The Thyroid-Fertility Connection

The thyroid gland regulates metabolism, energy, and hormonal balance throughout the body. In women, thyroid dysfunction can cause irregular periods, fertility challenges, miscarriage, and complications in pregnancy — even at subclinical levels that a standard TSH test might not fully capture.

Thyroid Conditions Dr. Juneja Treats

  • Hypothyroidism — underactive thyroid; causes fatigue, weight gain, cold intolerance, constipation, hair loss, and fertility problems
  • Subclinical hypothyroidism — TSH mildly elevated but T4 normal; particularly important to treat in pregnancy and in women trying to conceive
  • Hashimoto's thyroiditis — autoimmune hypothyroidism; anti-TPO antibodies present; increased miscarriage risk
  • Hyperthyroidism — overactive thyroid; causes anxiety, weight loss, palpitations, heat intolerance
  • Thyroid nodules — requires evaluation and monitoring

Thyroid Management in Pregnancy

Thyroid requirements increase significantly during pregnancy. Women with pre-existing hypothyroidism need dose adjustment as soon as pregnancy is confirmed. TSH targets in pregnancy are stricter than outside pregnancy (TSH should be <2.5 mIU/L ideally), and inadequately treated hypothyroidism has been linked to pregnancy loss and impaired fetal neurological development.

Adrenal Health & Adrenal PMOS

The adrenal glands produce androgens (DHEAS) that can contribute to PMOS symptoms independently of ovarian androgen excess. Adrenal PMOS — where elevated DHEAS rather than ovarian testosterone drives symptoms — requires a different treatment approach. Dr. Juneja assesses adrenal function as part of every comprehensive PMOS workup.

Comprehensive Hormonal Testing

  • TSH, free T4, free T3
  • Anti-TPO and anti-thyroglobulin antibodies
  • DHEAS, cortisol (morning and/or 24-hour urinary)
  • Full reproductive hormone panel as clinically indicated
  • Adrenal stress response assessment where needed