Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug;101(2):180-190.
doi: 10.1111/cen.15099. Epub 2024 Jun 10.

Use of levothyroxine for euthyroid, thyroid antibody positive women with infertility: Analyses of aggregate data from a survey of European thyroid specialists (Treatment of Hypothyroidism in Europe by Specialists: An International Survey)

Roberto Negro  1 , Miloš Žarković  2 , Roberto Attanasio  3 , Laszlo Hegedüs  4 , Endre V Nagy  5 , Enrico Papini  6 , Ersin Akarsu  7 , Maria Alevizaki  8 , Göksun Ayvaz  9 , Tomasz Bednarczuk  10 , Biljana Nedeljković Beleslin  2 , Eszter Berta  5 , Miklos Bodor  5 , Anna Maria Borissova  11 , Mihail Boyanov  12 , Camille Buffet  13 , Maria-Cristina Burlacu  14 , Jamina Ćirić  2 , Chagit Adler Cohen  15 , Juan J Díez  16   17   18 , Harald Dobnig  19 , Valentin Fadeyev  20 , Benjamin C T Field  21 , Eric Fliers  22 , Dagmar Führer  23 , Juan C Galofré  24 , Tommi Hakala  25 , Jiskra Jan  26 , Peter Kopp  27 , Michael Krebs  28 , Michal Kršek  26 , Martin Kužma  29 , Laurence Leenhardt  13 , Vitaliy Luchytskiy  30 , Francisca Marques Puga  31 , Anne McGowan  32 , Miguel Melo  33 , Saara Metso  34 , Carla Moran  35   36   37 , Tatyana Morgunova  20 , Dan Alexandru Niculescu  38 , Božidar Perić  39 , Tereza Planck  40 , Catalina Poiana  38 , Eyal Robenshtok  41 , Patrick Olivier Rosselet  42 , Marek Ruchala  43 , Kamilla Ryom Riis  4 , Alla Shepelkevich  44 , Mykola Tronko  45 , David Unuane  46 , Irfan Vardarli  47   48 , Edward Visser  49 , Andromachi Vryonidou  50 , Younes R Younes  51 , Petros Perros  52
Affiliations

Use of levothyroxine for euthyroid, thyroid antibody positive women with infertility: Analyses of aggregate data from a survey of European thyroid specialists (Treatment of Hypothyroidism in Europe by Specialists: An International Survey)

Roberto Negro et al. Clin Endocrinol (Oxf). 2024 Aug.

Abstract

Objectives: The use of levothyroxine (LT4) treatment aiming to improve fertility in euthyroid women with positive thyroid peroxidase antibodies (TPOAb) is not supported by the available evidence. The aim of the study was to document the use of LT4 by European thyroid specialists in such patients.

Design: The data presented derive from Treatment of Hypothyroidism in Europe by Specialists, an International Survey (THESIS), a questionnaire conducted between 2019 and 2021 to document the management of hypothyroidism by European thyroid specialists. Here, we report the aggregate results on the use of LT4 in infertile, euthyroid women with positive TPOAb.

Results: A total of 2316/5406 (42.8%) respondents stated that LT4 may be indicated in TPOAb positive euthyroid women with infertility. The proportion of those replying positively to this question varied widely across different countries (median 39.4, range 22.9%-83.7%). In multivariate analyses males (OR: 0.8; CI: 0.7-0.9) and respondents >60 years (OR: 0.7; 0.6-0.8) were the least inclined to consider LT4 for this indication. Conversely, respondents managing many thyroid patients ("weekly" [OR: 1.4; CI: 1.0-1.9], "daily" [OR: 1.8; CI: 1.3-2.4]) and practicing in Eastern Europe (OR: 1.5; CI: 1.3-1.9) were most likely to consider LT4.

Conclusions: A remarkably high number of respondents surveyed between 2019 and 2021, would consider LT4 treatment in TPOAb positive euthyroid women with infertility. This view varied widely across countries and correlated with sex, age and workload, potentially influencing patient management. These results raise concerns about potential risks of overtreatment.

Keywords: antithyroid antibodies; female infertility; levothyroxine; survey; thyroid hormone; treatment.

PubMed Disclaimer

References

REFERENCES

    1. Silva JF, Ocarino NM, Serakides R. Thyroid hormones and female reproduction. Biol Reprod. 2018;99:907‐921.
    1. Krassas GE, Pontikides N, Kaltsas T, Papadopoulou P, Batrinos M. Menstrual disturbances in thyrotoxicosis. Clin Endocrinol. 1994;40:641‐644.
    1. Krassas GE, Pontikides N, Kaltsas T, et al. Disturbances of menstruation in hypothyroidism. Clin Endocrinol. 1999;50:655‐659.
    1. Ylöstalo P, Kujala P, Kontula K. Amenorrhea with low normal thyroid function and thyroxine treatment. Int J Gynecol Obstet. 1980;18:176‐180.
    1. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87:489‐499.

LinkOut - more resources