Mark F Prummel and Wilmar M Wiersinga, "Thyroid Autoimmunity and Miscarriage," European Journal of Endocrinology (2004) 150: 751-755
"Abstract
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.
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9 comments:
What about TPO-antibodies? I Have read that they can increase the risk of miscarriage? Do you know if there is anything to do about them? I have read that you can eat Selenium to get them down but I don't know.
Glad to hear you have your baby now!
Did you know that 1 in 20 women suffer from some sort of Thyroid imbalance? It's so common that it's commonly overlooked.
Get tested for thyroid levels at every check up and monitor them through the years. They are a good indicator for many things including miscarriage, but also cancer.
Thank you for posting this information! I am one of the lucky ones - My ATA elevated level was just caught because the BCPs I was taking over the summer elevated my T4 levels (my TSH was perfectly normal).
My endocrinologist has written a report to my ob/gyn and MFM doc that my TSH levels MUST be under 2 before I get PG again - it is currently at 2.012.
It is great information. Thank you and I hope you realize your dream of a healthy baby very soon.
I am posting this not in anger or disrepect, but only in an attempt to tell of my experience, which has not been the same as yours...
I have Hashimoto's disease. Very high levels of thyroid antibodies, yet my TSH, T4, and T3 levels are all normal. By normal, I mean my TSH has been between 1.2 and 1.25 (without medication) for decades. I believe that 1.2 is actually the TSH level a doctor is trying to achieve for a patient when prescribing T4 substitution therapy.
Yet I have had 3 miscarriages and no live births.
So, personally, I believe the association between thyroid antibodies and miscarriage is not due to the mild thyroid failure. Of course, there is always the possibility that my miscarriages were due to something totally unrelated to this. I guess I'll never know.
I am very happy for you (and your Turtle too!) but I think your point #3 is grossly misleading and may raise false hopes for people who read your posting, when you say "Keep TSH under 2. Voila. Wait 9 months and enjoy your baby."
This is such valuable information. I have been undergoing fertility treatments (clomid/iui) for almost a year with no success. Within that year, my primary care practitioner has identified a high TSH and low T3 results. She was reluctant to initiate a thyroid medication right away because of the chance I would have to take it for the rest of my life and she felt I was too young for that. Since then, I got pregnant naturally while on vacation. Then I miscarried. I am going to revisit this conversation with her as well as share this with my fertiity specialist and be more insistent. Thank you.
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Yeah, I definitely agree...it is not that simple. I too have Hashimoto's and I kept my TSH within the range, and did everything "right" but I still had a miscarriage (my 2nd since being diagnosed with Hashi's) and I strongly believe it is due to my high thyroid antibodies. The bad thing is there is no treatment for lowering the antibodies - I tried Selenium, and my antibodies actually went up!! So, I am pretty much done trying for my third little miracle, because I don't think I can take another loss :(
Yes, I will have to be the third person to post with Hashimoto's and the last two pregnancies have ended in miscarriage. I had 6 healthy children before I was diagnosed with Hashimotos. My TSH levels are normal. 0.1-0.5 I firmly believe there is a connection and have since read some studies suggesting heparin or aspirin for pregnant women right away, but do not know what success rate is.
JB
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