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Old 02-17-2008, 07:08 PM   #1
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Question thyroid peroxidase and miscarriage

I have had 2 miscarriages within 2 years. The last was in December, and I was 11 weeks. My first ultrasound was great and everything was fine. When I had my miscarriage the dr told me that the baby stopped growing about 5 days later. In trying to find a cause for the MC, he checked my thyroid and found that my thryroid perodxidase level was over 1000. He told me that thyroid problems are a cause of recurrent MC. He told me to go to my primary who would run blood tests and an endo. I went to my primary and she told me that she totally disagreed with him. Has anyone ever heard of thyroid problems causing MC's? I have always had a slightly slow thyroid, but it has never been slow enough to have medication. But in the last 7 years I have gained 80 lbs with no real reason. I have gained 30 of it in the last year. My appointment is next Tuesday. I am just worried that the endo will disagree with my OB. I'm just discouraged.... again
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Old 02-18-2008, 06:51 AM   #2
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Re: thyroid peroxidase and miscarriage

You need a new primary. Even my IM told me I was at an increased rate of miscarriage with levels of 286 TPOAb and 284 TGAb. Our Hashimoto's antibodies can cross the placenta and attack and kill off the fetus thyroid as well as our own. This we need to be treated with care. If you are still trying to conceive and want the best care you need a thyroid savvy Endo or Internal medicine specialist and you need to get a genetic profile and consultation with a specialized OB. (Maternal Fetal Medicine) or MFM OB's are associated with the hospital and while they do not catch the baby upon delivery they do monitor you and the baby with blood work and targeted ultrasounds that can see if the babies thyroid is being compromised. It sounds to me like you are hypoT as a result of Hashimoto's.

I was told by all my resources these following facts to do in order to be ready to get pregnant, but your should check with your OB and an MFM for your own information:
1) Start a multivitamin with iodine and selenium in it.
2) Talk with all your family members especially the ladies. Thyroid AI's and conditions are hereditary. Having that family history is important in getting proper treatment for all concerned. If any have an issue, get a copy of their blood work as well.
3) To get pregnant and have only the same risks as a normal thyroid functioning patient. Make sure that your FT4 level is at 50%. The first 12 weeks the fetus is dependent on your for it T4 and if you have less that 50% you and your child are in danger of being thrown hypoT and suffering ill effects as a result. The child will take up to 30% of your T4 and as a result you will have inadequate amount to cover your own needs. If you were like me at 5% you wouldn't have had enough for the baby or yourself. Also keep the TSH below 2.5.. but the T4 concentration is the most important.
4) Now some facts for your to ask your Endo to determine if they are thyroid savvy are concerning optimal levels and optimal treatment in recent statistical studies (2005 to date):
*****TSH(3rd Gen) - .89-1.1 [Since 2002 A C E E and A T A acknowledge and recommend a TSH normal range of 0.3-3.0] Board of OBs recommend that the FT4 not fall below 50% and the TSH not exceed 2.5 during pregnancy otherwise chances of increased MC and congnitive development of the fetus are greatly increased (2.5% thyroid normal pregnancy to 30+% depending on hypoT and AIT factors).
*****FT3 and FT4 should fall in the optimal 50-80% of normal range and they should be with in 10% of each other. Greater than 10% point to conversion issues and therefore if the T3 is significantly lower than the T4 T3 supplementation in addition to T4 supplementation may be required.
5) Get a referral to an MFM, make them work together with the Endo if the Endo is good.
6)Your thyroid supplement demands will increase 25-50% during pregnancy.. also you should be tested every 4 week minimum to make sure your Fts are in the optimal range.
7) Search and read up on Prophylactic Treatment of Euthyroid Hashimoto’s Thyroiditis for your personal knowledge.

