Skip to main content
SpringerLink
Log in

Thyroid Autoimmunity and Miscarriage

  • Chapter
  • First Online:
Thyroid Disease and Reproduction

  • 973 Accesses

Abstract

Thyroid autoimmunity describes the condition in which one or more antibodies are directed at the thyroid gland. Examples of these antibodies include the thyroid peroxidase (TPO), thyroglobulin (Tg), and thyroid receptor antibodies (TRAbs). The presence of these antibodies has been associated with adverse pregnancy outcomes in some populations. This chapter explores the current literature regarding the association between thyroid autoantibodies and miscarriage in various patient populations, including patients with isolated thyroid autoimmunity, thyroid autoimmunity and subclinical hypothyroidism, thyroid autoimmunity in patients undergoing assisted reproduction, and thyroid autoimmunity in patients with recurrent pregnancy loss. The chapter also discusses current evidence regarding treatment with levothyroxine in these populations. Finally, we summarize the recommendations from the American Thyroid Association and the American Society for Reproductive Medicine for thyroid antibody-positive patients who are either currently pregnant or attempting to conceive.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ASRM:

American Society for Reproductive Medicine

ATA:

American Thyroid Association

hCG:

human chorionic gonadotropin; SAB, spontaneous abortion

RPL:

recurrent pregnancy loss

T3:

triiodothyronine

T4:

thyroxine

TBG:

thyroid-binding globulin

Tg:

thyroglobulin

TgAb:

thyroglobulin antibodies

TPO:

thyroid peroxidase

TPOAb:

thyroid peroxidase antibodies

TRAb:

thyroid receptor antibodies

TSH:

thyroid-stimulating hormone

TSI:

thyroid-stimulating immunoglobulin

References

  1. Chardès T, Chapal N, Bresson D, Bès C, Giudicelli V, Lefranc M-P, Péraldi-Roux S. The human anti-thyroid peroxidase autoantibody repertoire in graves’ and Hashimoto’s autoimmune thyroid diseases. Immunogenetics. 2002;54:141–57.

    Article  Google Scholar 

  2. Li L, Paul S, Tyutyulkova S, Kazatchkine MD, Kaveri S. Catalytic activity of anti-thyroglobulin antibodies. J Immunol. 1995;154(7):3328–32.

    CAS  PubMed  Google Scholar 

  3. Wootla B, Lacroix-Desmazes S, Warrington AE, Bieber AJ, Kaveri SV, Rodriguez M. Autoantibodies with enzymatic properties in human autoimmune diseases. J Autoimmun. 2011;37:144–50.

    Article  CAS  Google Scholar 

  4. Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and nutrition examination survey (NHANES III). J Clin Endocrinol Metab. 2002;87:489–99.

    Article  CAS  Google Scholar 

  5. La’ulu SL, Roberts WL. Second-trimester reference intervals for thyroid tests: the role of ethnicity. Clin Chem. 2007;53:1658–64.

    Article  Google Scholar 

  6. Shi X, Han C, Li C, et al. Optimal and safe upper limits of iodine intake for early pregnancy in iodine-sufficient regions: a cross-sectional study of 7190 pregnant women in China. J Clin Endocrinol Metab. 2015;100:1630–8.

    Article  CAS  Google Scholar 

  7. Twig G, Shina A, Amital H, Shoenfeld Y. Pathogenesis of infertility and recurrent pregnancy loss in thyroid autoimmunity. J Autoimmun. 2012;38:J275–81.

    Article  CAS  Google Scholar 

  8. Unuane D, Velkeniers B, Anckaert E, Schiettecatte J, Tournaye H, Haentjens P, Poppe K. Thyroglobulin autoantibodies: is there any added value in the detection of thyroid autoimmunity in women consulting for fertility treatment? Thyroid. 2013;23:1022–8.

    Article  CAS  Google Scholar 

  9. Alexander EK, Pearce EN, Brent GA, et al. 2017 guidelines of the American Thyroid Association for the diagnosis and Management of Thyroid Disease during Pregnancy and the postpartum. Thyroid. 2017;27:315–89.

