الفهرس 
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Abstract
Recurrent pregnancy loss (RPL) is defined as three or more consecutive spontaneous pregnancy losses before 20 weeks of gestation. Hypothyroidism is linked to recurrent pregnancy loss.
Hypothyroidism complicates 0.3-0.7% of all pregnancies .Women with overt hypothyroidism are at an increased risk for complications such as early pregnancy failure, preeclampsia, placental abruption, low birth weight, and stillbirth. Also hypothyroidism that occurs during the first half of pregnancy is associated with a risk of a poor neurodevelopmental outcome.
Subclinical hypothyroidism (SCH) is biochemically diagnosed when there is a persistently high TSH level, while circulating free thyroid hormone levels are within range.
Consequently, the present study aimed to asses the prevalence of subclinical hypothyroidism in a sample of Egyptian women suffering from recurrent early miscarriage. This case control study was conducted at Ain Shams University Maternity Hospital specialized clinic for recurrent miscarriage in the period between June 2011 and January 2014.
The study included 300 women divided into two equal groups:
A) Case group: consists of 150 women with recurrent early miscarriage.
B) Control group: consists of 150 women with at least one successful pregnancy and no history of miscarriage.
All participants were subjected to careful history taking, thorough clinical examination and thyroid function testing (TSH, FT4 and FT3) by enzyme linked immunosorbent Assay [ELISA] after exclusion of women with overt thyroid dysfunction, all known causes of miscarriage either general or local causes and women taking medications that may alter thyroid gland function.
Laboratory reference levels for TSH, free T4 and free T3 in the present study were 0.4-6 mIU/L, 0.65-1.97 ng/dl and 1.4-4.2 pg/ml respectively according to used kit’s references (Burger and Patel, 1977), (Midgley, 2001) and (Wild, 2005) respectively. In the present study, cases group had significantly lower parity and higher frequency of previous abortions when compared with controls, this is due to inclusion and exclusion criteria in the present study.
In the present study, no statistically significant differences were found between cases group and control group regarding age and BMI and this give homogeneity to the present study.
In present study, no statistically significant differences were found between patients and controls regarding TSH levels.
The mean TSH level in case group is 3.82±2.39 mIU/L and 3.43±1.62 mIU/L in control group and p-value is 0.102 (NS). In addition, no statistically significant difference between patients and controls was found regarding fT4 and fT3 levels.
The present study demonstrates that number of women with subclinical hypothyroidism in cases and controls was 12 (8%) and 7 (4.7%) respectively with p-value 0.236 (NS) denoting no statistically significance between subclinical hypothyroidism and recurrent early miscarriage.
Summary
The sensitivity and specificity of TSH, FT3 and FT4 at different cutoff points were as follows:
For TSH ≥ 2.5mIU/L showed the highest specificity (76.7%), while the highest sensitivity was at ≥ 2.85mIU/L (66.0%).
For FT3 ≤ 2.35pg/ml showed the highest specificity (66%), while the highest sensitivity was at ≤ 1.85pg/ml (74.7%)
For FT4 ≤ 0.95ng/dl showed the highest specificity (74.7%), while the highest sensitivity was at ≤ 0.65ng/dl (63.3%)
Multiple studies are needed to solve the enigma of hypothyroidism and its relation to recurrent pregnancy loss.