Hypothyroidism’s Proven Link to Miscarriage
So I’ve been diving even deeper into hypothyroidism and have learned more than I almost wanted to know. Did you know that “a maximum TSH level of 2.5 before pregnancy in HYPO-Rx women has been recommended recently by the Endocrine Society in a Clinical Practice Guideline”? Which means, even though “normal range” is anything under 4.0, that’s just not good enough.
In April we retested my thyroid and it’d gone up to 8.4, more than double the normal range. Rather than take intense action pre-IVF, my (now former) ND only bumped me up from 125 to 137 mcg – a smidge (even though I’d asked to go to 150 then) – then did not schedule any follow up with me. As usual, left me alone to figure things out. My RE had deferred to her since at the time she was my primary care. Well, just days post-miscarriage, we tested it again and it had reduced, but only to 5.1. A bigger dose should have been prescribed. Who knows if that caused my miscarriage, but it certain So, still above “normal range” and – as I found out this week – DOUBLE what it should be for a healthy pregnancy and to minimize hypothyroidism-related miscarriage risk. This time I asked my RE to prescribe me a higher dose and now I’m at 150 mcg. Three weeks (a bit early, but time is not on our side) later I had my blood drawn to check it again along with the antibodies I spoke of in my last post. If it’s not under 2.5 (I’ll find out this week), I’m going to insist that we go up to 175 mcg by September. I cannot and will not go into another transfer knowing it’s not where it should be.
The amazing Hypothyroid Mom did her research into the various medical studies out there that show the strong tie of untreated or undertreated hypothyroidism to miscarriage, compiled and shared them. Here are a few quotes (not from her but from the actual studies she mentioned on her website) that are particularly impactful:
- “Women with mild thyroid dysfunction had double the risk of miscarriage, premature labor or low birth weight as compared to pregnant women with normal thyroid function. They also had seven times greater risk of still birth.”
- “In the Journal of Medical Screening, researchers in a large study of 9,400 pregnant women demonstrated that pregnant women with hypothyroidism had a second trimester miscarriage risk four times the risk of women who were not hypothyroid.“
- “Thyroid hormones are essential for the growth and metabolism of the growing fetus. Early in pregnancy the mother supplies her fetus with thyroid hormones. If the mother is hypothyroid, she cannot supply her fetus with enough thyroid hormones. Hence hypothyroidism is a risk factor for pregnancy loss.”
- “If hypothyroidism has been diagnosed before pregnancy, thyroid hormone replacement medication dosage should be adjusted to reach a TSH level not higher than 2.5 mIU/L prior to pregnancy. If overt hypothyroidism is diagnosed during pregnancy, thyroid function tests should be normalized as rapidly as possible to TSH levels of less than 2.5 mIU/L in the first trimester (or 3 mIU/L in the second and third trimester).”
Whoa. I could fucking bitch slap everyone who did not tell me this information who should have over the past 20 months of hell we’ve endured. Irresponsibility at it’s finest.
By the way, do you know how I originally figured this thyroid thing out? I pulled up the physical copies of my lab results I’d kept in an email and in a very small font, there is a section on it with ranges for pregnancy, and considering it said that a “normal” range was 4.0 and lower, but for pregnancy it was EVEN lower, something clicked that my doctors were not treating my hypothyroidism aggressively enough.
Again, Dr. Google to the rescue. We’ve been so trained to NOT go online for data but when it comes to hard research data by major medical/scientific organizations, and that not a damn soul I spoke to provided this info, it was absolutely devastating to hear that my fucking thyroid problems may have contributed to this lack of success.
So to my sistas like me who are still trying out there to start a family with your partner, get your thyroid checked, and re-checked. Don’t take the “it’s just fine” response at face value – get the ACTUAL numbers and copies of your labs, insist on treatment if you’re not under 2.5, and do NOT be afraid to question their advice or get more help if you need it.
While I don’t know if this will be the answer, I’m not going to leave any stone unturned.
An Update on Black Cohosh
So something wasn’t sitting with me right on the black cohosh recommendation of New Naturopath. I had taken it for one day and found myself for one of the few times in my life (TMI alert…) constipated and in pain. Something wasn’t right. So I started doing my homework on it and found that while it has been shown to help increase/improve the lining of your uterus during natural cycles, there is very little evidence of it helping during IVF. Why? Because it is actually an estrogenic (estrogen-mimicking) herb and on IVF you’re taking estrogen prescribed by your doctor. Some sites said yes, take it, others said no, don’t take it as it can affect your existing regimen. And here’s the thing – soy does the same thing and I’ve been told to stay far from soy in my diet (both for that and for my thyroid). My gut just said this needed to be questioned beyond this new well-meaning provider.
