How 'off' does TSH have to be to affect fertility and ovulation?

[Juliet1971]

I'm 35 with a 2-year-old son conceived very easily. I've been trying to conceive #2 for 6 months. I had what I think are hypothyroid symptoms (thinning and dry hair, dry eyes, cold) and had a complete thyroid test by my primary care doc. My TSH was 6.5 (other levels all in normal ranges). He said it's subclinical and won't treat me. I also had ANA and Sjogren's tests done because of the dry eyes. Sjogren's was totally normal; ANA was 1:64, homogeneous. Primary care doc was not at all concerned about this (I am, of course!). I also saw a rheumatolgist who was not concerned about any particular autoimmune problem (although I do not think my thyroid antibodies were checked).

I've been temping and charting for three months and using Clearplan ovulation monitor for one month. My temps appear to have a slight upward swing in mid-cycle, but often have a single or two low temps during what should be post-ovulation. I did not get a positive OPK result last month. Of course, I'm TERRIFED that I'm in premature ovarian failure and reading the internet isn't helping. I have my first RE visit next week and my husband can't come. I am so scared I am going to get terrible news by myself.

Any advice/thoughts on what I should be asking. I honestly do not believe I am ovulating. Could a TSH of 6.5 be enough to affect ovulation or is that false hope? Can I possibly conceive with that level? What do I need to do to be prepared to see this RE?
Thank you!
Juliet

[Mark Lupo, M.D.]

The TSH is too high for your situation.  I would treat to target TSH around 1.0.  Also check thyroid antibodies -- positive antibodies are associated with miscarriage & infertility -- a recent study suggested that treating with synthroid type meds is very effective (even if the TSH is "normal").

[lumley801]

I am certainly no doctor but I can't help but say, "get a second opinion."  A TSH of 6.5 sounds high to me.  And you say you're experiencing hypo symptoms...  Do yourself a favor and get another opinion.  Have that doctor check antibodies.  If you can't get another doctor to check it (and depending on your location), you might be able to order your own tests: http://www.healthcheckusa.com/ )

I had "normal" TSH (1.xx) but still had a LOT of hypo symptoms AND pain in my neck/throat.  Blood work revealed Hashimoto's.

[lhowell]

Your TSH level is a bit high.  When I was diagnosed with hypothyroidism, my TSH was a little over 6.0 and I felt AWFUL.  My hair was falling out pretty badly and I was so tired and sluggish.  I've been on .75mcg of Synthroid for the past couple of months and my TSH is now at 1.75.  I feel so much better!

I've been ttc for about 3 years.  No luck yet (but I'm just getting back on track).  Our TSH has to be around 1.0 to conceive.

You may want to find another doctor to treat you.  Endocrinologists specialize in thyroid disorders, (though my GP is treating me since endos are hard to find), and keep in mind that if you start meds, it will take a while before you start seeing results (about a month for some symptoms to 6 months for others).

[lhowell]

Juliet, let me also add that I don't think seeing an RE will really do any good until your TSH levels are lower.  From what I've read, you can't get pregnant (or carry the pregnancy) when the levels are over 5.0...and the closer to 1.0, the greater the chances of conceiving.

IMHO, if I were you, I'd cancel the appt with the RE and see an endo instead.  Take your current lab results with you.  I believe an endo will start you on meds and probably check your thyroid antibodies to determine if you have Hashimoto's.

I am amazed at all of the things the thyroid gland affects and even more amazed at how much better I feel everyday thanks to the meds.

Good luck to you.

[Juliet1971]

Whoa...if my GP is really that far off (he KNOWS I've been TTC and that was one of the reasons I approached him about my thyroid function...I'd been experiencing symptoms and begged to be tested) and I've been suffering and wasting precious time for five months, I'm going to be so irritated!!  I think I'll keep my RE appt for now...my GP doesn't believe my 6.5 level is meaningful (T3 and T4 in  normal range, low cholesterol) and he didn't want to refer me anywhere. My OB got me in to see the RE and I trust my OB more than anyone, so at least that will be a starting point. If nothing else, maybe that will lead me to a referral with an endo and the RE can make sure nothing else seems wrong.  I am just so angry right now. I'm too old to mess around with this and I feel like my GP could have cost me months in this whole process.

