Hypothyroidism and Miscarriage

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.

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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.

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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.

 

 

 

  One thought on “Hypothyroidism and Miscarriage

  1. August 30, 2016 at 3:47 pm

    I am hypo as well, and I didnt know until my current RE about that 2.5 TSH cut off. I got diagnosed at 25, and since I wasn’t TTC, or even thinking about it, I was always told to follow the 4 rule. When I first was having fertility problems, my OBGYN basically didnt even retest my thyroid, because it had been tested like 6 months prior. Then when I finally got to my fertility clinic, they told me to get it retested- and it came back above 3. They upped my meds, for which I am grateful (although clearly nothing has worked thus far).

    Now that I’ll be prepping for FET in October, I just shot my nurse a note demanding another TSH test. So yes, this is tremendously good advice. I’m sorry you didnt have this months earlier.

    And I’m sorry to hear about your mom. That is unfortunately not the loving behavior that you deserve.

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  2. August 30, 2016 at 10:47 pm

    Hypothyroidism has also been linked to learning disorders if untreated, even at subclinical levels. At one time my thyroid was 2.4 and my specialist treated me because of this. It definitely sounds like a change of naturopath is in order. I also tried out one who just didn’t get me or my journey at all, despite being a fertility specialist. I found another one who I love and who has been am enormous support. She helped me diagnose mthfr and has got me ovulating naturally for the first time in my life. We still need to do donor egg ivf but it has been wonderful to feel ‘normal’ again. All the bestxxx

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  3. August 31, 2016 at 12:12 am

    Sorry to hear about your hypothyroidism results. Can’t believe this hasn’t been picked up by your medical team so far…they are big on TSH over here in Europe. I think I had mine checked at every cycle. And as for your naturopath person….I think it’s time to say adios. You really do not need the additional stress once you start cycling again. If ‘get some exercise’ qualifies as professional advice then I am obviously in the wrong line of work and should offer my services as an infertility specialist 😀

    Liked by 1 person

  4. August 31, 2016 at 5:28 am

    Your doctor’s don’t give you a printout of your lab results?! My General Practitioner not only gives me a printout with my readings but also what the normal range for that reading is. Any of mine that are close to being abnormal or are abnormal are even highlighted with a damn highlighter for me! I wonder if my Doctor is just amazing (she is obviously never allowed to move cities ever) or if it is an Australian thing….

    Sorry to hear about your mum 😦 sometimes people just suck and we have to accept what they are instead of what we know they should be.

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    • August 31, 2016 at 7:19 am

      You have to ask for copies of your records here and the standard range for thyroid is 4.0 and under, which is a larger range than 0-2.5 which is for pregnancy. Not all doctors take stock in the thyroid’s connection to miscarriage, so ‘normal’ vs ‘abnormal’ ranges can be different depending on the doctor.

      Liked by 1 person

      • August 31, 2016 at 1:17 pm

        Urgh, my GP seems to just be an amazing one because my mother said hers doesn’t give printouts either! That just sucks that some doctors won’t keep up to date with studies etc. Hope you find some who are more proactive!

        Liked by 1 person

        • August 31, 2016 at 2:17 pm

          Crossing fingers – I just reached out to a new one today and before making an appointment asked her about her philosophy with using ‘real’ medication and not just herbs and she’s all over it. And as expected, my thyroid results came in today with no changes so tomorrow I’m going in and getting things MOVING! 🙂 thanks for your support!

          Liked by 1 person

  5. August 31, 2016 at 7:45 pm

    I am so sorry your doctor didn’t take this more seriously. I insisted that my level be under two while going through fertility treatment and would ask my doc to order regular blood tests as my levels have known to change without reason. You can also take a mixed dose of 150 and 175 on different days of the week to find a good balance if 150 isn’t enough and 175 is too high. I have been hypo my whole life so I have done a lot of research. Also 4 is too high for me even when not pregnant or TTC. At 4 I am insanely tired and bloated. I think it’s crazy they say it’s “normal”

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  6. September 4, 2016 at 9:34 pm

    I have hypothyroidism too — Hashimoto’s. Wasn’t caught for years while TTC & I’m still furious, Optimal TSH range is closer to 1.0-1.5. The MTHFR stuff is pretty important so I hope you can get to that soon. I’ve seen huge health improvements from addressing genetics & methylation issues. While I don’t have the very common MTHFR, I do have several other problems with my folate cycle creating similar problems. In the end, I think the folate/methylation issues plus autoimmunity from Hashimoto’s have been a sort of 1-2 punch leading to multiple miscarriages for me.

