Autoimmune thyroid disease and subfertility, miscarriage link

autoimmue thyroid miscarriage Dr Agnes Ryu

Thyroid antibodies (anti-thyroperoxidase and anti-thyroglobulin antibodies) are often elevated for decades before showing any change in TSH level, as often seen in Hashimoto’s disease, the most common cause of hypothyroidism. The presence of thyroid antibodies means that the immune system is targeting the thyroid gland and active destruction is occurring. Women with Hashimoto’s autoimmune thyroid disease are at higher risk of fertility problems.

  • The general rate of infertility in the population is 10-15%. However, the infertility rate among women with autoimmune thyroid disease is as high as 50%.
  • The general miscarriage rate (pregnancy loss before week 24) is around 20%; however, the risk of miscarriage for a woman who tests positive for thyroid antibodies is at least doubled or tripled, especially during the first trimester.
  • Studies have also demonstrated that the miscarriage rate with IVF is higher in women who have thyroid antibodies.


It is suggested that thyroid antibodies not only attack the thyroid gland but may “cross-react” and attack other tissues. The presence of anti-thyroid antibodies in ovarian follicles may play a critical role in female subfertility.  The attack in placental or foetal tissues may cause early miscarriage. It has been found that a person who has an autoimmune condition like Hashimoto’s is more vulnerable to developing other autoimmune conditions that can attack reproductive tissues.  Autoimmunity to reproductive tissue can cause premature ovarian failure (POF), the loss of ovarian function before age 40. A woman with premature ovarian failure goes into menopause a decade earlier and will likely struggle with fertility due to the lack of ovulation and many serious health issues arising from oestrogen deficiency.


I find that a high proportion of the patients who come with fertility issues have suboptimal thyroid function and they are living with a long term hypometabolic condition.

  • Those diagnosed with underactive thyroid function are rarely checked for the existence of thyroid antibodies and many patients do not realize the autoimmune nature of their condition.
  • It is known that most cases of thyroid disease are autoimmune disease. Autoimmune thyroid disease, Hashimoto’s thyroiditis is one of the most common yet commonly undiagnosed diseases in the world.
  • The conventional treatment with L-thyroxine (thyroid hormone T4) is not always satisfactory, patients remain tired, do not feel well and autoimmune thyroid destruction continues.
  • Elevation of antibodies may occur insidiously over a long period of time with or without symptoms and this elevation is often not reflected in changes in TSH level.
  • Being within a normal TSH range does not guarantee normal thyroid function and doesn’t rule out autoimmunity.
  • There is no pharmaceutical solution for thyroid autoimmunity.
  • Autoimmune disorder is no longer a rarity, it has increased rapidly recently. Something in our environment or modern lifestyle is conflicting with our genome and causing our immune system to malfunction.
  • Birth control pills wreak havoc on thyroid. All hormonal treatment is known to tax the thyroid heavily.  Assisted reproduction, such as IVF is an additional strain on the thyroid. Pregnancy is regarded as a stress test for the thyroid.
  • Thyroid autoimmunity should be addressed using a whole-person perspective and multi-faceted lifestyle modifications are often required.
  • Low vitamin D3 levels have been linked to autoimmune thyroid diseases including Hashimoto’s and Graves’ thyroiditis. Adequate levels of vitamin D3 protect the immune system from attacking itself.
  • Autoimmunity is known to originate from the gut. Therefore, restoration of gut intestinal permeability, microbiome and food/chemical sensitivity or intolerance issues should be addressed. Nutritional support is essential.
  • Stress management, treatment of viral infections, removal of environmental toxins are part of the treatment plan.


Dr Ryu’s articles on thyroid:

The master gland of metabolism, the thyroid

Thyroid assessment for pregnancy

How fatigue depletes fertility?

Agnes Ryu

Agnes Ryu

Dr. Ryu is a clinician and biochemist specializing in integrative medicine. Her clinical interests include fertility, hormones, metabolism, healthy ageing, menopause, and natural breast cancer care. As an integrative practitioner, Dr. Ryu aims to uncover the root causes of health issues and strives to empower patients with the knowledge and tools to take charge of their own health.

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