High Thyroid Antibodies and Multiple Miscarriage

[Krjung]

I have had a total of 6 miscarriages (3 in the past year) all 1st trimester losses < 9weeks. I am now 40.
I did have 1 baby (my son) 3 years ago who was born 8 weeks early but is otherwise a very healthy boy.  We have been trying to conceive for the past year and a half with no luck maintaining the pregnancies (2 blighted ovum) and one very early loss.  Termed "secondary infertility" and unexplained by my current specialists.
I am seeing a "fertility specialist" here and have undergone several IUI with Clomid but none have ended in a live birth.  My cycles are relatively normal 30-31 days and ovulate Day 14-16.  We have done numerous blood tests but for some reason they have ignored my TSH and not ever done a test for that (why, I am not sure.)  My last trip for blood work, I checked the box because I wanted it done.  

Here are my test results:

JUNE 17, 2011
(Day 3 of cycle tests)

Estradiol-------------------- 211 pmol/L
FSH--------------------------- 6 IU/L
LH----------------------------- 4 IU/L
TSH--------------------------- 0.02 mIU/L
INR---------------------------- 1.0
PTT---------------------------- 33.6 sec
Cardiolipin Antibody----- NEGATIVE
Anti-nuclear Antibody Screen-----NEGATIVE 1:80

My TSH level prompted the clinic to do further tests

JUNE 24, 2011
Free T4--------------------------------------------- 9.4L pmol/L
Thyroid Peroxidase Antibody--------------- 154.6 H klU/L
TSH--------------------------------------------------- 0.79 mIU/L

Hoping that someone can tell me whether or not I have reason for concern with my TSH/Antibodies and impact on a possible pregnancy.  I may or may not be pregnant right now (still too early to tell).  I believe that I have some sort of un-diagnosed thyroid dysfunction and that this maybe the underlying problem for my pregnancy losses.

Thanks

[Krjung]

Now in week 5 of my pregnancy #8 and it seems to be progressing well (so far).
HCG levels being checked weekly.  This week HCG level was 1333.  Won't have an ultrasound for another 2-3 weeks to check for a heartbeat (which is usually where we find out the bad news) so I don't get so excited about the rising HCG anymore.

A week after starting Synthroid Therapy (150mcg/day) my TSH levels are starting to correct themselves and I feel SO much better!

My numbers are moving around A LOT and I'm wondering how much of it is because I'm pregnant?  I guess the goal is to get my TSH down to level no more than 2.5.  Here's my numbers this week...

JULY 19, 2011

TSH-----------------------------------------------------------8.87  H mIU/L !!!
FREE T4---------------------------------------------------- 16.8  L pmol/L

[Krjung]

So we did more blood work...  I am indeed pregnant (4 weeks only) HCG=58 VERY worried now as I believe I should have been treated MUCH earlier...

Now as for my thyroid issue...We tested it again JULY 11, 2011 a little more than 2 weeks since my last tests...

TSH-----------------------------------------------------------36.85  H mIU/L !!!
THYROID PEROXIDASE ANTIBODIES---------154.6  H kIU/L
FREE T4---------------------------------------------------- 7.1    L pmol/L

My doctor FINALLY gave me 150mcg/day Synthroid....

My question NOW is...will this high TSH interfere with a pregnancy or cause any problem for the baby?  

We are just going to check my TSH level in a few weeks and every month through the pregnancy (if I get that far).

What is your position on taking Synthroid while also taking an Iodine/Selenium Supplement?  Should I stop this while on the medication?

Thanks

[Mark Lupo, M.D.]

Thyroid antibodies increase the risk of miscarriage.
The TSH changed quite a bit in one wek -- would repeat this in 4 weeks to determine trend and see if medication is needed.

The usual situation is normal or high TSH with positive TPO antibodies (ie, Hashimoto's) -- in this case treating with levothyroxine may decrease the miscarriage risk and would be recommended especially if TSH is >2.