The prevalence of thyroid dysfunction and autoimmunity in women with history of miscarriage or subfertility.
Open accessAbstract
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. INTERVENTION: 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.
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In individuals with a history of infertility or recurrent miscarriages, the prevalence of subclinical hypothyroidism is 2.4%.
“In individuals with a history of infertility or recurrent miscarriages, the prevalence of overt hypothyroidism is approximately 0.2% and the prevalence of subclinical hypothyroidism is 2.4%, 19 which is similar to the general population of women of childbearing age. 20”
From Hypothyroidism: A Review (2025) · cites this paper as [19]
The Main findings section reports subclinical hypothyroidism in 2.4% of women with a history of miscarriage or subfertility, using a TSH threshold above 4.50 mU/L. The Eligibility criteria section shows that the cohort included women with a single miscarriage, so 2.4% is not established specifically for those with infertility or recurrent miscarriages. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn individuals with a history of infertility or recurrent miscarriages, the prevalence of overt hypothyroidism is approximately 0.2%.
“In individuals with a history of infertility or recurrent miscarriages, the prevalence of overt hypothyroidism is approximately 0.2% and the prevalence of subclinical hypothyroidism is 2.4%, 19 which is similar to the general population of women of childbearing age. 20”
From Hypothyroidism: A Review (2025) · cites this paper as [19]
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Cites
Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E. N., Soldin, O. P., Sullivan, S., et al. (2011) · Thyroid · doi:10.1089/thy.2011.0087 · Cited by 2,942 · see citing works
Alexander, E. K., Pearce, E. N., Brent, G. A., Brown, R. S., Chen, H., Dosiou, C., Grobman, W. A., Laurberg, P., Lazarus, J. H., Mandel, S. J., et al. (2017) · Thyroid® · doi:10.1089/thy.2016.0457 · Cited by 2,731 · see citing works
DeGroot, L. J., Abalovich, M., Alexander, E. K., Amino, N., Barbour, L. A., Cobin, R. H., Eastman, C. J., Lazarus, J. H., Luton, D., Mandel, S. J., et al. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-2803 · Cited by 1,862 · see citing works
Subclinical Thyroid Disease: Scientific Review and Guidelines for Diagnosis and Management
Surks, M. I., Ortiz, E., Daniels, G. H., Sawin, C. T., Col, N. F., Cobin, R. H., Franklyn, J. A., Hershman, J. M., Burman, K. D., Denke, M. A., et al. (2004) · JAMA · doi:10.1001/jama.291.2.228 · Cited by 1,800 · see citing works
Garber, J. R., Cobin, R. H., Gharib, H., Hennessey, J. V., Klein, I., Mechanick, J. I., Pessah-Pollack, R., Singer, P. A., & Woeber, K. A. (2012) · Endocrine Practice · doi:10.4158/ep12280.gl · Cited by 1,567 · see citing works
ESHRE guideline: recurrent pregnancy loss
The ESHRE Guideline Group on RPL, Bender-Atik, R., Christiansen, O. B., Elson, J., Kolte, A. M., Lewis, S. E. M., Middeldorp, S., Nelen, W. L. D. M., Peramo, B., Quenby, S. M., et al. (2018) · Human Reproduction Open · doi:10.1093/hropen/hoy004 · Cited by 1,014 · see citing works
Self-citation2013 ETA Guideline: Management of Subclinical Hypothyroidism
Pearce, S. H. S., Brabant, G., Duntas, L. H., Monzani, F., Peeters, R. P., Razvi, S., & Wemeau, J.-L. (2013) · European Thyroid Journal · doi:10.1159/000356507 · Cited by 877 · see citing works