Where does all this information come from? I am not an MD. Just a Chemist and chemical engineer. However, my husband and I wanted to have a second child, and given the increase in X,Y, and Z symptoms and my mother having a thyroidectomy.. my OB looked back at my first pregnancy and told me that she thought I might have a thyroid problem, research it fully through my IM and come back to her with the results. It took six months of badgering to get my full family history and the IM to consent to test me. My mother is one of five sisters.. all have thyroid issues. Four have thyroid autoimmune diseases they were ashamed of their conditions and made to feel it was their fault by their MDs. IT ISN'T YOUR FAULT any more than it was theirs.. it is just a bad genetic lottery ticket. AITs are a dominant genetic trait and there is an 80% passage on to female offspring, males the chances drop to 20-40% depending on the studies you read. I have a son and glad of it. Well given personal research on my mother's Hashi's(HT)/Graves(GD) condition and the fact she had one other sister HT/GD, one pure HT, one pure GD, and one just hypoT. I became certain that all these symptoms I had were linked to my thyroid. I had been going to an ENT, Dermatologist, pulmonologist/cardiologist sleep specialist and Allergist for treatment and they were doing what they could.. but barely keeping things in check. So I fought for testing and was determined to have Hashi's.. it was a relief in some ways, I knew I wasn't a crazy hypochondriac.. and now I could treat the source. Yeah, right! This is where things get tricky. Getting diagnosis is one fight.. getting optimal treatment is another life long struggle. Here is a bit more of my story of getting treatment for you.. so you can see you are not alone and learn from my struggles.

I am secondary hypoT (very common with Hashimoto's patients and very hard to get treated) as a result of Hashimoto's as well. I was denied treatment by my original IM and the Endo I fought to get referred too. I was told my issues were not bad enough and to live with the fact that I was at an increased chance for miscarriage and to come back in for testing immediately after I got pregnant. A second pregnancy would most likely kill off my thyroid. I wasn't willing to accept this and went on the MD hunt. The Endo assured me the migraines and vision impairment I have had since my first pregnancy had to be in my head.. so I got a referral to a Neurologist, and my heart/blood pressure issues could not be due to my thyroid either. My Endo was flat out wrong. And thousands of dollars spent on tests for all sorts of symptoms and conditions that the neuro and cardiologist and allergist and dermatologist could think to be the source of the symptoms all pointed back to one thing. My thyroid. In three months my TSH had only risen to 2 from 1.6... very normal for most. But my FT4 and Ft3 levels had plummeted to 5% and 30% of range and the most telling was my antibodies and rapidly growing groiter. My antibodies went from 286/284 to 1695/195 (TPOAb/TGAb) respectively. These antibodies began attacking my heart and vision and a multitude of other things in my Cardiologist and Neurologist and Neuro-Opthamologists opinions. So I was certain I would get treatment by the Endo now.. my Neurologist and Cardiologist wrote back to the Endo and called her up.. only to be told I had to wait until my TSH hit 2.5 and my FTs fell completely out of range. This got them and me mad. So we looked locally and a far for treatment. I wasn't concerned about just my symptoms and issues, but any child I have and my current child's risks due to antibodies and hypoT condition. My SIL is an OB she has directed me greatly in getting good care and advice. The MFM/OB's and FACOG OB supported each others plans to not get pregnant until my antibodies dropped and/or my Ft4 levels climbed to 50%. This required T4 supplementation minimum.

I got lucky and a center for integrative care practice in town had an IM and FP that were thyroid savvy and listed on the Armour Physician Finder database. They treated me day one after visiting. Now I am on 75 mcgs of Synthroid and my FT4 levels are climbing with no hyperT symptoms in sight. The sad thing is there are four hospitals in town and many MDs(10 Endos).. only the one group of three MDs (IM, 2 FP's) were willing to treat thyroid conditions prophylacticly, most are hung up on a TSH being range X.. symptoms and Fts are not irrelevant IMO. DO NOT TAKE the word of the Endo or GP as the undeniable truth. Get a copy of your lab work check it here or by your OB. Make sure they do the works. FT3, FT4, T3 Uptake, RT3, TSH (3rd Gen), and TPOAb/TGAb minimum! Also get a referral to an MFM near you. The Endos are not specialized in treating the needs of a developing fetus in addition to the mother.

I hope this isn't WTMI and that it helps you in your search for treatment and care.
MG
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Old 02-18-2008, 08:48 AM   #3
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Re: thyroid peroxidase and miscarriage

Your primary MD is an idiot. Her credentials are questionable at best.

There is considerable evidence that treating with levothyroxine when TPO antibodies are present, even when thyroid levels are within normal range, will prevent TPO-related miscarriage and premature birth.

