The Prevalence of Thyroid Dysfunction and Autoimmunity in Women With History of Miscarriage or Subfertility

R.K. Dhillon-Smith, A. Tobias, P.P. Smith, L.J. Middleton, K.K. Sunner, K. Baker, S. Farrell-Carver, R. Bender-Atik, R. Agrawal, K. Bhatia, J.J. Chu, E. Edi-Osagie, A. Ewies, T. Ghobara, P. Gupta, D. Jurkovic, Y. Khalaf, K. Mulbagal, N. Nunes, C. OvertonS. Quenby, R. Rai, N. Raine-Fenning, L. Robinson, J. Ross, A. Sizer, R. Small, M. Underwood, M.D. Kilby, J. Daniels, S. Thangaratinam, S. Chan, K. Boelaert, A. Coomarasamy

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34 Citations (Scopus)


OBJECTIVE: To describe the prevalence of and factors associated with different thyroid dysfunction phenotypes in women who are asymptomatic preconception. DESIGN: Observational cohort study. SETTING: A total of 49 hospitals across the United Kingdom between 2011 and 2016. PARTICIPANTS: Women aged 16 to 41years with history of miscarriage or subfertility trying for a pregnancy. METHODS: Prevalences and 95% confidence intervals (CIs) were estimated using the binomial exact method. Multivariate logistic regression analyses were conducted to identify risk factors for thyroid disease.None. MAIN OUTCOME MEASURE: Rates of thyroid dysfunction. RESULTS: Thyroid function and thyroid peroxidase antibody (TPOAb) data were available for 19213 and 19237 women, respectively. The prevalence of abnormal thyroid function was 4.8% (95% CI, 4.5-5.1); euthyroidism was defined as levels of thyroid-stimulating hormone (TSH) of 0.44 to 4.50 mIU/L and free thyroxine (fT4) of 10 to 21 pmol/L. Overt hypothyroidism (TSH > 4.50 mIU/L, fT4 < 10 pmol/L) was present in 0.2% of women (95% CI, 0.1-0.3) and overt hyperthyroidism (TSH < 0.44 mIU/L, fT4 > 21 pmol/L) was present in 0.3% (95% CI, 0.2-0.3). The prevalence of subclinical hypothyroidism (SCH) using an upper TSH concentration of 4.50 mIU/L was 2.4% (95% CI, 2.1-2.6). Lowering the upper TSH to 2.50 mIU/L resulted in higher rates of SCH, 19.9% (95% CI, 19.3-20.5). Multiple regression analyses showed increased odds of SCH (TSH > 4.50 mIU/L) with body mass index (BMI) ≥ 35.0 kg/m2 (adjusted odds ratio [aOR] 1.71; 95% CI, 1.13-2.57; P = 0.01) and Asian ethnicity (aOR 1.76; 95% CI, 1.31-2.37; P < 0.001), and increased odds of SCH (TSH ≥ 2.50 mIU/L) with subfertility (aOR 1.16; 95% CI, 1.04-1.29; P = 0.008). TPOAb positivity was prevalent in 9.5% of women (95% CI, 9.1-9.9). CONCLUSIONS: The prevalence of undiagnosed overt thyroid disease is low. SCH and TPOAb are common, particularly in women with higher BMI or of Asian ethnicity. A TSH cutoff of 2.50 mIU/L to define SCH results in a significant proportion of women potentially requiring levothyroxine treatment.

Original languageEnglish
JournalThe Journal of clinical endocrinology and metabolism
Issue number8
Publication statusPublished - 1 Aug 2020


  • miscarriage
  • preconception
  • prevalence
  • subfertility
  • thyroid autoimmunity
  • thyroid disease


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