Subclinical Hypothyroidism in the Infertile Female Population

Publication Date: September 1, 2015
Last Updated: March 14, 2022


Currently available data support that it is reasonable to test TSH in infertile women attempting pregnancy. If TSH concentrations are over the nonpregnant lab reference range (typically >4 mIU/L), patients should be treated with levothyroxine to maintain levels below 2.5 mIU/L. (, B)

Given the limited data, if TSH levels prior to pregnancy are between 2.5 and 4 mIU/L, management options include either monitoring levels and treating when TSH >4 mIU/L, or treating with levothyroxine to maintain TSH <2.5 mIU/L. (, C)

During the first trimester of pregnancy it is advisable to treat when the TSH is >2.5 mIU/L. (, B)

While thyroid antibody testing is not routinely recommended, one might consider testing anti-thyroperoxidase (TPO) antibodies for repeated TSH values >2.5 mIU/L or when other risk factors for thyroid disease are present. (, C)

If anti-TPO antibodies are detected, TSH levels should be checked and treatment should be considered if the TSH level is over 2.5 mIU/L. (, B)

Recommendation Grading




Subclinical Hypothyroidism in the Infertile Female Population

Authoring Organization

Publication Month/Year

September 1, 2015

Last Updated Month/Year

December 2, 2022

Document Type


External Publication Status


Country of Publication


Document Objectives

There is controversy regarding whether to treat subtle abnormalities of thyroid dysfunction in the infertile female patient. This guideline document reviews the risks and benefits of treating subclinical hypothyroidism in female patients with a history of infertility and miscarriage, as well as obstetrical and neonatal outcomes in this population.

Target Patient Population

Female patients who have subclinical hypothyroidism with a history of infertility and miscarriage

Inclusion Criteria

Female, Adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D007037 - Hypothyroidism, D007246 - Infertility, D007247 - Infertility, Female


infertility, hypothyroidism, thyroid stimulating hormone (TSH), levothyroxine

Source Citation

Subclinical hypothyroidism in the infertile female population: a guideline

Fertility and Sterility, Volume 104, Issue 3, 545 - 553