    Article  Google Scholar 

  10. Moreno-Reyes R, Glinoer D, Van Oyen H, Vandevijvere S. High prevalence of thyroid disorders in pregnant women in a mildly iodine-deficient country: a population-based study. J Clin Endocrinol Metab. 2013;98:3694–701.

    Article  CAS  Google Scholar 

  11. Ashoor G, Maiz N, Rotas M, Jawdat F, Nicolaides KH. Maternal thyroid function at 11 to 13 weeks of gestation and subsequent fetal death. Thyroid. 2010;20:989–93.

    Article  Google Scholar 

  12. Benhadi N, Wiersinga WM, Reitsma JB, Vrijkotte TGM, van der Wal MF, Bonsel GJ. Ethnic differences in TSH but not in free T4 concentrations or TPO antibodies during pregnancy. Clin Endocrinol. 2007;66:765–70.

    Article  CAS  Google Scholar 

  13. Abbassi-Ghanavati M, Casey BM, Spong CY, McIntire DD, Halvorson LM, Cunningham FG. Pregnancy outcomes in women with thyroid peroxidase antibodies. Obstet Gynecol. 2010;116:381–6.

    Article  Google Scholar 

  14. Pearce EN, Oken E, Gillman MW, Lee SL, Magnani B, Platek D, Braverman LE. Association of first-trimester thyroid function test values with thyroperoxidase antibody status, smoking, and multivitamin use. Endocr Pract. 2008;14:33–9.

    Article  Google Scholar 

  15. Wasserman EE, Nelson K, Rose NR, Eaton W, Pillion JP, Seaberg E, Talor MV, Burek L, Duggan A, Yolken RH. Maternal thyroid autoantibodies during the third trimester and hearing deficits in children: an epidemiologic assessment. Am J Epidemiol. 2008;167:701–10.

    Article  Google Scholar 

  16. Geva E, Vardinon N, Lessing JB, Lerner-Geva L, Azem F, Yovel I, Burke M, Yust I, Grunfeld R, Amit A. Organ-specific autoantibodies are possible markers for reproductive failure: a prospective study in an in-vitro fertilization-embryo transfer programme. Hum Reprod. 1996;11:1627–31.

    Article  CAS  Google Scholar 

  17. Kaider AS, Kaider BD, Janowicz PB, Roussev RG. Immunodiagnostic evaluation in women with reproductive failure. Am J Reprod Immunol. 1999;42:335–46.

    Article  CAS  Google Scholar 

  18. Janssen OE, Mehlmauer N, Hahn S, Offner AH, Gärtner R. High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Eur J Endocrinol. 2004;150:363–9.

    Article  CAS  Google Scholar 

  19. Kutteh WH, Yetman DL, Carr AC, Beck LA, Scott RT. Increased prevalence of antithyroid antibodies identified in women with recurrent pregnancy loss but not in women undergoing assisted reproduction. Fertil Steril. 1999;71:843–8.

    Article  CAS  Google Scholar 

  20. Negro R, Formoso G, Coppola L, Presicce G, Mangieri T, Pezzarossa A, Dazzi D. Euthyroid women with autoimmune disease undergoing assisted reproduction technologies: the role of autoimmunity and thyroid function. J Endocrinol Investig. 2007;30:3–8.

    Article  CAS  Google Scholar 

  21. Bussen S, Steck T. Thyroid autoantibodies in euthyroid non-pregnant women with recurrent spontaneous abortions. Hum Reprod. 1995;10:2938–40.

    Article  CAS  Google Scholar 

  22. Pratt D, Novotny M, Kaberlein G, Dudkiewicz A, Gleicher N. Antithyroid antibodies and the association with non-organ-specific antibodies in recurrent pregnancy loss. Am J Obstet Gynecol. 1993;168:837–41.

    Article  CAS  Google Scholar 

  23. Muller AF, Verhoeff A, Mantel MJ, Berghout A. Thyroid autoimmunity and abortion: a prospective study in women undergoing in vitro fertilization. Fertil Steril. 1999;71:30–4.

