thyroid autoimmunity and miscarriage

[childrenrtreasures]

I have Hashi's and although my thyroid function tests come back in range (they've never been out of range; I was diagnosed and treated based on high antibody titers, strong family history and symptoms) I continue to have symptoms and frequent flare-ups. My endo will not increase my medication (she switched me from Armour 90mg to Levoxyl 50 in August).

I am 29 and in the past have had no problems with staying pregnant. Since becoming ill with Hashi's two years ago(meaning onset of symptoms) I have not been able to carry a baby to term (7 miscarriages so far; two were in the second trimester). I also experience menorrhagia and have had three ruptured ovarian cysts since May. I'm currently on a trial of birth control to try to prevent this.

I have been tested for "everything that is treatable" (those are my OBs words) with my labs coming back normal. I strongly feel my thyroid condition is being undertreated.

Is it possible to suppress thyroid function with meds to the extent that it reduces antibody levels and is it possible this will increase my odds of carrying a baby to term?

Would total thyroidectomy with replacement hormone reduce my risk of miscarrying due to thyroid autoimmunity?

I do not have nodules or cancer and only a slight goiter but the condition is debilitating at times. I flare up mild/moderate once or twice a month and quite severly (symptomatically I mean) every 2-4 months.

Is it likely this is thyroid related or am I barking up the wrong tree? Where do I go from here?

Thank You!

childrenrtreasures

[Mark Lupo, M.D.]

The "flares" may be thyroid -- typically the symptoms are persistent not intermittent - but it is possible.  There are no data to support removing the thyroid to help with infertility in this case and the studies looking at positive antibodies suggest that thyroid hormone treatment may be helpul -- but too much also effects fertility -- would try to keep the TSH around 1.0 with levoxyl or armour.  More medication usually does not consistently lower antibodies and once antibodies are documented most of us do not follow them to see if they are going up or down.

May also consider a second opinion with a reproductive endocrinologist (an OB who has at least 3 additional years after residency dealing with fertility disorders).

[ancientmariner]

Hi, I have heard that there's a connection, so just for the heck of it, I did a search on hypothyroid + miscarriage - there are a ton of articles about low thyroid and miscarriages, especially in the second trimester. Best wishes.

[mshypo]

What is your antibody level?  and what is your TSH?  Most docs, including dr. mark here, recommend keeping a TSH around 1 for pregnancy.  
I'm an Armour advocate...thinking it a far superior treatment than a T4 med like levoxyl...and that's based on my own research and lots and lots of patient testimonies.  But armour advocates seem to get beat up for saying that...but if i were you, I'd insist upon Armour or find a doctor who used it exclusively.

It makes me mad that they have apparently left you so undertreated for your Hashi's that you have had to lose those precious babies. I'm sorry for your losses.

Effective thyroid treatment usually lowers antibodies.  Selenium supplements may help with that too.

[childrenrtreasures]

Thank you for the replies! Many of my symptoms are persistant (such as joint stiffness...that one is unrelenting) but they fluctuate in intensity (the flare-ups are different in that I have a return of all my symptoms at the same time). I also seem to have symptoms that get worse in the winter than in the summer and vice versa.

My endo's colleague is a reproductive endocrinologist but since my endo does not feel my miscarriages are endocrine related she won't give me the referral.

My TSH has been around 1 during the pregnancies I've miscarried. I've read many articles also pointing to low thyroid function increasing miscarriage risk but my endo does not feel I have low thyroid function because my TSH is in the optimal range for pregnancy.

My antibodies are:

Tg- 396 (range: less than 2)
TPO- 8 (range: less than 2)

I take 200mg of selenium per day but since my TPO really isn't that high I'm not sure if it's going to make a difference.

mshypo- I agree with you about Armour. That's what I was taking when I first saw the endo. She immediately gave a speech about why Armour should be "removed from the market" because it increases antibody levels etc... She feels Levoxyl is superior to all the other meds available (she thinks Synthroid should be phased out...not sure about her reasoning there...). My TSH was showing hyper but I wasn't feeling poorly and my FT4 was .9 (range- .8-1.8); she didn't test my FT3.

It seems Armour shoots my TSH down quickly and even my regular dr that prescribed it was very leery about letting me continue.

A month ago my labs were:

TSH 1.08
FT4 .74 (range .58-1.64...used a different lab this time)
Total T3 90 (range 87-187)

I was having menstrual difficulties at that time and may have miscarried later in the month (still waiting on the pathology report to verify...I didn't know I had become pregnant if that's the case).