    If you need any help figuring out how to even begin evaluating genetics beyond MTHFR I’d be happy to point you toward some helpful resources. (If you don’t want to wait for your naturopath to get on the ball you can even order yourself a kit straight from 23&Me ($199) and get an answer on MTHFR and several other key genes immediately. It’s a saliva test you do at home and then takes a few weeks to process I think, but it’s entirely under your own control and no waiting on lousy slow docs. Good luck!

    Liked by 1 person

    • September 4, 2016 at 10:30 pm

      Thanks! I wrote in a blog post about my brand new naturopath and we’re bypassing the MTHFR and simply going ahead as if I have it and increasing my folate intake since it doesn’t do any harm either way 🙂 My transfer is in 4 weeks so I don’t have time to wait for test results at this point now , so we’re taking an aggressive approach. Just glad I trusted my gut and dumped the last person who was taking her own sweet time! Thanks for your comments!!!

      Liked by 1 person

  7. myrainbowdream
    September 6, 2016 at 2:32 am

    I thought about you and this post today! I went for my pre-treatment appointment for my FET and she went through the protocol and in addition to drugs I was taking last time he has added 25mg Thyroxine! She asked if I took this last time (nurse) and I said no and she is going to check with the consultant as I was not aware of any thyroid issues coming up in tests. I am wondering if this is anything to do with normal levels and pregnancy levels? He may have also just made a mistake ha. I hope you are are doing okay.

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    • September 15, 2016 at 4:18 pm

      Did they tell you what your TSH was at?

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      • myrainbowdream
        September 16, 2016 at 1:56 am

        No they tend to say ‘everything is fine’ so I never asked. If it is still on my drug list when everything is sent out and was not a mistake I am going to ask. What should it be pre starting this cycle? I did wonder if he had just thrown it in as a precaution with the link to miscarriage and antibodies but erm maybe he should tell me first plus I know I tested ok for that. She was going to speak to him. I am currently waiting for my period to start as I have to go on the pill for this FET as I am having the dreaded pipelle scratch again.

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        • September 16, 2016 at 7:50 am

          Needs to be 2.5 or below, “ok” is not a sufficient answer. The sooner you can find out the better, as too many doctors go with the old standard of 4.0. Make sure you get all your actual blood test results in writing so you are in charge of your health 🙂

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        • myrainbowdream
          September 16, 2016 at 10:13 am

          Thank you I will take your advice. I think it is very much like this in the UK, they look at you strange if you ask for a copy of results but you are right why shouldn’t you its your body. I should be calling in day 1 Monday (hopefully) and I am going to ask then as they will be ringing my prescription in. Thank you for your advice I really appreciate it. 🙂

          Liked by 1 person

        • September 16, 2016 at 12:09 pm

          Go get em grrrl!!!!

          Liked by 1 person

  8. September 15, 2016 at 8:15 am

    I haven’t used an OB but my midwife for my first pregnancy was totally on top of my thyroid, always wanting to to know when it was getting checked and wanted to me to see and endocrinologist instead of just a GP. New to your site so the first post I’ve read, but if not already try to avoid plastics, use glass instead. BPA and other EDCs in plastics, and just EDCs in general, can inc hypothyroid. Even if it says BPA free they are replacing BPA with BPS (just a different version of the compound) so its not really any better. Glass is the best way to go. Good luck!! i need to go get mine checked, just moved and haven’t got a GP yet.

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    • September 15, 2016 at 8:21 am

      Thanks! We don’t have any plastics in our home…too many chemicals! My fertility doctors is a reproductive endocrinologist by the way…check out the “my infertility timeline” link off of the Two Plus One category on my blog to get an overview of my struggles with DEIVF and miscarriage.

      Liked by 1 person

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