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Cited by 1,223Thyroid Disorders and TreatmentsReproductive System and PregnancyReproductive Health and Technologies

Thyroid Function and Human Reproductive Health

Krassas, G. E., Poppe, K., Glinoer, D.·2010·Endocrine Reviews
DOI 10.1210/er.2009-0041
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Abstract

Via its interaction in several pathways, normal thyroid function is important to maintain normal reproduction. In both genders, changes in SHBG and sex steroids are a consistent feature associated with hyper- and hypothyroidism and were already reported many years ago. Male reproduction is adversely affected by both thyrotoxicosis and hypothyroidism. Erectile abnormalities have been reported. Thyrotoxicosis induces abnormalities in sperm motility, whereas hypothyroidism is associated with abnormalities in sperm morphology; the latter normalize when euthyroidism is reached. In females, thyrotoxicosis and hypothyroidism can cause menstrual disturbances. Thyrotoxicosis is associated mainly with hypomenorrhea and polymenorrhea, whereas hypothyroidism is associated mainly with oligomenorrhea. Thyroid dysfunction has also been linked to reduced fertility. Controlled ovarian hyperstimulation leads to important increases in estradiol, which in turn may have an adverse effect on thyroid hormones and TSH. When autoimmune thyroid disease is present, the impact of controlled ovarian hyperstimulation may become more severe, depending on preexisting thyroid abnormalities. Autoimmune thyroid disease is present in 5–20% of unselected pregnant women. Isolated hypothyroxinemia has been described in approximately 2% of pregnancies, without serum TSH elevation and in the absence of thyroid autoantibodies. Overt hypothyroidism has been associated with increased rates of spontaneous abortion, premature delivery and/or low birth weight, fetal distress in labor, and perhaps gestation-induced hypertension and placental abruption. The links between such obstetrical complications and subclinical hypothyroidism are less evident. Thyrotoxicosis during pregnancy is due to Graves’ disease and gestational transient thyrotoxicosis. All antithyroid drugs cross the placenta and may potentially affect fetal thyroid function.

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  • In young fertile women, undertreatment with levothyroxine is associated with subnormal fertility.

    “In young fertile women, the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, compromised fetal growth, and neurocognitive development.”

    From Risks of suboptimal and excessive thyroid hormone replacement across ages (2023) · cites this paper as [26]

  • Undertreatment of hypothyroid women often leads to irregular menstrual periods and infertility.

    “Furthermore, undertreatment of hypothyroid women will often lead to irregular menstrual periods and infertility, which is also the reason for the internationally recommended screening for thyroid dysfunction of all women referred to fertility treatment [25, 26].”

    From Risks of suboptimal and excessive thyroid hormone replacement across ages (2023) · cites this paper as [26]

  • Maternal gestational thyroid function has a crucial impact on pregnancy, fetal, and neonatal outcomes.

    “The maternal gestational thyroid function has a crucial impact on pregnancy, fetal, and neonatal outcomes; therefore, TD occurring during pregnancy, especially if overt, require a prompt correction [71, 72].”

    From 2019 European Thyroid Association Guidelines on the Management of Thyroid Dysfunction following Immune Reconstitution Therapy (2019) · cites this paper as [71]

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Authors
Krassas, G. E., Poppe, K., & Glinoer, D.
Affiliations
  • Department of Endocrinology, Diabetes, and Metabolism (G.E.K.), Panagia General Hospital, 55132 Thessaloniki, Greece;
  • Centre Hospitalier Universitaire Brugmann (BE)
  • Centre Hospitalier Universitaire de Saint-Pierre (BE)
ORCID
Poppe, K.
Venue
Endocrine Reviews
Publisher
The Endocrine Society
Published
2010-10-01
Volume
31
Issue
5
Pages
702-755
ISSN
  • 0163-769X (ISSN-L)
  • 1945-7189
DOI
10.1210/er.2009-0041
OpenAlex
W1968156993
Cited by
1,223
References
400
Citations by year
2026: 43 · 2025: 78 · 2024: 91 · 2023: 77 · 2022: 121 · 2021: 97 · 2020: 96 · 2019: 75 · 2018: 87 · 2017: 80 · 2016: 71 · 2015: 67 · 2014: 78 · 2013: 59 · 2012: 53
FWCI
7.14
Type
journal article
Language
en
Open access
closed
Locations
  • Endocrine Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
  • VUBIR (Vrije Universiteit Brussel) (submittedVersion)
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 › Reproductive Medicine › Reproductive Health and Technologies
Keywords
thyroid function, reproductive health, hyperthyroidism, hypothyroidism, thyrotoxicosis, sex hormone-binding globulin, sex steroids, male fertility, sperm motility, sperm morphology, menstrual irregularity, fertility, controlled ovarian stimulation, estradiol, thyroid-stimulating hormone, autoimmune thyroid disease, pregnancy, hypothyroxinemia, miscarriage, preterm birth, low birth weight, Graves' disease, antithyroid drugs, placental transfer, fetal thyroid function
MeSH terms
Animals, Female, Humans, Infertility, Male, Pregnancy, Reproduction, Thyroid Diseases, Thyroid Gland, Thyroid Hormones

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