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Review
. 2023 Jun 6;24(12):9815.
doi: 10.3390/ijms24129815.

The Thyroid Hormone Axis and Female Reproduction

Ethan D L Brown  1 , Barnabas Obeng-Gyasi  2 , Janet E Hall  1 , Skand Shekhar  1
Affiliations
Review

The Thyroid Hormone Axis and Female Reproduction

Ethan D L Brown et al. Int J Mol Sci. .

Abstract

Thyroid function affects multiple sites of the female hypothalamic-pituitary gonadal (HPG) axis. Disruption of thyroid function has been linked to reproductive dysfunction in women and is associated with menstrual irregularity, infertility, poor pregnancy outcomes, and gynecological conditions such as premature ovarian insufficiency and polycystic ovarian syndrome. Thus, the complex molecular interplay between hormones involved in thyroid and reproductive functions is further compounded by the association of certain common autoimmune states with disorders of the thyroid and the HPG axes. Furthermore, in prepartum and intrapartum states, even relatively minor disruptions have been shown to adversely impact maternal and fetal outcomes, with some differences of opinion in the management of these conditions. In this review, we provide readers with a foundational understanding of the physiology and pathophysiology of thyroid hormone interactions with the female HPG axis. We also share clinical insights into the management of thyroid dysfunction in reproductive-aged women.

Keywords: PCOS; female reproduction; hypothyroidism; pregnancy; thyroid.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Hypothalamic Pituitary Thyroid Axis. Interactions between TRH, TSH, T3, and T4 along the hypothalamic pituitary thyroid axis are shown alongside their transport by thyroxine binding globulin and conversion by deiodinase 1, 2, and 3 [32,33,34].
Figure 2
Figure 2
Effects of Thyroid Hormones on Reproductive Physiology. Interactions between TRH, TSH, T3, and T4 and organ systems relevant to reproduction are shown alongside key effects of each hormone on these systems [17,18,49,55,56,57,58,59]. Annotation: solid arrows represent stimulatory effects, dashed arrows represent minor/weak effects, and block arrows represent inhibitory effects.
Figure 3
Figure 3
Thyroid Pathology in Pregnancy: A Decision-Making Algorithm. Key decision-making steps in treating thyroid pathology in pregnant women are outlined according to latest recommendations from ACOG and ATA. * fT4 is assay is a newer assay and trimester range published, # high risk: previous miscarriages, infertility etc. RR: non pregnant reference range, TR: Trimester specific range, TPOAb: TPO Antibodies, TRAb: TSH Receptor Antibodies [135,195].
See this image and copyright information in PMC

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