Thyroid stimulating hormone levels rise after assisted reproductive technology

Reinblatt, Shauna; Herrero, Belen; Correa, José A.; Shalom-Paz, Einat; Ata, Barış; Wiser, Amir; Morris, David; Holzer, Hananel

doi:10.1007/s10815-013-0081-3

Cited by 34 publications

(24 citation statements)

References 31 publications

(35 reference statements)

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“…In this special setting of IVF, however, caution has to be used when measuring TSH at an early time of pregnancy since blood levels of TSH and fT4 show a unique positive feedback situation with slightly elevated TSH levels. This TSH peculiarity has also been observed by other authors [21]. Parallel to this early elevation of TSH levels we also observed a reciprocal decrease of magnesium levels.…”

Section: Clinical Studies Dealing With Reference Levels For Tsh In Prsupporting

confidence: 91%

A post-publication analysis of the idealized upper reference value of 2.5 mIU/L for TSH: Time to support the thyroid axis with magnesium and iron especially in the setting of reproduction medicine

Moncayo¹,

Moncayo²

2017

BBA Clinical

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Laboratory medicine approaches the evaluation of thyroid function mostly through the single determination of the blood level of thyroid stimulating hormone (TSH). Some authors have suggested an upper reference value for TSH of 2.5 mIU/L. This suggestion has not been confirmed by recent clinical studies. These studies have delivered a clinically valid reference range going from 0.3 to 3.5 mIU/L. These values are valid for both for the general population as well as in the setting of fertility and pregnancy.Current biochemical evidence about the elements required to maintain thyroid function shows that these not only include dietary iodine but also magnesium, iron, selenium and coenzyme Q10. Iron is important for the synthesis of thyroid peroxidase; magnesium-ATP contributes to the active process of iodine uptake; iodine has to be sufficiently present in the diet; selenium acts through selenoproteins to protect the thyroid cell during hormone synthesis and in deiodination of thyroxine; coenzyme Q10 influences thyroid vascularity. As a consequence, good clinical practice requires additional biochemical information on the blood levels of magnesium, selenium, coenzyme Q10 as well as iron status.Since these elements are also important for the maintenance of reproductive function, we postulate that they constitute the connecting link between both endocrine systems.

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Section: Clinical Studies Dealing With Reference Levels For Tsh In Prsupporting

confidence: 91%

A post-publication analysis of the idealized upper reference value of 2.5 mIU/L for TSH: Time to support the thyroid axis with magnesium and iron especially in the setting of reproduction medicine

Moncayo¹,

Moncayo²

2017

BBA Clinical

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“…Several independent studies have reported a significant increase in serum TSH during COH or within 1 month after COH (6,7,8,9,10,11,12). The causes of these modifications have not yet been fully clarified.…”

Section: Introductionmentioning

confidence: 99%

Levothyroxine dose adjustment in hypothyroid women achieving pregnancy through IVF

Busnelli

Vannucchi

Paffoni

et al. 2015

European Journal of Endocrinology

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Objective: About one out of two women with primary hypothyroidism has to increase the dosage of exogenous levothyroxine (L-T 4 ) during pregnancy. Considering the detrimental impact of IVF on thyroid function, it has been claimed but not demonstrated that L-T 4 dose adjustment may be more significant in hypothyroid women who become pregnant after IVF. Design: Retrospective cohort study. Methods: Hypothyroid-treated women who achieved a live birth through IVF were reviewed. Women could be included if thyroid function was well compensated with L-T 4 before the IVF cycle (i.e., serum TSH !2.5 mIU/l and serum free T 4 within the normal range). Serum TSH and dose adjustment were evaluated at five time points during pregnancy. The trimester ranges for serum TSH considered as reference to adjust L-T 4 therapy were 0.1-2.5 mIU/l for the first trimester, 0.2-3.0 mIU/l for the second trimester, and 0.3-3.0 mIU/l for the third trimester. Results: Thirty-eight women were selected. During the whole pregnancy 32 women (84%; 95% CI: 72-96%) required an increase in the dose of L-T 4 . In most cases (nZ28), this occured within the first 5-7 weeks of gestation (74%, 95% CI: 58-85%). At 5-7 weeks of gestation, the median (interquartile range) increase of L-T 4 dose for the whole cohort was 26% (0-50%). At 30-32 weeks, it was 33% (14-68%). In order to identify predictive factors of dose adjustment, we compared women who did (nZ28) and did not (nZ10) adjust L-T 4 dosage at 5-7 weeks' gestation. Significant differences emerged for thyroid autoimmunity prevalence and for the distribution of hypothyroidism aetiology. Conclusions: The vast majority of hypothyroid-treated women who achieve pregnancy through IVF need an increase in the L-T 4 dose during gestation. This requirement tends to occur very early during gestation.

