Abstract
Overt hypothyroidism characterized by an elevated TSH accompanied with low free T4 has been associated with oligo-ovulation, pregnancy complications, and adverse fetal neurodevelopment. Subclinical hypothyroidism has been classically defined as an elevated TSH above the laboratory normal value with a normal free T4. Recently, some have advocated lowering the upper limit of normal to 2.5 mIU/L in some patient groups at high risk of hypothyroidism including women with infertility. While subclinical hypothyroidism when defined by the classic definition may be associated with adverse outcomes, data are lacking regarding the impact of TSH between 2.5 and 4 mIU/L with respect to fertility, pregnancy outcomes, or fetal neurodevelopment. In addition, the association between the presence of thyroid peroxidase antibody and infertility or miscarriage is controversial. TSH screening test has become a standard test in the basic evaluation of infertility, and clinicians are obligated to decide how to manage TSH valued between 2.5 and 4 mIU/L without strong evidence in the literature.
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