Wednesday, July 19, 2006

Thyroid Autoimmunity and Miscarriage

Mark F Prummel and Wilmar M Wiersinga, "Thyroid Autoimmunity and Miscarriage," European Journal of Endocrinology (2004) 150: 751-755


To ascertain the strength of the association between thyroid autoimmunity and miscarriage…A CLEAR ASSOCIATION BETWEEN THE PRESENCE OF THYROID ANTIBODIES AND MISCARRIAGE WAS FOUND…This associaion may be explained by a heightened autoimmune state affecting the fetal allograft, of which thyroid antibodies are just a marker. Alternatively, the association can be partly explained by the slightly higher age of women with antibodies compared with those without…A THIRD POSSIBILITY IS MILD THYROID FAILURE, as thyroid-stimulating hormone (TSH) levels in antibody-positive but euthyroid women are higher than antibody negative women…"

Treatment Recommendations:

"It is possible that the association between thyroid antibodies and miscarriage has to be explained by a general increase in autoimmunity against the fetal allograft. If this were to be the case, there are almost no theraputic interventions to offer these women. The two other explanations, i.e. MILD THYROID FAILURE or the TPO antibodies themselves DO HOLD PROMISE FOR SUCCESSFUL INTERVENTION. The higher TSH values in antibody positive women warrent a randomized clinical trial to evaluate the effect of T4 substitution therapy AIMING AT TSH VALUES BETWEEN 0.4 AND 2.0 mU/L." *

* Emphasis in ALL CAPS is mine, not the authors'.

Folks, I am one person, not a randomized clinical trial. But I would just like you all to know that I tested positive for thyroid antibodies before my first pregnancy and was diagnosed as "euthyroid," that is as having subclinical thyroid disease. Yet my TSH levels were never monitored carefully until my 4th pregnancy. With each of my 3 losses, by the time my TSH was tested it had already climbed to anywhere between 6 and 10 mU/L.

Not that I'm the slightest bit bitter or angry at all the doctors who claimed my thyroid disease was way too mild to be the explanation for my 3 losses. But I beg you, if you're having recurrent miscarriages:

1-GET TESTED for THYROID ANTIBODIES. Do NOT just let them test your TSH. Lots of docs are too conservative and think anything under 5 is fine. Some even say anything under 10. SO FIND OUT IF YOU HAVE THYROID ANTIBODIES.

2-If you test positive for antibodies & are diagnosed with mild hypothyroidism, please, please, please know how important it is to keep that TSH UNDER 2 from the very beginning of the pregnancy.

3- "T4 substitution therapy," the cure for this disease, involves nothing more than taking 1 tiny pill a day to "substitute" synthetic thyroid hormone for the body's deficit. Give your body the hormone it needs and TSH (the hormone that stimulates the body to make thyroid hormone) falls to safe levels. Keep a close eye on those levels because your body's needs can fluctuate very rapidly. Repeat: keep TSH under 2. Voila. Wait 9 months and enjoy your baby.

I love my Turtle soo much, but I will never stop wishing those first three could have stayed with me. This is such a ridiculously easy thing to fix, it's amost incomprehensible that I went through such suffering before it was addressed at my stubborn insistence.