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My Take on SCH
in Infertile Women Planning IVF
• To treat or not?
• At what TSH level? – All >=2.5
– Lower threshold?
• Thyroid antibody +
• Thyroid nodules
• FH of thyroid disorders
• Treat with what ??
– Levothyroxine (T4)
– Dose 25-50 mcg/day; retest in 4-6 weeks
• Monitor
– Anticipate fluctuation in TSH levels in cycle
– Need for dose increase with positive pregnancy test!
SLIDE 26
Key Concepts
• Thyroid hormone signaling is relevant to normal reproductive physiology, and for fetal/neonatal wellbeing
• Thyroid hypofunction is common & affects women more than men
• Subclinical hypothyroidism (SCH):
– is NOT innocuous
– Is often associated with less than optimal pregnancy outcomes
– Benefitsoftreatmentfaroutweightherisksoftreatment with thyroxine
– Identifies individuals at lifetime risk for progression to overt hypothyroidism
• Thyroid autoimmunity
– Common in SCH & is a road to overt hypothyroidism – Adverse pregnancy outcomes are more common
– Pregnancy outcomes MAY be optimized with thyroxine supplementation
SLIDE 27
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