid Disease ◽  
Thyroid Autoimmunity ◽  
Thyroid Peroxidase ◽  
Normal Range ◽  
Baseline Characteristics ◽  
Serum Tsh ◽  
Tsh Levels

ObjectiveIn the recently revised guidelines on the management of thyroid dysfunction during pregnancy, treatment with thyroid hormone (LT4) is not recommended in women without thyroid autoimmunity (TAI) and TSH levels in the range 2.5–4.0 mIU/L, and in a recent study in that particular group of pregnant women, more complications were observed when a treatment with LT4 was given. The objective of the study was therefore to investigate whether variation in thyroid function within the normal (non-pregnant) range in women free of thyroid disease was associated with altered pregnancy outcomes?DesignCross-sectional data analysis of 1321 pregnant women nested within an ongoing prospective collection of pregnant women’s data in a single centre in Brussels, Belgium.MethodsThyroid peroxidase antibodies (TPO-abs), thyroid-stimulating hormone (TSH), free T4 (FT4) and ferritin levels were measured and baseline characteristics were recorded. Women taking LT4, with TAI and thyroid function outside the normal non-pregnant range were excluded. Pregnancy outcomes and baseline characteristics were correlated with all TSH and FT4 levels within the normal range and compared between two groups (TSH cut-off < and ≥2.5 mIU/L).ResultsTobacco use was associated with higher serum TSH levels (OR: 1.38; CI 95%: 1.08–1.74);P = 0.009. FT4 levels were inversely correlated with age and BMI (rho = −0.096 and −0.089;P < 0.001 and 0.001 respectively) and positively correlated with ferritin levels (rho = 0.097;P < 0.001). Postpartum haemorrhage (>500 mL) was inversely associated with serum FT4 levels (OR: 0.35; CI 95%: 0.13–0.96);P = 0.040. Also 10% of women free of thyroid disease had serum TSH levels ≥2.5 mIU/L.ConclusionsVariation in thyroid function during the first trimester within the normal (non-pregnant) range in women free of thyroid disease was not associated with altered pregnancy outcomes. These results add evidence to the recommendation against LT4 treatment in pregnant women with high normal TSH levels and without TPO antibodies.

scholarly journals Does foetal gender influence maternal thyroid parameters in pregnancy?

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
Georgiana Sitoris ◽  
Flora Veltri ◽  
Pierre Kleynen ◽  
Malika Ichiche ◽  
Serge Rozenberg ◽  
...  
Keyword(s):  
Reference Range ◽  
Thyroid Autoimmunity ◽  
First Trimester ◽  
Thyroid Peroxidase ◽  
Reference Ranges ◽  
Free T4 ◽  
Cross Sectional ◽  
Maternal Thyroid ◽  
Serum Tsh ◽  
Tsh Levels

Objective It is unknown if foetal gender influences maternal thyroid function during pregnancy. We therefore investigated the prevalence of thyroid disorders and determined first-trimester TSH reference ranges according to gender. Methods A cross-sectional study involving 1663 women with an ongoing pregnancy was conducted. Twin and assisted pregnancies and l-thyroxine or antithyroid treatment before pregnancy were exclusion criteria. Serum TSH, free T4 (FT4) and thyroid peroxidase antibodies (TPOAb) were measured at median (interquartile range; IQR) 13 (11–17) weeks of gestation. Subclinical hypothyroidism (SCH) was present when serum TSH levels were >3.74 mIU/L with normal FT4 levels (10.29–18.02 pmol/L), and thyroid autoimmunity (TAI) was present when TPOAb were ≥60 kIU/L. Results Eight hundred and forty-seven women were pregnant with a female foetus (FF) and 816 with a male foetus (MF). In women without TAI and during the gestational age period between 9 and 13 weeks (with presumed high-serum hCG levels), median (IQR range) serum TSH in the FF group was lower than that in the MF group: 1.13 (0.72–1.74) vs 1.24 (0.71–1.98) mIU/L; P = 0.021. First-trimester gender-specific TSH reference range was 0.03–3.53 mIU/L in the FF group and 0.03–3.89 mIU/L in the MF group. The prevalence of SCH and TAI was comparable between the FF and MF group: 4.4% vs 5.4%; P = 0.345 and 4.9% vs 7.5%; P = 0.079, respectively. Conclusions Women pregnant with an MF have slightly but significantly higher TSH levels and a higher upper limit of the first-trimester TSH reference range, compared with pregnancies with a FF. We hypothesise that this difference may be related to higher hCG levels in women pregnant with a FF, although we were unable to measure hCG in this study. Further studies are required to investigate if this difference has any clinical relevance.