    Article  CAS  Google Scholar 

  24. Glinoer D, Riahi M, Grün JP, Kinthaert J. Risk of subclinical hypothyroidism in pregnant women with asymptomatic autoimmune thyroid disorders. J Clin Endocrinol Metab. 1994;79:197–204.

    CAS  PubMed  Google Scholar 

  25. Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab. 2006;91:2587–91.

    Article  CAS  Google Scholar 

  26. Ellish NJ, Saboda K, O’Connor J, Nasca PC, Stanek EJ, Boyle C. A prospective study of early pregnancy loss. Hum Reprod. 1996;11:406–12.

    Article  CAS  Google Scholar 

  27. Wilcox AJ, Weinberg CR, O’Connor JF, Baird DD, Schlatterer JP, Canfield RE, Armstrong EG, Nisula BC. Incidence of early loss of pregnancy. N Engl J Med. 1988;319:189–94.

    Article  CAS  Google Scholar 

  28. De Vivo A, Mancuso A, Giacobbe A, Moleti M, Maggio Savasta L, De Dominici R, Priolo AM, Vermiglio F. Thyroid function in women found to have early pregnancy loss. Thyroid. 2010;20:633–7.

    Article  Google Scholar 

  29. Liu H, Shan Z, Li C, et al. Maternal subclinical hypothyroidism, thyroid autoimmunity, and the risk of miscarriage: a prospective cohort study. Thyroid. 2014;24:1642–9.

    Article  CAS  Google Scholar 

  30. Stagnaro-Green A, Roman SH, Cobin RH, el-Harazy E, Alvarez-Marfany M, Davies TF. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. JAMA. 1990;264:1422–5.

    Article  CAS  Google Scholar 

  31. Sieiro Netto L, Medina Coeli C, Micmacher E, Mamede Da Costa S, Nazar L, Galvão D, Buescu A, Vaisman M. Influence of thyroid autoimmunity and maternal age on the risk of miscarriage. Am J Reprod Immunol. 2004;52:312–6.

    Article  Google Scholar 

  32. Poppe K, Glinoer D, Tournaye H, Devroey P, van Steirteghem A, Kaufman L, Velkeniers B. Assisted reproduction and thyroid autoimmunity: an unfortunate combination? J Clin Endocrinol Metab. 2003;88:4149–52.

    Article  CAS  Google Scholar 

  33. Seungdamrong A, Steiner AZ, Gracia CR, et al. Preconceptional antithyroid peroxidase antibodies, but not thyroid-stimulating hormone, are associated with decreased live birth rates in infertile women. Fertil Steril. 2017. pii: S0015-0282(17)31748-X; https://doi.org/10.1016/j.fertnstert.2017.08.026.

    Article  CAS  Google Scholar 

  34. Unuane D, Velkeniers B, Bravenboer B, Drakopoulos P, Tournaye H, Parra J, De Brucker M. Impact of thyroid autoimmunity in euthyroid women on live birth rate after IUI. Hum Reprod. 2017;32:915–22.

    CAS  PubMed  Google Scholar 

  35. Negro R, Mangieri T, Coppola L, et al. Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies: a prospective study. Hum Reprod. 2005;20:1529–33.

    Article  CAS  Google Scholar 

  36. Singh A, Dantas ZN, Stone SC, Asch RH. Presence of thyroid antibodies in early reproductive failure: biochemical versus clinical pregnancies. Fertil Steril. 1995;63:277–81.

    Article  CAS  Google Scholar 

  37. Leiva P, Schwarze JE, Vasquez P, Ortega C, Villa S, Crosby J, Balmaceda J, Pommer R. There is no association between the presence of anti-thyroid antibodies and increased reproductive loss in pregnant women after ART: a systematic review and meta-analysis. JBRA Assist Reprod. 2017;21(4):361–5.

