Thyroid and TTC

[annab]

Hello,

I am about to start fertility treatment (my husband has a zero sperm count). I am 39 years old.

In the run up to beginning the process (DI) I have had a series of tests - including T4, TSH and a scan.

My TSH came back high at 8 but my Free T4 was within the normal range (12-22) at 14.7.

I was also found to have mild polycystic ovaries (but no underlying hormonal imbalance - that is testesterone, FSH/LH, oestrogin and prolocatin normal, thoughprolactin at high end of normal range).

The doctor has not discussed hte results with me; she simply said that if my level has not risen next month -when I begin my first treatment - I should take some thyroxine.

I have absolutely no symptoms so assume this is sub-clinical hypothyroydism.

My question is this:

- Are there any other tests my doctor should take (she has not suggested any, like T3 for example).

- Do I HAVE to take thyroxine if I am TTC. I rarely take any kind of drugs, as I have (up to now) always been very healthy.  Can I suggest simply having my Free T4 monitored and if it dips below the normal level boosing it.

- WIll these drugs interfere with 1) clomid and 2) pregnancy

- I have a normal 28-29 day cycle. I understand thyroid problems interfere with fertility - is this the case even when the Free T4 is normal and I have no symptoms?

Your advice really gratefullly received.

Thanks.

[Mark Lupo, M.D.]

The high TSH is the earliest indication of low thyroid -- don't wait for the T4 to drop - if the TSH is elevated at a repeat test 8 weeks or so after the first - treat it, especially with an expected pregnancy.  No problems in interacting with fertility drugs -- monitor thyroid treatment every 6-8 weeks to keep the TSH around 1.

[annab]

Correction: she said if my second TSH and Free T4 test comes back with similar results she will put me on thyroxine, even though I have no symptoms.

[mshypo]

No symptoms?  Doesn't infertility and high prolactin levels count?  both are hypo symptoms.  
Even though your Free T4 is normal, you may not have enough active thyroid hormone, which is T3.  You would need a Free T3 lab to know that.  And I wonder if your Free T4 is in the bottom 1/3 of the range.

[mshypo]

oh - i see your Free T4 is low in range.  
ya sure you don't have any other symptoms?  no digestive problems?  no skin disorder?  are you pale?  no fatigue?  low blood pressure?  slow pulse?  low body temperature?  
the list goes on and on and i have found many folks don't realize something they are experiencing is related to hypo.

[annab]

Hi,

I don't know if I am infertile!  My husband has zero sperm count!  The tests were done as part of a routine check before DI.

I honestly don't seem to have any symptoms. I have been a bit stressed lately, but I have had major life changes.  I'm no more tired than normal - perhaps the only possible symptoms are slightly more pronounced memory loss and inability to concentrate (or rather I can concentrate, but only on this stuff!).

On the blood tests the free t4 was the lower end of normal and the prolactin was the higher end of normal, and I presume this is indicative of hypothyroidism (this is what i thought from looking at hte internet, the doctor did not give me any analysis.

So:
Does this mean I have sub-clinical Hypothyroid?
Does this need to be treated, or should i wait until my hormones are really out/I have symptoms.
Specifically does it need to be treated if I am trying to conceive?
Can I simply be monitored and if my T4 levels fall, I start on thyroxine.
I want to avoid drugs for as long as possible.

Hope this is clearer.

Thanks,

Anna

[mshypo]

I realized when i read these posts over that you didn't know if You were infertile...but it is a symptom.  I'd hate to go thru fertility treatments to later find out my own hypo was making Me infertile too.

I think sub-clinical is just a term that docs like...smile...I had pretty bad hypo symptoms with a TSH of 2 and because I wasn't treated for all those problems...everything became much more severe over time with some areas having permanent damage.  Some sources say that in about 1/3 of people, the TSH will not rise to reflect severity of hypo.  Guess I was in the unlucky 1/3.  But you can understand why I detest the term subclinical.  

It does sound like you are having some of the cognitive issues associated with hypothyroidism, doesn't it?  trust me, it can get a lot worse if untreated.  and especially that fatigue.

Let's see what Dr. Mark says about all your questions...but i sure wish I had been treated in the early stages.  It would have made a huge difference in the way I felt and in the quality of my life.

btw, thyroid replacement is not a DRUG per se, but rather a hormone.  A hormone that your body has naturally...and thus if you're low in it, it would be best to supplement it imo.

[annab]

Perhaps the question I need to ask is this;

I will be beginning a natural insemination cycle IUI next month (mid January)
I have a just diagnosed high TSH and a normal Free T4 in bottom third of normal range.
I have a regular cycle.
I will be forty in two months and thus have age counting against me...I can't wait months because it will count against my fertiliy.

GIVEN THIS
Is it dangerous - and how dangerous is it - to start trying to conceive before my TSH levels come down?

I will repeat the Free T4 and TSH (and request a Free T3) at the start of January (a month after my last test).
If they are still high my doctor will put me on drugs.
I will not start clomid until the second cycle (I understand that clomid can mask the levels of TSH in the blood).

Thank you.

[Mark Lupo, M.D.]

Ideally would normalize TSH prior to TTC as key developmental changes in the fetus occur early and are sensitive to proper thyroid levels.

[katherine67]

I've been fighting hypo for about 2 years now... a few basic answers to your questions... FIRST-- I had gone off Synthroid because of the side effects and I didn't feel any better, despite a lower TSH.  Decided to go off the pill to see if the estrogen was a factor-- went to see an OB who specializes in high-risk pregnancy (I was 37 at the time) and she told me that hypo mothers can have children with lower IQ... as well as a much higher risk of miscarriage.  So, on her advice I went back on the meds, but this time I tried Armour (natural) 30 mg and cut my dose so that I took it twice a day instead of just once.  This has made a huge difference in my symptoms!  I'm convinced the Synthroid did not work well with my system. I just turned 38, I am pregnant and working to keep my TSH below 2, preferably closer to 1.  This should lower my risk of miscarriage and give my child the best chance for a higher IQ.  I am 13 weeks in and have had to increase my dosage once already,(45mg) will go in for another blood test next week.  But so far, a healthy baby!  
Some hypo symptoms you might not be aware of... heavy periods are symptomatic, as well as sleep problems and focus issues.  I'm cold all the time. Also, the outer third of your eyebrows may be very sparse.  I DO NOT have a weight issue, even though that is constantly given as a symptom.  I'm actually on the slim side. I also have very dry skin. To me, your TSH of 8 seems extremely high, based on what my endo has told me.  Mine was tested at age 36 and was 4.35.. She said this was the Thyroid of a 56 year old woman!
Good luck to you and your husband!

[kygal2]

I am wanting to try to conceive, but have had 4 thyroid blood tests done over the last 6 months - all basically showing the same thing, TSH  around .008, T4 around 10.4 to 11.2.  Should I be concerned about the low TSH?  A thyroid ultrasound showed normal thyroid.  I am 35 and do not want to wait any longer to try again (I have had 2 miscarriages over the last 2 years...last one 7 months ago).

My doctor suggested Thyroid scan with iodine to rule out nodules or beginnings of Grave's disease.  What is the time period to wait for trying to conceive after this test?

I feel like there is probably nothing wrong and she indicated she would be surprised if the scan found anything.  My husband says just forget it, but I don't want to be irresponsible with my health or the health of a possibly baby.

Thoughts?

[NURSELPN]

You probably should post your question above. I don't think it will be addressed this far down on the board. Dr Mark will probably answer your question if you post it at or near the top of the message board. You'll also get comments from other forum members.             Good Luck