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Early gestational hCG elevation, sharing structural α subunit homology with TSH, exerts mild thyroid-stimulating effects, physiologically elevating maternal thyroid hormone levels while suppressing TSH ( 5.1 Infectious etiologies of thyroid-reproductive dysfunction Beyond SARS-CoV-2, Cytomegalovirus (CMV) infection, present in 0.5-2% of pregnancies, triggers robust IL-6 and TNF-α production from infected trophoblasts through viral protein US2-mediated activation of NF-κB pathways, leading to disrupted placental thyroid hormone transporters (MCT8 and MCT10) and resulting in fetal hypothyroxinemia despite normal maternal thyroid function ( 5.2 Thyroid hormone associations: thyroid stimulation Thyroid-stimulating components encompass thyroxine (T4) and the more biologically active triiodothyronine (T3)