Considering all the testing I've had done I'm really not sure where to go from here.

Thank you again for taking the time to consider my post!

Kelly

[mshypo]

Armour does shoot the TSH down quite easily...that's why TSH is so bad to rely upon in dosing with armour...and it's better to go by Frees imo...and lots of other folks too.

Your Frees are really low.  not even at the midpoint.  .77 is considered hypo by many...you're not much higher.  remember there is controversy over these ranges...and anything in the lower 1/3 is suspect because those with thyroid antibodies and family history of disease were not excluded from the sample population when determining the ranges - thereby lending those Free ranges to be suspect for hypo in the lower 1/3.  I think if you test Free T3, you might might it below range because your Total is so low.  

I agree with the doc that Synthroid should be phased out..but not so sure why she loves levoxyl.  and for sure she is wrong on armour.

[mshypo]

Armour does shoot the TSH down quite easily...that's why TSH is so bad to rely upon in dosing with armour...and it's better to go by Frees imo...and lots of other folks too actually.

Your Frees are really low.  not even at the midpoint.  .77 is considered hypo by many...you're not much higher.  remember there is controversy over these ranges...and anything in the lower 1/3 is suspect for hypo because those with thyroid antibodies and family history of disease were not excluded from the sample population when determining the ranges.  I also think if you test Free T3, you might might it below range because your Total is so low.

I agree with the doc that Synthroid should be phased out..but not so sure why she loves levoxyl.  and for sure she is wrong on armour.

[mshypo]

oh - the thing about armour raising antibodies is a new one..and i thought i'd heard them all.  but it's another lie about armour.  successful thyroid treatment usually helps antibodies go down considerably...as someone with high antibodies is probably miserable.  with the way yours are, it's hard to tell if you're in beginning stages or final stages of hashi's though...as antibodies can also go down when thyroid damage is done.  But given your age, i'd be more inclined to think yours were on the upswing...and really needs suppressive therapy to get rid of symptoms.  just my opinion.  i'm not a doctor.  just a hashi's patient who has no hypo symptoms anymore due to suppressive armour therapy.

[childrenrtreasures]

I came across this study (pasted the entire thing in response to a different post):

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15554886&itool=iconabstr

It states that the ideal for pregnancy is to keep the TSH in the lower half of the range and the FT4 in the upper half but I have never been able to accomplish that. Is it a realistic goal I wonder?

I've often thought about a suppressive dose as well. How is it accomplished? Lowering the TSH and getting the FTs up I mean. I've never been able to get my FT4 to budge at all. Maybe we just needed to hold out longer with the Armour?

My endo and I don't see eye to eye at all (we actually argued for half an hour at my first appointment). The only thing she offers me is birth control (which my OB put me on a trial of for a month). She just doesn't believe my symptoms could possibly be caused by thyroid because my TSH is "perfect".

It's been a long road and although treatment has greatly reduced the severity of my symptoms they still persist. The "flare-ups" I get can take several weeks to several months to recover from. The worst flare-up I had lasted 3 weeks and caused debilitating weakness in my hips and shoulders. I had to use a cane for 6 months afterwards. My neurologist did a variety of tests including thyroid but everything came back fine...he noted the significant weakness but was stumped (I've only been on thyroid treatment since April). Most of the time when I get a flare-up I sleep 14-16 hours per day and have difficulty doing the smallest things like holding a book up in bed. I homeschool my children so it poses quite a challenge at times. As I said, thankfully treatment has reduced their severity but I still have significant reduction of activity level during them.

Sorry to be so long winded...it's nice to be in a place where people understand what I'm going through!

Kelly

[mshypo]

well yea, i almost died while my TSH was looking pretty to the doctors.  TSH is only reliable in about 1/3 of patients.  Dr. Mark will repeat that it's the most reliable screening tool there is...but if you're one of those who has a sluggish pituitary from hypo or Hasimoto's affecting the brain, i guess you're out of luck.  I heard a doc from the netherlands the other day had said that TSH is only about 10% of the thyroid story...and that Frees and Totals had to be looked at.  He's got it right i think.

I repeat..your Free T4 looks really bad. And I imagine your Free T3 looks even worse.  