scholarly journals Hashimoto’s thyroiditis worsens ovaries in polycystic ovary syndrome patients compared to Anti-Müllerian hormone levels

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aliye Nigar Serin ◽  
Özer Birge ◽  
Aysel Uysal ◽  
Süheyla Görar ◽  
Feyza Tekeli
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Ovarian Reserve ◽  
Hashimoto’S Thyroiditis ◽  
Polycystic Ovary ◽  
Hashimoto's Thyroiditis ◽  
Thyroid Peroxidase ◽  
Ovary Syndrome ◽  
Hormone Levels ◽  
Autoimmune Attack ◽  
Pcos Group

Abstract Background The human ovary is the target of autoimmune attack in cases of autoimmune disorders, which can cause ovarian dysfunction. Due to the higher prevalence of Hashimoto’s Thyroiditis (HT) in Polycystic Ovary Syndrome (PCOS) patients, we aimed to evaluate ovarian reserve and the effect of autoimmune exposure time on ovarian reserve in PCOS patients with HT by Anti-Müllerian hormone (AMH) levels. Methods Forty-six PCOS patients and 46 PCOS with HT diagnosed patients who are between 18 and 35 years old were recruited for this study. Detailed medical histories were obtained from all participants. Polycystic ovary image was evaluated and antral follicles were counted by transvaginal ultrasound. Modified Ferriman Gallwey score, body mass index, waist/hip ratio of the patients were examined. Hormonal, biochemical profiles and AMH levels of the patients were evaluated during the early follicular phase. The data of both groups were statistically analyzed with SPSS 18.0. Results 20 (43.5%) patients in the PCOS group were fertile, 8 (17.4%) patients in the PCOS + HT group were fertile, fertility rate was significantly lower in PCOS + HT group. The mean AMH value was 8.8 ± 8.8 in the PCOS + HT group and 12.4 ± 8.1 in the PCOS group and it was significantly lower in the PCOS + HT group (p = 0.043). AMH values were significantly negatively correlated with anti-thyroid peroxidase antibody (anti-TPO) level and the duration of HT. There was a significant positive correlation between the anti-TPO level and the duration of HT. Conclusıon We pointed out that the coexistence of PCOS and HT, two prevalent diseases of reproductive age, further diminished ovarian reserve. More exposure of the ovaries to autoantibodies can cause ovarian destruction, similar to the thyroid gland like HT. Because of all these close relations with PCOS and thyroid dysfunctions, we recommend evaluating both thyroid autoantibodies and hormone levels in PCOS patients at the first visit. Patients with PCOS + HT should be monitored more closely to determine the fertility treatment options and control premature ovarian failure (POF) table.

scholarly journals Thyroid Autoimmunity and Thyroid Cancer – The Pathogenic Connection: A 2018 Update

2018 ◽  
Vol 50 (12) ◽  
pp. 922-931 ◽  
Author(s):  
Yuji Nagayama
Keyword(s):  
Thyroid Cancer ◽  
Large Scale ◽  
Thyroid Autoimmunity ◽  
Thyroid Peroxidase ◽  
Reference Ranges ◽  
Lymphocyte Infiltration ◽  
Papillary Thyroid ◽  
Thyroid Cancers ◽  
Benign Nodules ◽  
Tsh Levels

AbstractThe association between thyroid cancer and thyroid autoimmunity has long been suggested, but remains to be elucidated for several decades. Here the data on this issue are updated by summarizing relevant papers published between 2012 and early 2018. Although numerous papers demonstrated the significant increase in the prevalence of thyroid autoimmunity (positive intrathyroidal lymphocyte infiltration and/or anti-thyroglobulin/thyroid peroxidase antibodies) in patients with thyroid cancers as compared to those with benign nodules, and also the significant increase in the prevalence of papillary thyroid cancer (PTC) in patients with thyroid autoimmunity as compared to those without, there are some crucial biases that should be taken into account for their interpretation. However, a difference in the incidence of thyroid autoimmunity in patients with PTCs and those with other types of thyroid cancers appears to support the significant association of two conditions. Thyroid autoimmunity is, at least partly, likely to be elicited against antigens shared by normal and cancerous thyroid tissues, thereby inducing autoimmunity. At the same time, elevated TSH levels (even within the normal reference ranges), which often accompany Hashimoto’s patients are a risk factor for thyroid cancer. However, it is still unclear whether or not the co-existence of thyroid autoimmunity impacts on cancer characteristics and prognosis. This issue needs to be further investigated with large-scale prospective studies.