Negro, R., Formoso, G., Mangieri, T., Pezzarossa, A., Dazzi, D., & Hassan, H. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-1603 · Cited by 756 · see citing works
Lazarus, J., Brown, R. S., Daumerie, C., Hubalewska-Dydejczyk, A., Negro, R., & Vaidya, B. (2014) · European Thyroid Journal · doi:10.1159/000362597 · Cited by 742 · see citing works
Thangaratinam, S., Tan, A., Knox, E., Kilby, M. D., Franklyn, J., & Coomarasamy, A. (2011) · BMJ · doi:10.1136/bmj.d2616 · Cited by 604 · see citing works
Self-citationvan den Boogaard, E., Vissenberg, R., Land, J. A., van Wely, M., van der Post, J. A. M., Goddijn, M., & Bisschop, P. H. (2011) · Human Reproduction Update · doi:10.1093/humupd/dmr024 · Cited by 528 · see citing works
Pregnancy in patients with mild thyroid abnormalities: maternal and neonatal repercussions
GLINOER, D., SOTO, M. F., BOURDOUX, P., LEJEUNE, B., DELANGE, F., LEMONE, M., KINTHAERT, J., ROBIJN, C., GRUN, J.-P., & NAYER, P. D. (1991) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-73-2-421 · Cited by 379 · see citing works
Levothyroxine in Women with Thyroid Peroxidase Antibodies before Conception
Dhillon-Smith, R. K., Middleton, L. J., Sunner, K. K., Cheed, V., Baker, K., Farrell-Carver, S., Bender-Atik, R., Agrawal, R., Bhatia, K., Edi-Osagie, E., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1812537 · Cited by 303 · see citing works
Self-citationFetal and Neonatal Hyperthyroidism
Zimmerman, D. (1999) · Thyroid · doi:10.1089/thy.1999.9.727 · Cited by 288 · see citing works
The Potential Repercussions of Maternal, Fetal, and Neonatal Hypothyroxinemia on the Progeny
Glinoer, D., & Delange, F. M. (2000) · Thyroid · doi:10.1089/thy.2000.10.871 · Cited by 261 · see citing works
Age- and Race-Based Serum Thyrotropin Reference Limits
Surks, M. I., & Boucai, L. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-1845 · Cited by 258 · see citing works
Maraka, S., Mwangi, R., McCoy, R. G., Yao, X., Sangaralingham, L. R., Singh Ospina, N. M., O’Keeffe, D. T., De Ycaza, A. E. E., Rodriguez-Gutierrez, R., Coddington, C. C., et al. (2017) · BMJ · doi:10.1136/bmj.i6865 · Cited by 249 · see citing works
Subclinical hypothyroidism and thyroid autoimmunity in women with infertility
Abalovich, M., Mitelberg, L., Allami, C., Gutierrez, S., Alcaraz, G., Otero, P., & Levalle, O. A. (2007) · Gynecological Endocrinology · doi:10.1080/09513590701259542 · Cited by 236 · see citing works
Okosieme, O., Gilbert, J., Abraham, P., Boelaert, K., Dayan, C., Gurnell, M., Leese, G., McCabe, C., Perros, P., Smith, V., et al. (2016) · Clinical Endocrinology · doi:10.1111/cen.12824 · Cited by 208 · see citing works
Self-citationSubclinical hypothyroidism in the infertile female population: a guideline
(2015) · Fertility and Sterility · doi:10.1016/j.fertnstert.2015.05.028 · Cited by 179 · see citing works
Ethnic differences in maternal thyroid parameters during pregnancy: the Generation R study
Korevaar, T. I. M., Medici, M., de Rijke, Y. B., Visser, W., de Muinck Keizer-Schrama, S. M. P. F., Jaddoe, V. W. V., Hofman, A., Ross, H. A., Visser, W. E., Hooijkaas, H., et al. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-2005 · Cited by 150 · see citing works
Negro, R., Formoso, G., Coppola, L., Presicce, G., Mangieri, T., Pezzarossa, A., & Dazzi, D. (2007) · Journal of Endocrinological Investigation · doi:10.1007/bf03347388 · Cited by 121 · see citing works
Thyroid dysfunction and pregnancy outcomes.