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“…In addition, this present study observed significantly higher TSH levels in women who were undertaking IVF treatment. There have been a few authors that have investigated the relationship between thyroid function and controlled ovarian hyperstimulation (COH) in IVF cycles and show that TSH increases significantly with a rise in oestrogen [38,39] and elevated TSH is linked to decreased fertilisation rates in those women undertaking IVF treatment [37]. The reasons as to why TSH is higher in this treatment group is uncertain, especially since these patients are undertaking fertility treatment due to a number of various underlying conditions (for example endometriosis, PCOS, male factor).…”

Section: Thyroid Function During Conception Cyclesmentioning

confidence: 99%

Longitudinal Changes in Thyroid Hormones During Conception Cycles and Early Pregnancy

Hamilton¹,

Hadlow²,

Roberts³

et al. 2017

Clin Med Biochemistry

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Objective: The aim of this study was to characterize changes in free triiodothyronine (fT3), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) during the follicular and luteal phase and during subsequent early pregnancy in individual women.Method: TPOAb negative women with a viable pregnancy (n=49) had fT3, fT4 and TSH measured longitudinally in serum samples at baseline/non-pregnant (gestation week 0), ovulation (gestation week 2), mid-luteal phase (gestation week 3) and twice weekly from gestation weeks 4 to 6.5. Patient groups received in their conception cycle either no medication (n=13), low ovarian stimulation, (n=17) or controlled ovarian hyperstimulation (COH) for IVF treatment (n=19).Results: Women receiving COH had a transient drop in TSH at the time of ovulation followed by a peak at midluteal (p=0.024). Levels of fT3 and fT4 at each gestation week were not significantly different between the treatment groups, whereas TSH levels were significantly higher at all gestation weeks (p=0.036) in the COH group compared to the natural and low stimulation groups. There were significant changes in thyroid function once pregnancy was established (gestation week 4) through to gestation week 6.5, with a gradual decrease in serum fT3 (r=-0.104, p=0.030) and TSH (r=-0.123 p=0.031), whilst fT4 levels remained constant. 3 women (6.1%) had TSH levels >4.0 mU/L during their pregnancy although these were isolated measurements. Conclusion:Thyroid hormones in individual women did not remain constant but showed discrete changes. TSH was significantly lower at time of ovulation in women who received high doses of ovarian stimulation medication for IVF, and was higher throughout pregnancy than for the other groups. Serum fT3 and TSH decreased significantly during early pregnancy irrespective of medication given in the conception cycle.

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Thyroid stimulating hormone levels rise after assisted reproductive technology

Cited by 34 publications

References 31 publications

A post-publication analysis of the idealized upper reference value of 2.5 mIU/L for TSH: Time to support the thyroid axis with magnesium and iron especially in the setting of reproduction medicine

A post-publication analysis of the idealized upper reference value of 2.5 mIU/L for TSH: Time to support the thyroid axis with magnesium and iron especially in the setting of reproduction medicine

Levothyroxine dose adjustment in hypothyroid women achieving pregnancy through IVF

Longitudinal Changes in Thyroid Hormones During Conception Cycles and Early Pregnancy

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