    PubMed  PubMed Central  Google Scholar 

  38. Iravani AT, Saeedi MM, Pakravesh J, Hamidi S, Abbasi M. Thyroid autoimmunity and recurrent spontaneous abortion in Iran: a case-control study. Endocr Pract. 2008;14:458–64.

    Article  Google Scholar 

  39. Dendrinos S, Papasteriades C, Tarassi K, Christodoulakos G, Prasinos G, Creatsas G. Thyroid autoimmunity in patients with recurrent spontaneous miscarriages. Gynecol Endocrinol. 2000;14:270–4.

    Article  CAS  Google Scholar 

  40. Chen L, Hu R. Thyroid autoimmunity and miscarriage: a meta-analysis. Clin Endocrinol. 2011;74:513–9.

    Article  Google Scholar 

  41. Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ. 2011;342:d2616.

    Article  Google Scholar 

  42. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Thyroid antibody positivity in the first trimester of pregnancy is associated with negative pregnancy outcomes. J Clin Endocrinol Metab. 2011;96:E920–4.

    Article  CAS  Google Scholar 

  43. Haddow JE, Cleary-Goldman J, McClain MR, et al. Thyroperoxidase and thyroglobulin antibodies in early pregnancy and preterm delivery. Obstet Gynecol. 2010;116:58–62.

    Article  Google Scholar 

  44. Korevaar TIM, Schalekamp-Timmermans S, de Rijke YB, et al. Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery: the generation R study. J Clin Endocrinol Metab. 2013;98:4382–90.

    Article  CAS  Google Scholar 

  45. Glinoer D, Soto MF, Bourdoux P, Lejeune B, Delange F, Lemone M, Kinthaert J, Robijn C, Grun JP, de Nayer P. Pregnancy in patients with mild thyroid abnormalities: maternal and neonatal repercussions. J Clin Endocrinol Metab. 1991;73:421–7.

    Article  CAS  Google Scholar 

  46. Männistö T, Vääräsmäki M, Pouta A, Hartikainen A-L, Ruokonen A, Surcel H-M, Bloigu A, Järvelin M-R, Suvanto-Luukkonen E. Perinatal outcome of children born to mothers with thyroid dysfunction or antibodies: a prospective population-based cohort study. J Clin Endocrinol Metab. 2009;94:772–9.

    Article  Google Scholar 

  47. Negro R. Thyroid autoimmunity and pre-term delivery: brief review and meta-analysis. J Endocrinol Investig. 2011;34:155–8.

    Article  CAS  Google Scholar 

  48. He X, Wang P, Wang Z, He X, Xu D, Wang B. Thyroid antibodies and risk of preterm delivery: a meta-analysis of prospective cohort studies. Eur J Endocrinol. 2012;167:455–64.

    Article  CAS  Google Scholar 

  49. Groer MW, Vaughan JH. Positive thyroid peroxidase antibody titer is associated with dysphoric moods during pregnancy and postpartum. J Obstet Gynecol Neonatal Nurs. 2013;42:E26–32.

    Article  Google Scholar 

  50. Kuijpens JL, Vader HL, Drexhage HA, Wiersinga WM, van Son MJ, Pop VJ. Thyroid peroxidase antibodies during gestation are a marker for subsequent depression postpartum. Eur J Endocrinol. 2001;145:579–84.

    Article  CAS  Google Scholar 

  51. Li Y, Shan Z, Teng W, et al. Abnormalities of maternal thyroid function during pregnancy affect neuropsychological development of their children at 25-30 months. Clin Endocrinol. 2010;72:825–9.

    Article  CAS  Google Scholar 

  52. Williams FLR, Watson J, Ogston SA, Visser TJ, Hume R, Willatts P. Maternal and umbilical cord levels of T4, FT4, TSH, TPOAb, and TgAb in term infants and neurodevelopmental outcome at 5.5 years. J Clin Endocrinol Metab. 2013;98:829–38.

    Article  CAS  Google Scholar 

  53. Wasserman EE, Pillion JP, Duggan A, Nelson K, Rohde C, Seaberg EC, Talor MV, Yolken RH, Rose NR. Childhood IQ, hearing loss, and maternal thyroid autoimmunity in the Baltimore collaborative perinatal project. Pediatr Res. 2012;72:525–30.