Curious to see what the doc here says. I sincerely appreciate all the advice I've gotten so far!
Juliet

[lhowell]

hehe, I'm a dork.  I'm pretty sure the RE can treat you if you hypothyroidism.  When I see RE, I automatically think of clomid and IVF...and completely forget they are endos as well.  :)

[Juliet1971]

:)

And maybe she won't treat me for hypo. But, ironically, one of my best friend's husband is an endo at the hospital my OB works through. I bet he can refer me to someone good if the RE isn't able to help.

I'm just glad that I'm not entirely crazy. I had just believed my GP that all was fine ("you're a little low, but nothing to worry about"). Then I ordered my bloodwork sent to ME to take to the RE  and I decided to look at it. I just about lost it.

[lhowell]

Juliet, I don't blame you for being irritated.  I was in your very shoes.  Some doctors don't treat subclinical hypothyroidism and other doctors use the old TSH ranges.  The new ranges (est. 2003) are that TSH levels should be between .3 & 3.04  Anything over or under indicates a thyroid problem.

This may interest you:

Journal of Clinical Endocrinology and Metabolism, 2001 Oct;86(10):4860-6]
There is also evidence in the literature that levels above 2.0 during pregnancy can potentially complicate pregnancy, and that upper level normal TSH levels can inhibit fertility. For example, in early 2005, Drs. Casey and colleague wrote in the journal Obstetrics and Gynecology that "Pregnancies in women with subclinical hypothyroidism were 3 times more likely to be complicated by placental abruption."

--Also--

1. "2003 Campaign Encourages Awareness of Mild Thyroid Failure, Importance of Routine Testing" (US, 2003)

Until November 2002, doctors had relied on a normal TSH level ranging from 0.5 to 5.0 to diagnose and treat patients with a thyroid disorder who tested outside the boundaries of that range. Now AACE encourages doctors to consider treatment for patients who test outside the boundaries of a narrower margin based on a target TSH level of 0.3 to 3.04. AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone untreated until now.

[Juliet1971]

The more I read, the angrier I get.
I think I need to just let this go until my appt on Monday. So help me, if this GP ignored me AND dipensed such poor advice.....grrrr.

Thanks again for your help!

[florinef]

Hi guys,

If I may ask a few questions I would be very grateful.  I recently became pregnant with a perfectly placed IUD after two years of use. The IUD was removed very early-4 weeks- and a sonagram showed a normal embyro at 6 weeks.  This was very unplanned as I have been dealing with fairly unstable hypo for about a year now.

I normally had to increase T4 from  88 ug to 100 ug during PMS or would have hypo symptoms-lethargy, facial swelling, and night blindess.  The incrase fixed this.  After the pregnanacy started I couldn't drop down and I just keep going up.  I am at the 8 week point and am taking 75 ug at 8 am, 50 ug and noon, 25 ug at four and started 12.5 ug in the evening today to keep the hypo symptoms controllable.  (my endo just loves me because I self mediacte but when he checks my TSH it is always perfect)

How high do you normally increase the T4 during pregnancy?  How fast does it need to be stopped after pregnancy?  What problems can the baby have due to the intermittant hypo symptoms?

Thanks!

[MINDYH]

Im 26yrs - I was dx with graves desease and treated with Radio-Active Iodine...due to the goiter I had developed...I now have Hypothyroidism, where as I was hyper.
It took me six years to become pregnant....and I underwent a
variety of fertillity testing.
My TSH were said to be in the normal range, but I still felt horrible overal. My Endo did something that worked for me!
He Up'd my does of synthroid beyond what was in the said range of what I would have needed based on guidlines.
I became pregnant after 40days of taking my pills regularly.
I had taken ovluation testing which never indicated that I had actually ovulated.. and We did a test that monitored the livelyhood of sperm within hours after normal intercourse.
My system seemed to kill off all the sperm, my husbends sperm motillity testing was normal.
Anyhow we determined that my body Temp was possibly affected just enough to not sustain the sperm - all factors of low thyroid function.  I would never accept test results for thyroid from anyone other than an obgyn or your endo. My Endo has now retired but he has seen several cases like mine afecting 1:100 women with hyper to hypo thyroidism.

