Prediction of early pregnancy maternal thyroid impairment in women affected with unexplained recurrent miscarriage

Alessandro Dal Lago, Elena Vaquero, Patrizio Pasqualetti, Natalia Lazzarin, Caterina De Carolis, Roberto Perricone, Costanzo Moretti

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Proper maternal thyroid function is necessary for a successful pregnancy. In order to identify women who may experience miscarriage due to transient impairment of the pituitarythyroid axis in early pregnancy, we aimed to investigate the ratio between basal and peak thyroid stimulating hormone (TSH) [following stimulus with thyrotrophin-releasing hormone (TRH)] in euthyroid women with unexplained recurrent miscarriage (RM). Methods We have established a 'iTSHa index (TSH increase after TRH adjusted for the levels of basal TSH), determining TSH serum levels at time 0 and 20 min after TRH stimulus in 463 consecutive women attending two antenatal care units for two or more miscarriages occurring within the first 10 weeks of pregnancy. Results The mean basal TSH serum levels were higher (P <0.001) in RM women [2.1 μIU/ml; 95% confidence interval (CI): 2.0-2.2] compared with the controls (1.3 μIU/ml; 95% CI: 1.2-1.4). Establishing serum TSH at an individual level, a large overlap was observed and the receiver operating characteristic curves did not allow us to find an optimal cut-off point with an adequate sensitivity/specificity ratio. Therefore, we suggest a novel statistical model, the 'iTSHa index (available on, that is capable of identifying women with RM due to transient thyroid function impairment of the early pregnancy, in particular when baseline serum TSH is less than 1.5 μIU/ml, i.e. well below the conventional upper cut-off indicated as 'safe in those who want to conceive. CONCLUSIONS A transient impairment of thyroid function in early pregnancy may cause an inadequate adaptation to the increased thyroid requirement and may be implicated in RM. The evaluation of the proposed iTSHa index, if validated in a larger cohort of patients, may provide information useful to identifying a subset of healthy women, without evidence of thyroid dysfunction or autoimmunity and a TSH in the low-normal reference range, who may be at risk of RM.

Original languageEnglish
Pages (from-to)1324-1330
Number of pages7
JournalHuman Reproduction
Issue number6
Publication statusPublished - Jun 2011


  • iTSHa
  • pregnancy
  • recurrent miscarriage
  • thyroid
  • TSH

ASJC Scopus subject areas

  • Rehabilitation
  • Obstetrics and Gynaecology
  • Reproductive Medicine


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