    Article  Google Scholar 

  54. Ghassabian A, Bongers-Schokking JJ, de Rijke YB, et al. Maternal thyroid autoimmunity during pregnancy and the risk of attention deficit/hyperactivity problems in children: the generation R study. Thyroid. 2012;22:178–86.

    Article  CAS  Google Scholar 

  55. Brown AS, Surcel H-M, Hinkka-Yli-Salomäki S, Cheslack-Postava K, Bao Y, Sourander A. Maternal thyroid autoantibody and elevated risk of autism in a national birth cohort. Prog Neuro-Psychopharmacol Biol Psychiatry. 2015;57:86–92.

    Article  CAS  Google Scholar 

  56. Lee YL, Ng HP, Lau KS, Liu WM, O WS, Yeung WSB, Kung AWC. Increased fetal abortion rate in autoimmune thyroid disease is related to circulating TPO autoantibodies in an autoimmune thyroiditis animal model. Fertil Steril. 2009;91:2104–9.

    Article  Google Scholar 

  57. Imaizumi M, Pritsker A, Kita M, Ahmad L, Unger P, Davies T. Pregnancy and murine thyroiditis: thyroglobulin immunization leads to fetal loss in specific allogeneic pregnancies. Endocrinology. 2001;142:823–9.

    Article  CAS  Google Scholar 

  58. Matalon ST, Blank M, Levy Y, et al. The pathogenic role of anti-thyroglobulin antibody on pregnancy: evidence from an active immunization model in mice. Hum Reprod. 2003;18:1094–9.

    Article  Google Scholar 

  59. Promberger R, Walch K, Seemann R, Pils S, Ott J. A retrospective study on the association between thyroid autoantibodies with β2-glycoprotein and Cardiolipin antibodies in recurrent miscarriage. Iran J Allergy Asthma Immunol. 2017;16:72–6.

    PubMed  Google Scholar 

  60. De Carolis C, Greco E, Guarino MD, Perricone C, Dal Lago A, Giacomelli R, Fontana L, Perricone R. Anti-thyroid antibodies and antiphospholipid syndrome: evidence of reduced fecundity and of poor pregnancy outcome in recurrent spontaneous aborters. Am J Reprod Immunol. 2004;52:263–6.

    Article  Google Scholar 

  61. Penna G, Adorini L. 1 Alpha,25-dihydroxyvitamin D3 inhibits differentiation, maturation, activation, and survival of dendritic cells leading to impaired alloreactive T cell activation. J Immunol. 2000;164:2405–11.

    Article  CAS  Google Scholar 

  62. Boonstra A, Barrat FJ, Crain C, Heath VL, Savelkoul HF, O’Garra A. 1alpha,25-Dihydroxyvitamin d3 has a direct effect on naive CD4(+) T cells to enhance the development of Th2 cells. J Immunol. 2001;167:4974–80.

    Article  CAS  Google Scholar 

  63. Stefanić M, Papić S, Suver M, Glavas-Obrovac L, Karner I. Association of vitamin D receptor gene 3′-variants with Hashimoto’s thyroiditis in the Croatian population. Int J Immunogenet. 2008;35:125–31.

    Article  Google Scholar 

  64. Lepoutre T, Debiève F, Gruson D, Daumerie C. Reduction of miscarriages through universal screening and treatment of thyroid autoimmune diseases. Gynecol Obstet Investig. 2012;74:265–73.

    Article  CAS  Google Scholar 

  65. TABLET trial. www.birmingham.ac.uk/research/activity/mds/trials/bctu/trials/womens/tablet/index.aspx.

  66. T4Life trial. http://www.studies-obsgyn.nl/T4-LIFE/page.asp?page_id=1326.

  67. Zhang Y, Wang H, Pan X, Teng W, Shan Z. Patients with subclinical hypothyroidism before 20 weeks of pregnancy have a higher risk of miscarriage: a systematic review and meta-analysis. PLoS One. 2017;12:e0175708.

