Miscarriage and Antithyroid Antibodies

[sarahleeapril22]

Hi - I have had 2 miscarriages/chemical pregnancies at 5 weeks. One in May and one in July. I did the m/c panel of tests and the only thing that came back abnormal is my antithyroid antibodies.

My doctor does not think I need to take thyroid medicine since my TSH was within their range (.5 - 4.5) But I have very high antibodies and I think my TSH is a little high and my T4 is borderline. My doctor said they would give me prednisone once I get pregnant for the first trimester to combat the antibodies. But I am wondering if I should take thyroid medication. I have read a lot about these antibodies causing muliple miscarriages and I feel like I should be doing something now, not just when I get pregnant since I miscarry so early. What are your thoughts on this? Here are my numbers. Thanks so much.

T4 (Thyroxine): 4.6 (reference 4.5 - 12.5)
T3 183 (reference: 80 - 200)
T4 Free: 1.2 (reference .8 - 1.7)
TSH 3.55 (reference .45 - 4.5)
TPO: 467 (reference <35)
Thyroglobulin: 695 (reference <41)

[Mark Lupo, M.D.]

You are right about the connection between antibodies and miscarriages -- there was a publication recently suggesting that treating with levothyroxine decreases the miscarriage rate.  I interpret the TSH as elevated in the setting of thyroid antibodies, and while there is no definite consensus, would consider treating with thyroid hormone and normalizing TSH (around 0.5-1.5) before trying to conceive again.

This is a tough topic and more research is needed, but my impression of the available data is that there is little risk to a low-medium dose of thyroid hormone in this situation.  There is not adequate data to suggest that prednisone has a role in this setting.

[Mark Lupo, M.D.]

antibodies are associated with miscarriage but are not the only cause of miscarriage.  There is limited data on selenium 200mcg/day being helpful in pregnancy complicated by antibodies but no data to suggest it will lower miscarriage rate.  Most women with hashimoto's have successful pregnancies, so it is not a contra-indication to pregnancy.

[grieving]

I have been on levothyroxine( 88mcg) for the past ten years. Is there nothing else I can do to lower or get rid of the antithyroid antibodies? Were they present in my other 4 successful pregnancies and I just got lucky? How do the antibodies form? Is it risky to get pregnant again if there are antibodies present in my body? Thanks,

[Mark Lupo, M.D.]

Miscarriage is associated with antibodies -- even with normal TSH -- there is debate about what to do but a low dose (25-50mcg) of levothyroxine may decrease the risk of miscarriage in this case as I mentioned above.  Not sure about the role of aspirin.

[grieving]

Hi! I am 38 years old and in excellent health except for a thyroid condition I was diagnosed with 11 years age after my fist son was born. I am taking 0.088 mg of L-thyroxine a day. My blood is checked every six months and my TSH is between 1 and 2. I have 4 healthy children ages 11, 8, 6 and my last was born in July2003. I was closely monitored for my thyroid condition during my pregnancies and had no trouble. I just miscarried for the first time this July. I was 11 1/2 weeks pregnant. The baby was 9 weeks and 6 days. All of my blood work and ultrasounds during this pregnancy was normal. The baby was tested and found to have no genetic defects. I am devastated! I have seen a reproductive endocrinologist who suggested checking for antithyroid antibodies. The test came back positive. I would like to have another child. The endocrinologist suggested trying aspirin therapy. Why am I having a miscarriage if my thyroid is considered stable? I would greatly appreciate any advice! Lynn

[borninquisitive]

I'm glad that you received a concrete answer and by a respectable endocrinologist. I suspect you will take this with you to your next appointment.

Best to you, Sarah and good luck!
~Kate