scholarly journals Thyroid autoimmunity and miscarriage

2004 ◽  
Vol 150 (6) ◽  
pp. 751-755 ◽  
Author(s):  
MF Prummel ◽  
WM Wiersinga
Keyword(s):  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Thyroid Autoimmunity ◽  
Case Control ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Peroxidase ◽  
Age Difference ◽  
Thyroid Antibodies ◽  
Mild Thyroid Failure ◽  
Tsh Levels

To ascertain the strength of the association between thyroid autoimmunity and miscarriage, we performed a meta-analysis of both case-control and longitudinal studies performed since 1990 when this association was first described. A clear association between the presence of thyroid antibodies and miscarriage was found with an odds ratio (OR) of 2.73 (95 % confidence interval (CI), 2.20-3.40) in eight case-control and ten longitudinal (OR, 2.30; 95 % CI, 1.80-2.95) studies. This association may be explained by a heightened autoimmune state affecting the fetal allograft, of which thyroid antibodies are just a marker. Alternatively, the association can be partly explained by the slightly higher age of women with antibodies compared with those without (mean+/-S.D. age difference, 0.7+/-1.0 years; P<0.001). A third possibility is mild thyroid failure, as thyroid-stimulating hormone (TSH) levels in antibody-positive but euthyroid women are higher than in antibody-negative women: difference 0.81+/-0.58 mU/l (P=0.005). Randomized clinical trials with l-thyroxine (aiming at TSH values between 0.4 and 2.0 mU/l) and with selenium (to decrease antibodies against thyroid peroxidase) are clearly needed to elucidate further the nature of this association.

scholarly journals SAT-433 The Influence of Thyroid Autoimmunity on Pregnancy Outcome in Infertile Women

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ken Takeshima ◽  
Yuko Inagaki ◽  
Masahiro Nishi ◽  
Hiroyuki Ariyasu ◽  
Shinsuke Uraki ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Live Birth ◽  
Intrauterine Insemination ◽  
Thyroid Autoimmunity ◽  
Multiple Logistic Regression Analysis ◽  
Thyroid Peroxidase ◽  
Infertile Women ◽  
Fertility Treatments ◽  
Tsh Levels

Abstract Background: Women with subclinical hypothyroidism (SCH) and thyroid autoimmunity (TAI) reportedly have high risks of miscarriage and preterm birth. Infertile women undergoing assisted reproductive technology (ART) are recommended for levothyroxine (L-T4) supplementation to maintain TSH levels below 2.5 mIU/mL according to ATA guideline; however, insufficient evidence exists to determine whether L-T4 treatment for infertile women with TSH levels between 2.5 and 5.0 mIU/mL. Objective: To clarify the influence of TAI on pregnancy in infertile women under L-T4 treatment to maintain TSH levels below 2.5 mIU/mL, and to compare its influence depending on fertility treatments. Methods: A total of 595 infertile women who visited a fertility clinic between January 2013 and December 2015 were prospectively recruited to this study. Five patients with Graves’ disease were excluded and remained 590 women were included in the analysis. Infertile women with TSH levels above 2.5 mIU/mL were treated with L-T4 followed by evaluation of fertility status and pregnancy outcomes. Factors affecting pregnancy were analyzed statistically depending on fertility treatments. Written informed consent was obtained from all patients, and the study protocol was approved by the Ethics Committee. Results: The proportion of SCH and thyroid peroxidase antibodies (TPOAb).positivity was 19.6% and 10.4%, respectively. Women who did not become pregnant were older than those who became pregnant (p=0.003), but no influence of thyroid-associated factors on pregnancy was confirmed. Pregnancy outcome contrarily showed that women who had a miscarriage were older (p&lt;0.001) and higher TPOAb titers (p=0.038) than those who had a live birth. In addition, higher age (OR 26.4, p&lt;0.001) and high TPOAb titer (OR 11.8, p=0.043) were decided as risk factors for miscarriage through multiple logistic regression analysis. Among women who treated with intrauterine insemination, TPOAb titers were higher in women who had a miscarriage than in those who had a live birth (p=0.040). We further focused on the difference between ART methods including in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Women undergoing IVF had higher TPOAb titers in women who had miscarriage than those who had a live birth (p=0.023), but in women undergoing ICSI there was no association between TPOAb titers and pregnancy outcome. Conclusion: Infertile women with high TPOAb titers are susceptible to miscarriage despite appropriate L-T4 treatment. The influence of TPOAb titers as well as TPOAb positivity on pregnancy should be considered, when undergoing fertility treatments.

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