Table 2.
Recommendations regarding the treatment for thyroid autoimmunity during preconception period and pregnancy.
| ASRM, 2015 (115) | ATA, 2017 (12) | ETA, 2021 (78) |
|---|---|---|
| Preconception | ||
| Not discussed | For women attempting natural conception: no recommendations for treatment with LT4, selenium, and glucocorticoids |
For women undergoing ART: No recommendations for routine LT4 treatment in euthyroid women with TAI before ART Consider LT4 treatment with a low dose of 25–50 μg/day before ovarian stimulation in women with TAI and TSH levels >2.5 and <4.0 mIU/L/ULRR in the following cases: • ovarian causes of subfertility • age >35 years • history of recurrent miscarriage • high levels of thyroid antibodies |
| For women undergoing ART: LT4 may be considered in a low starting dose (25–50 µg/day) Glucocorticoid therapy not recommended | ||
| Pregnancy | ||
| Consider treatment with LT4 in TPOAb-positive women when TSH >2.5 mIU/L | Consider treatment with LT4 in a low starting dose (25-50 μg/day): • when TPOAb-positive and 2.5 mIU/L < TSH <pregnancy-specific reference range (or 4 mIU/L) • in women with recurrent pregnancy loss |
Not discussed |
| LT4 not recommended in the prevention of premature delivery | ||
| Intravenous immunoglobulin treatment not recommended in women with recurrent pregnancy loss | ||
| Selenium not recommended in TPOAb-positive pregnant women | ||
| TPOAb- or TgAb-positive euthyroid pregnant women should be monitored with TSH measurement every 4 weeks until midgestation and at least once near 30 weeks of gestation | ||
ASRM, American Society for Reproductive Medicine; ATA, American Thyroid Association; ETA, European Thyroid Association; TPOAb, thyroperoxidase antibody; TgAb, thyroglobulin antibody; TSH, thyroid-stimulating hormone; LT4, levothyroxine; ART, assisted reproductive technology; TAI, thyroid autoimmunity; ULRR, upper limit of the reference range.