[lhowell]

Hi Mindy, can you explain more about the body temps?  Low temps = meds increased, therefore, temps went up??  My BBT is always soooo low.  I know during the luteal phase your body temp increases (to act as an incubator).  Perhaps low BBT would inhibit that?  Thanks for sharing.

[TB07]

MINDYH
You mentioned:
He Up'd my does of synthroid beyond what was in the said range of what I would have needed based on guidlines.

What was your actual doseage?  I am experiencing a lot of symptoms (initially hair loss, clammy hands and feet, extremely hot and then later really cold, extreme fatigue in the morning and awake most of the night and now extreme blood pressure fluctuations - Normally 110/68 ; Yesterday 160/100!) and my obgyn thinks it is hypothyroid.  My mother has problems with her TSH levels, but her T3 and T4 are normal.  She was taken off Synthroid and seems to be doing well on Armour.  I should get the results of my bloodwork on Monday.
I am 41 years old.  I went to my obgyn because I was afraid I was going through menopause or something.  I have been on the pill for years and stopped taking it a month ago.  I am at a point in my life that I would love to have a child.  I am scared that it may be too late.  My Obgyn thinks my ovaries are healthy and this is my thyroid causing all of this.  I don't know much about the thyroid and pregnancy, but I am learning.
The tests don't seem to be conclusive other than you need to have TSH levels of 1.0 to conceive.  You seemed to have the most experience with this.  It also seems that synthroid is the best to take when you are trying to get pregnant.  What doseage were you initially put on and did it change?
Any other information you would like to add would be much appreciated!
Thanks!  TB

[Juliet1971]

Just an update...I had another  thyroid panel done by my RE. Those results will be in next week. She plans to medicate me if the TSH is even close to where it had been. She's hopeful that the TSH is a major reason I'm not pregnant.  Side note, I got sick this week and got squeezed in to see another gp in the practice my regular gp works at. I saw this new doc flipping through my chart and saw that page with my thyroid tests from May.  I said, "So, if you saw a patient my age, trying to conceive, with a TSH of 6.5, would you medicate her?" He didn't skip a beat and said "YES!" I'm not into pitting doc against doc, so I didn't say anything else. He asked, "Why?? This isn't at THIS practice, is it?" Then he more or less demanded I tell him what was going on and said that he plans to talk with my regular gp to find out what his "plan" for me was. He wonders if maybe the nurse who gave me the results misunderstood something. This doc said that it would be "hard for a baby to have a totally positive outcome" with a high TSH.

Curious to see what happens this week...what my RE will find, what my regular GP will do after talking to this other doc I saw.

Best wishes, everyone. And thanks to all for your help!
J.

[marie2]

I don't know why they are looking at TSH at all. That is a pituitary hormone and it only kicks in if it thinks there is a problem. Meanwhile there can be all kinds of problems: problems converting T4 to T3, problem circulating T3, and blocked hormone receptors in cells that prevent the T3 from getting there.

The free t3 lab test is the closest you are going to get to "accurate" in a lab test to see if your cells are getting enough T3. But the most accurate test is YOU: how do you feel? Are you infertile and tired and losing hair and have other hypo symptoms?

Then you need hormone. Synthroid is going to give you T3 which needs to go through the above steps SUCCESSFULLY to make it to your cells. Are you going to take the risk?

You can also take Armour which will put T3 directly into your bloodstream. Then all you need to worry about is not eating goitrogens (receptor blockers) and circulating the hormone... with a little exercise .. and sometimes you don't even need to do that.

The TSH and the Synthroid method are relatively new, 1973, and obviously weren't designed by someone who is hypo and infertile. I was infertile for 20 years before they found out why. If I had it to do over again I sure as heck wouoldn't mess around with Synthroid. I would dump that T3 right into my bloodstream.

I would ALSO take iodine - Lugor's drops or something equally strong. Iodine deficiency is implicated in 3 problems: ovarian, breast (even cancer) and thyroid, because that's where it's concentrated.

see stopthethyroidmadness.com and this great presentation from just a couple of months ago by Dr. Miller:


The TSH method of determining whether a SICK person with hypothyroid symptoms needs help has got to go!  

http://www.donaldmiller.com/Iodine%20Talk.doc

[marie2]

>>Synthroid is going to give you T3 which needs to go through the above steps SUCCESSFULLY to make it to your cells. <<

That was a typo. Synthroid will give you T4....