A 28 year old married female GO with a complaint of alopecia, weight gain, fatigue, cold intolerance, constipation and oligomenorrhea report that she has never been able to conceive (infertility) x 5 years. She weighs 250 lbs. you proceed to check all the necessary labs which came back normal except free T4 was low and TSH was 300.
What is the diagnosis and how would you treat?
Endocrine Corner (Answer)
So you diagnose her with Hypothyroidism and start levothyroxine at 1.6 mcg/kg per day and you schedule her for a follow up in 4-6 weeks with TSH and T4 labs.
You also educate her that studies have shown that hypothyroidism can affect infertility due to
anovulatory cycles, Luteal phase defects, hyperprolactinemia, and sex hormone imbalance. It can reduce size of ovarian follicles as well (Verma, I. Sood, R., Juneja, S, Kaur, S (2002), Longo et al. 2012)