TPO antibodies in subclinical hypothyroidism and pregnancy

Should management be the same in thyroid peroxidase antibody (TPOAb)-negative and TPOAb-positive women with subclinical hypothyroidism who are planning a pregnancy and who are newly pregnant?

Leonard Wartofsky, MD: TPO-positive women, meaning that they have underlying Hashimoto thyroiditis, are at greater risk for infertility, difficulty with conception, miscarriage once pregnant, and in general for other problems with pregnancy. So we are a bit more aggressive about initiating thyroxine therapy in TPO-positive women.

If the TPO-negative woman still has subclinical hypothyroidism, then the result would be the same in terms of initiation of thyroxine replacement.