    Article  Google Scholar 

  68. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab. 2010;95:1699–707.

    Article  CAS  Google Scholar 

  69. Practice Committee of the American Society for Reproductive Medicine. Subclinical hypothyroidism in the infertile female population: a guideline. Fertil Steril. 2015;104:545–53.

    Article  Google Scholar 

  70. Nazarpour S, Ramezani Tehrani F, Simbar M, Tohidi M, Alavi Majd H, Azizi F. Effects of levothyroxine treatment on pregnancy outcomes in pregnant women with autoimmune thyroid disease. Eur J Endocrinol. 2017;176:253–65.

    Article  CAS  Google Scholar 

  71. Negro R, Schwartz A, Stagnaro-Green A. Impact of levothyroxine in miscarriage and preterm delivery rates in first trimester thyroid antibody-positive women with TSH less than 2.5 mIU/L. J Clin Endocrinol Metab. 2016;101:3685–90.

    Article  CAS  Google Scholar 

  72. Negro R, Greco G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. The influence of selenium supplementation on postpartum thyroid status in pregnant women with thyroid peroxidase autoantibodies. J Clin Endocrinol Metab. 2007;92:1263–8.

    Article  CAS  Google Scholar 

  73. Karanikas G, Schuetz M, Kontur S, Duan H, Kommata S, Schoen R, Antoni A, Kletter K, Dudczak R, Willheim M. No immunological benefit of selenium in consecutive patients with autoimmune thyroiditis. Thyroid. 2008;18:7–12.

    Article  CAS  Google Scholar 

  74. Mao J, Pop VJ, Bath SC, Vader HL, Redman CWG, Rayman MP. Effect of low-dose selenium on thyroid autoimmunity and thyroid function in UK pregnant women with mild-to-moderate iodine deficiency. Eur J Nutr. 2016;55:55–61.

    Article  CAS  Google Scholar 

  75. Goodwin TM, Montoro M, Mestman JH. Transient hyperthyroidism and hyperemesis gravidarum: clinical aspects. Am J Obstet Gynecol. 1992;167:648–52.

    Article  CAS  Google Scholar 

  76. Tan JYL, Loh KC, Yeo GSH, Chee YC. Transient hyperthyroidism of hyperemesis gravidarum. BJOG. 2002;109:683–8.

    Article  Google Scholar 

  77. Laurberg P, Wallin G, Tallstedt L, Abraham-Nordling M, Lundell G, Tørring O. TSH-receptor autoimmunity in graves’ disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study. Eur J Endocrinol. 2008;158:69–75.

    Article  CAS  Google Scholar 

  78. Cooper DS, Laurberg P. Hyperthyroidism in pregnancy. Lancet Diabetes Endocrinol. 2013;1:238–49.

    Article  CAS  Google Scholar 

  79. Andersen SL, Olsen J, Wu CS, Laurberg P. Spontaneous abortion, stillbirth and hyperthyroidism: a danish population-based study. Eur Thyroid J. 2014;3:164–72.

    Article  CAS  Google Scholar 

  80. Uenaka M, Tanimura K, Tairaku S, Morioka I, Ebina Y, Yamada H. Risk factors for neonatal thyroid dysfunction in pregnancies complicated by graves’ disease. Eur J Obstet Gynecol Reprod Biol. 2014;177:89–93.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Duke University Medical Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Durham, NC, USA

    Kelly S. Acharya & Jennifer L. Eaton

Authors
  1. Kelly S. Acharya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer L. Eaton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer L. Eaton .

Editor information

Editors and Affiliations

  1. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA

    Jennifer L. Eaton

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Acharya, K.S., Eaton, J.L. (2019). Thyroid Autoimmunity and Miscarriage. In: Eaton, J. (eds) Thyroid Disease and Reproduction. Springer, Cham. https://doi.org/10.1007/978-3-319-99079-8_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-99079-8_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-99078-1

  • Online ISBN: 978-3-319-99079-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation