Pre-conceptional Management of Thyroid Dysfunction and Presumption of Recurrent Pregnancy Loss

Open Access

Abstract

Background: Recurrent pregnancy loss (RPL) affects 1-2% of women, with many cases remaining unexplained. Thyroid dysfunction and autoimmunity may contribute to pregnancy loss, but evidence on pre-conceptional thyroid evaluation and management in women with RPL is limited. This study assessed its association with subsequent pregnancy outcomes. Methods & Materials: A hospital-based prospective observational study was conducted among 60 women with recurrent pregnancy loss and thyroid dysfunction at the study was conducted at the Outpatient Department of Feni Diabetes Hospital (a sister concern of BIRDEM) 100-Bed Hospital in Feni Sadar, from January 2025 to December 2025. 30 with subclinical hypothyroidism, 18 with overt hypothyroidism, and 12 with hyperthyroidism. Baseline demographic and thyroid profiles were recorded, followed by individualized thyroid management and serial thyroid function monitoring before conception. Participants were prospectively followed for conception, miscarriage, and live birth. Data were analyzed using IBM SPSS Statistics, with p<0.05 considered statistically significant. Results: Among 60 women, 30 (50.0%) had subclinical hypothyroidism, 18 (30.0%) overt hypothyroidism, and 12 (20.0%) hyperthyroidisms. Mean age was 30.19±2.89 years, and 28 (46.7%) were TPO-Ab positive. Pre-conceptional management significantly reduced mean TSH from 8.28±6.88 to 2.44±1.87 mIU/L (p<0.001), with 49 (81.7%) achieving target thyroid status. Overall, 54 (90.0%) conceived and 48 (88.9%) achieved live birth. Among women who conceived, miscarriage was significantly lower in those achieving the thyroid target than in those who did not (6.5% vs. 37.5%, p=0.036). Age, BMI, previous pregnancy losses, post-management TSH, and TPO-Ab status did not differ significantly between women with live birth and miscarriage (p>0.05). Conclusion: Pre-conceptional thyroid management was associated with improved thyroid control and favorable pregnancy outcomes, with significantly lower miscarriage among women who achieved the predefined thyroid target.