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CPE-001 · synthetic case FX-006
Preconception infertility context
Trying to conceive, TSH 4.8, Anti-TPO positive.
Purpose: Route guideline-sensitive fertility case without automatic treatment.
Inputs the engine received
Patient
- Age and sex
- 36, female
Context
- Trying to conceive or fertility treatment
- Yes
Symptoms
- Fatigue
- Present
Laboratory
- TSH
- 4.8 mIU/L (ref 0.4–4.5)
- FT4
- 1.1 ng/dL (ref 0.8–1.8)
- ANTI-TPO
- 142 IU/mL (ref 0–35)
What the engine reports
Guideline-Sensitive Context
Preconception or fertility-treatment context identified. Interpretation of mild TSH elevation and antibody positivity is guideline-sensitive and requires physician-directed review.
Detected clinical pattern
Biochemical Pattern Compatible with Possible Subclinical Hypothyroidism
Elevated TSH with FT4 within the laboratory reference range; persistence and clinical context require review.
- Etiology / context: Autoimmune Thyroiditis Supported
Why this pattern was identified
- Elevated TSH with normal FT4. TSH 4.8 mIU/L (ref 0.4–4.5) and FT4 1.1 ng/dL (ref 0.8–1.8). TSH elevation is mild.
- Autoimmune etiology supported. ANTI-TPO 142 IU/mL (ref 0–35). Etiology is separate from the functional state.
Context modules routed
CTX-HT-FERTILITY Preconception / Infertility Thyroid Context
Flag guideline sensitivity; no automatic treatment claims from TSH 2.5–4.0 or antibody positivity alone. ATA pregnancy guidance and the ASRM 2024 fertility guideline are surfaced for physician interpretation.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Confirm persistence with repeat TSH and FT4 when clinically appropriate before long-term therapy decisions.
- 2Review symptoms, age, TSH magnitude and persistence, Anti-TPO status, cardiovascular context, goiter and special-population routing.
- 3Apply the dedicated pregnancy / fertility context module.
Evidence and rule trace · 2 rules
PR-HT-02Possible Subclinical Hypothyroidism Pattern
Inputs: TSH 4.8 mIU/L (ref 0.4–4.5) · FT4 1.1 ng/dL (ref 0.8–1.8)
TSH above and FT4 within the laboratory reference range.
CTX-HT-FERTILITYPreconception / Infertility Thyroid Context
Context module routed.
Evidence
- EV-AACE-ATA-2012 · Garber JR et al. Clinical Practice Guidelines for Hypothyroidism in Adults. Endocr Pract. 2012;18(6):988-1028.
- EV-ATA-PREG · American Thyroid Association. Hypothyroidism in Pregnancy; based on ATA pregnancy guidance.
- EV-ASRM-2024 · ASRM Practice Committee. Subclinical hypothyroidism in the infertile female population: a guideline. Fertil Steril. 2024;121:765-782.
Physician adjudication required. For clinician review only. This output identifies clinical patterns and safety considerations from the documented inputs. It does not establish an autonomous diagnosis or treatment plan. Physician confirmation is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Thyroid-function testsMove the sliders or type values
- below range
- within range
- above range
- below range
- within range
- above range
Zones are drawn from your reference intervals. The engine, not the map, decides the pattern.
Laboratory values and reference rangesUse your lab's own interval
µIU/mL and mIU/L are numerically identical.
Interpreted against the reporting assay's upper limit.
Only used in the thyrotoxicosis pathway.
Patient context
Medications and exposures
Symptoms and physical findingsSupportive only: never classify on their own
Symptoms
Signs and decompensation red flags
More thyroid cases
FX-001
Overt primary hypothyroidism with autoimmune support
A 54-year-old with fatigue, cold intolerance and a TSH of 18.4.
FX-002
Antibody positive with euthyroid function
Strongly positive antibodies, but TSH and FT4 are both normal.
FX-003
Mild subclinical pattern with positive Anti-TPO
Mildly high TSH, normal FT4, positive Anti-TPO.
FX-004
TSH at or above 10 with normal FT4
TSH of 12 with a normal FT4 in a woman of 57.
FX-005
Pregnancy context with mild TSH elevation and Anti-TPO positivity
Pregnant, TSH 3.1 against a pregnancy range, Anti-TPO positive.
FX-007
Central hypothyroidism after traumatic brain injury
Fatigue and low libido after a head injury. TSH 1.4, FT4 0.5.
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