Supressive therapy is just TSH suppression which comes with taking a full replacement of ARmour - usually 3-5 grains.  Dr. Mark will disagree with that - but older studies indicate that 3-5 grains was the usual dosage for Armour patients before the introduction of the TSH test.  They have done current studies with Armour because the pharmaceutical reps all push synthetic meds...and everything is done according to TSH these days.  Armour will easily tank the TSH.  With just 1 grain, my TSH plummeted to 1. something, but my Free T4 had not changes at all.  It took 4 grains for me to get my Frees in the upper 1/3 of the range to resolve symptoms.  Many doctors DO understand that this dosing method is far more effective with Armour than TSH dosing. I'll be thrown off of here for stating this probably, but I'm just agreeing with the old Armour docs and the new alternative and other docs who use Armour and know about how to use it and dose it.

[mshypo]

oops...that should read they have NOT done current studies with armour.  in fact, many of the current studies that docs rely upon have been done with T4 meds...and don't translate well to armour.  example:  you'll see "suppressed TSH" used in many studies..when what they are really talking about is high T4 levels.  Suppression of TSH is so common when optimally treated with Armour that it's difficult to translate those studies to Armour treated patients...although understanding this quirk does help us armour patients know to be aware of high Free T4 levels that can cause harm.

[Beeze]

Wow.  I'm so sorry for all that you've been suffering with for two years.  I had an early miscarriage in August 05 and another on in October 05.  It was very frustrating having doctors who didn't offer to get to the bottom of anything.  I suspected my thyroid had something to do with it.  After getting all new doctors and demanding a complete thyroid panel, I was diagnosed with Hashimoto's.  Like you, I had no problem with my first pregnancy (my son is now 3).  I noticed my hypo symptoms after his birth (no milk supply, fatigue, etc. so my assumption is that I maybe had post-partum thyroiditis which progressed).  I lived with that for a year before being put on Levoxyl.  I was only tested for TSH and never for anything else.  After the 2nd miscarriage, I saw an endocrinologist who put me on Armour.  I am still getting use to the Armour and trying to get my dosage right.  This endocrinologist told me that I need to see a rheumatologist as well.  I will be seeing her next week for the first time.  Should I become pregnant again, the rheumatologist will work closely with my obgyn.  My obgyn told me the next pregnancy has to be managed from the moment I find I'm pregnant.  I don't know what all this means but I wanted to share with you a couple things I've learned:
1.  You need to see a rheumatologist as well as an endo. & obgyn
2.  Selenium supplements are a good idea
3.  A study was done that suggested a gluten-free diet for      Hashi patients can lower antibodies (interesting considering I've been told there is no way to lower them). Do a search for "gluten free" and "Hashimoto's" to find the article
4.  Give Eastern medicine a try in conjunction with your Western plan(there are accupuncturists who specialize in fertility)and I personally know people who have had success.  I am seeing an accupuncturist who had Grave's Disease and does not have it anymore.  Western medicine would say that's impossible but stranger things have happened I say.
It's such a frustrating thing.  I really feel for you.  I hope you get better, get those antibodies down and bring a happy healthy baby into the world.  Sorry for the long post.

[ancientmariner]

Wow! You found an endo that gave you Armour? Very rare, from what I'm hearing on my other groups! I'm on Armour, too, but had to go to an alternative med doc to get it.....I'm past child-bearing years, but from what I've heard, you need to keep your Free T3 in the top 1/3 of the range and Free T4 at least in the upper half of the range. And that's aprticularly important during pregnancy, because the thyroid hormone has a huge effect on the developing brain of your baby.....It's good you have a doc that seems to know this!

[Beeze]

I found an article called "Top Thyroid Doctors" from AboutThyroid.com and it has a list of patients who rave about their endocrinologists (also lists their addresses & phone numbers).  I think a good number of these endocrinologists are open to Armour which is why their patients so appreciate them.  You can take a look at it and see if there is one listed in a city near you.  I got lucky that one of these doctors was near me (Burbank, CA).

[Beeze]

OOPS!  Sorry for giving you the wrong web address.  Here is the address for the page that lists the doctors.

http://www.thyroid-info.com/topdrs/

[gyrus]

have you been tested for polycystic ovarian syndrome? there is a secondary phase that affects women in their 20's and can happen even after childbirth. you should get your glucose levels checked as well as look on your neck for skin tags. these are just 2 of the many symptoms and seeing a specialist in this area would be wise. a good site to look at is www.soulcysters.com

[laurawd]

A related discussion, is a suppressed TSH while on Armour a problem in pregnancy was started.