Nazarpour, S., Tehrani, F. R., Simbar, M., & Azizi, F. (2015) · PubMed Central · Cited by 115 · see citing works
Feldthusen, A.-D., Pedersen, P. L., Larsen, J., Kristensen, T. T., Ellervik, C., & Kvetny, J. (2015) · Journal of Pregnancy · doi:10.1155/2015/132718 · Cited by 83 · see citing works
A review of the iodine status of UK pregnant women and its implications for the offspring
Bath, S. C., & Rayman, M. P. (2015) · Environmental Geochemistry and Health · doi:10.1007/s10653-015-9682-3 · Cited by 78 · see citing works
Interventions for preventing and treating hyperthyroidism in pregnancy
Earl, R., Crowther, C. A., & Middleton, P. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008633.pub2 · Cited by 15 · see citing works
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Chaker, L., & Papaleontiou, M. (2025) · JAMA · doi:10.1001/jama.2025.13559 · Cited by 63 · see citing works
Dhillon‐Smith, R. K., Boelaert, K., Jeve, Y. B., Maheshwari, A., Coomarasamy, A., & Royal College of Obstetricians and Gynaecologists (2022) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.17187 · Cited by 16 · see citing works
Self-citation
- Authors
- Dhillon-Smith, R. K., Tobias, A., Smith, P. P., Middleton, L. J., Sunner, K. K., Baker, K., Farrell-Carver, S., Bender-Atik, R., Agrawal, R., Bhatia, K., Chu, J. J., Edi-Osagie, E., Ewies, A., Ghobara, T., Gupta, P., Jurkovic, D., Khalaf, Y., Mulbagal, K., Nunes, N., Overton, C., Quenby, S., Rai, R., Raine-Fenning, N., Robinson, L., Ross, J., Sizer, A., Small, R., Underwood, M., Kilby, M. D., Daniels, J., Thangaratinam, S., Chan, S., Boelaert, K., & Coomarasamy, A.
- Affiliations
- Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women’s and Children’s NHS Foundation Trust (GB)
- University of Birmingham (GB)
- University of Oxford (GB)
- Miscarriage Association (GB)
- University Hospital Coventry (GB)
- Burnley General Teaching Hospital (GB)
- St Mary's Hospital (GB)
- Birmingham City Hospital (GB)
- University Hospital Birmingham, Birmingham, UK
- University College Hospital (GB)
- Guy's Hospital (GB)
- Bolton NHS Foundation Trust (GB)
- Chelsea and Westminster Hospital NHS Foundation Trust (GB)
- University Hospitals Bristol NHS Foundation Trust (GB)
- Imperial College Healthcare NHS Trust (GB)
- Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK
- King's College Hospital NHS Foundation Trust (GB)
- Shrewsbury and Telford Hospital NHS Trust (GB)
- University of Nottingham (GB)
- Queen Mary University of London (GB)
- National University of Singapore (SG)
- ORCID
- Dhillon-Smith, Rima K
- Smith, Paul P
- Middleton, Lee J
- Sunner, Kirandeep K
- Farrell-Carver, Samantha
- Bender-Atik, Ruth
- Agrawal, Rina
- Bhatia, Kalsang
- Chu, Justin J
- Edi-Osagie, Edmond
- Ewies, Ayman
- Ghobara, Tarek
- Gupta, Pratima
- Jurkovic, Davor
- Khalaf, Yacoub
- Mulbagal, Khashia
- Nunes, Natalie
- Overton, Caroline
- Quenby, Siobhan
- Ross, Jackie
- Sizer, Andrew
- Small, Rachel
- Underwood, Martyn
- Kilby, Mark D
- Daniels, Jane
- Thangaratinam, Shakila
- Chan, Shiao
- Boelaert, Kristien
- Coomarasamy, Arri
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2020-06-17
- Volume
- 105
- Issue
- 8
- Pages
- 2667-2677
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W3036640180
- Cited by
- 67
- References
- 26
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 9 · 2023: 11 · 2022: 16 · 2021: 7 · 2020: 2
- FWCI
- 6.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (publishedVersion, other-oa)
- Funders
- Efficacy and Mechanism Evaluation program (09/100/10)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- thyroid dysfunction, subclinical hypothyroidism, thyroid peroxidase antibodies, thyroid autoimmunity, miscarriage, subfertility, thyroid-stimulating hormone, body mass index, obesity, overt hypothyroidism, overt hyperthyroidism, prevalence, risk factors, women of reproductive age, infertility, thyroid function tests, TSH reference range
- MeSH terms
- Abortion, Spontaneous, Adolescent, Adult, Autoantibodies, Female, United Kingdom, Humans, Hypothyroidism, Infertility, Pregnancy, Prospective Studies, Reference Values, Thyroid Function Tests, Thyrotropin, Cohort Studies, Prevalence, Young Adult, Asymptomatic Diseases
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