Thyroid Function and Conception

This clinical decision article examines whether to initiate levothyroxine treatment in a 31 year old woman with normal thyroid function but positive thyroid peroxidase antibodies (TPOAb) and a history of miscarriage. Two expert perspectives are presented:

1. Option 1 (Leung): Advocates for low-dose levothyroxine, citing studies linking TPOAb positivity to increased miscarriage risk and potential benefits of treatment (e.g., reduced pregnancy loss in some trials).

2. Option 2 (Korevaar): Recommends against treatment, noting lack of robust evidence that levothyroxine improves live birth rates in TPOAb positive women with normal thyroid function, and emphasizes monitoring instead.
   Key considerations include thyroid hormone’s role in early pregnancy, conflicting trial results (e.g., the TABLET trial showed no benefit), and the safety of levothyroxine. The debate highlights the need for personalized care and further research.

This clinical decision article examines whether to initiate levothyroxine treatment in a 31 year old woman with normal thyroid function but positive thyroid peroxidase antibodies (TPOAb) and a history of miscarriage. Two expert perspectives are presented:

1. Option 1 (Leung): Advocates for low-dose levothyroxine, citing studies linking TPOAb positivity to increased miscarriage risk and potential benefits of treatment (e.g., reduced pregnancy loss in some trials).

2. Option 2 (Korevaar): Recommends against treatment, noting lack of robust evidence that levothyroxine improves live birth rates in TPOAb positive women with normal thyroid function, and emphasizes monitoring instead.
   Key considerations include thyroid hormone’s role in early pregnancy, conflicting trial results (e.g., the TABLET trial showed no benefit), and the safety of levothyroxine. The debate highlights the need for personalized care and further research.