And so I decided I needed to trust my gut and ask the rest of my ‘care team’. The responses from both were as close to an ‘aw hell no!’ that I can imagine coming from them. When it comes to hormones, your RE is prescribing a certain amount of estrogen for a reason, and messing with that on your own is not a good idea as it has the potential for negative consequences. Considering I’ve never had a problem building up my lining, why would I mess with it or disregard this particular instruction? So Friday I emailed New ND that I was not going to be taking her recommendation when it came to black cohosh. I’ll take a vitamin C supplement, I’ll switch to the folate-happy prenatal, and we’ll watch my thyroid, but the black cohosh is not going to be on the list. I appreciate her zeal for MTHFR and thyroid monitoring and so that’ll be my focus for the time being.
And speaking of MTHFR, I still haven’t had it tested yet as New ND as of last week has to order a kit for me to take to the natural medicine college who does testing for her. When I asked if other labs do it, she said she doesn’t want to research other labs that do it because she already knows them – even though it’s completely slowed down the process (won’t get results until next week which would leave us with just 4 weeks). And as she sent me to an out-of-network lab the first time for the thyroids, I’m getting a little peeved that there is no sense of urgency with this New ND. I honestly am starting to think that her ‘infertility specialty’ is basically for women who have not been through IVF. She’s made recommendations that even other holistic practitioners advise against, and my radar started to go off in my head.
While I didn’t feel a tremendous connection to her at the appointment, I kind of blew it off because I was so damn fragile. But I remember some blank stares talking about my miscarriage and what I was going through. Today she said that when my thyroid results come in that I need to make an appointment to go over the results – but she doesn’t have anything for over a week! I put my foot down and said no, I need my results when they come in, as I need to take them to my RE, and as next week I start estrogen and do NOT want to still be in the dark about this. She mentioned alternative ways of improving my thyroid through diet and exercise and I nearly blew a gasket. Not only had I already told her about my first ND who recommended this and my thyroid went to hell, but she is still not getting the sense of urgency we now have in preparing for the next transfer. As if it’s super duper easy to just do another one if we don’t fix this thyroid situation in time. Then she said that she can’t keep discussing things over email as she needs to get paid for her work (mind you, my only emails were to ask her about her existing recommendations and the tests being done, and at the appointment she encouraged me to email her with questions), and so I made it clear: email me my results the day I come in, period. They’re my fucking labs (didn’t say that, but wanted to) and if I’m going to be told to “get more exercise” (when every time I get halfway down the block my eyes well up with tears and I have to turn around and go home) or get my vagina steamed (aw hell no) as ways to improve my odds, I have wasted a fuck-ton of money.
Here’s the deal though after that rant – I’m not on any injections this month so this is pure Me being honest. The drugs have cleared out of my system and I’m seeing a lot of things more clearly. I’m not seeking a babysitter for my emotions but I do want empathy and someone who gets it. I do want whoever I pay for their services to clearly know what I’m dealing with. 20 months straight of infertility drama requires that.
And with that hormone-free clarity, I’m seeing that my mother’s choice to go spend time with her new boyfriend and fly to see her oldest son during the time I was suffering my miscarriage reminds me that, now that I’m off the hormones, this is NOT someone who I feel happier after hearing from or spending time with and rather just feel exhausted for attending to her narcissism. If the conversation isn’t about her, it’s not important to her. And while I tried to go into Customer Service Mode – why the fuck should I? If I am not going to be treated with love and respect and concern during this time, what will I get during the other times? If I don’t feel better for being around her, why am I around her at all? She wants us to come visit her, yet she can’t pick up the phone or volunteer to come see me while I sit here in my home, grieving for the baby that we never got to meet. Off the hormones, I don’t crave mothering from her. Off the hormones, I don’t have the interest or energy in attending to her. Off the hormones, I remember why I’d ended this relationship. She’s never tried to get to know my husband and she’s still never asked me anything about infertility, IVF, etc. So I’m done for right now.
With that I count my blessings. I am grateful for the friends who have reached out. I am grateful for the providers who do make me want to hug them at the end rather than shake their hand (even if they’re not huggers, haha). I am grateful for the long easy call from Mum C in Australia who does give me that daughter love I need so much. And dammit, I am most grateful for the best guy a gal could ask for to wake up next to every morning, one who will start dancing silly in the backyard just to make me laugh, one who gets who I am through and through, one who loves me til the cows come home…and then some.