Take this information to your idiot MD ~ Here is the title of the respected major study on this issue, and where to locate it:
Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H 2006 Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab 91:2587–2591

The conclusion drawn by these learned people concludes that early levothyroxine treatment in women with TPO antibodies and a normal thyroid function at the onset of pregnancy will result in a 75% reduction in the miscarriage rate and a 69% reduction in the risk of premature delivery than in women not given treatment.

The information can also be found at thyroidmanager.org, chapter 14.

I'm in St. Louis, too. Just for curiosity's sake, may I ask who is that idiot MD so that I know who to avoid for my own best interests? Board rules allow you to post name and city only.

 
Old 02-18-2008, 01:58 PM   #4
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Re: thyroid peroxidase and miscarriage

Thanks for the replies. I wouldnt go as far as calling my DR and idiot. I do like her, and I just think that she is not well versed in anything having to do with pregnancy. I have MTHFR also, and she knew nothing about that and its effect on preg so she would not test me for it. My OB tested me, thats how I knew I had it. He knew everything about it. I really love him. My general pract is really good at the general stuff. I am just hoping the endo will know more than my general. My dad goes to him, and he has helped him alot.
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Old 02-18-2008, 03:30 PM   #5
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Re: thyroid peroxidase and miscarriage

OK then, if you feel that way, I sincerely apologize for the name-calling. But she really knows diddly-squat about thyroid disorders, and I would not trust her at all in that arena.

Wishing you a happy pregnancy and bouncing babe very soon!

 
Old 02-19-2008, 02:10 PM   #6
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Re: thyroid peroxidase and miscarriage

Thanks. I am hoping that I will be able to get pregnant (and retain it) by this summer. Is there anywhere I can find information about the dr I am going to see? I would like to know a little more about him. My dad goes to him, but that doesnt mean he is well versed in thyroid and pregnancy.
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Old 02-19-2008, 02:15 PM   #7
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Re: thyroid peroxidase and miscarriage

My friend who had multiple miscarriages finally went to a reproductive endocronologist, who specializes in analyzing all the hormones that play a role in maintaining and growing a healthy pregnancy---if you live in a big city like St. Louis, I wonder if you might find a reproductive endocronologist there---I'm in NY and there's more of them here than ordinary endos.

 
Old 02-19-2008, 05:45 PM   #8
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Re: thyroid peroxidase and miscarriage

Thanks for the tip I think my ob would like me to see one if this guy does not work out.
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Old 02-19-2008, 07:36 PM   #9
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Re: thyroid peroxidase and miscarriage

Keep us posted. I am wishing you the best.

MG
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Old 02-20-2008, 11:30 AM   #10
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Re: thyroid peroxidase and miscarriage

I am going to see a repro. endo in April (it sucks that it takes so long to get into those place). But I am waiting for my OB to call me back so I can find out if he wants me to go see a regular endo also. But I taked to the nurse at my OB's office and she said the dr that I am going to is really great, so that makes me excited
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Old 02-27-2008, 09:19 AM   #11
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Re: thyroid peroxidase and miscarriage

I went to the endo yesterday and he diagnosed me with Hashimoto's. He put me on synthroid and I am getting an ultrasound done on my thyroid today. The weird thing is, when he was feeling on my thyroid, he was very gentle, but it hurt like crayz! It still hurts! I know thats not normal. Anyways, I am still seeing the reproductive endo. in April, so hopefully by that time I will have some changes in my tests results and the baby making can start
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Old 02-27-2008, 09:36 AM   #12
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Re: thyroid peroxidase and miscarriage

Great deal. Oh palpating the thyroid in Hashi's can be painful. Mine hurts when messed with. It is a side effect of the inflammation. When i had my ultrasound in Jan. 2008.. man did my thyroid flare up. It hurt for days. I am glad that you are on your way to getting treated. Stay on him and make sure you get medicated. T4 levels must be high enough to support you and a developing fetus.

MG
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Old 03-27-2008, 06:29 PM   #13
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Re: thyroid peroxidase and miscarriage

Well... I got preg before I was able to see the reproductive endo, hehe. My thyroid levels are doing great, and I go to my first ultrasound on the 15th and go for blood work to my endo at the end of April and see him in May. I'm keeping my fingers crossed that everything goes ok.
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Old 03-27-2008, 07:07 PM   #14
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Re: thyroid peroxidase and miscarriage

Hey, CONGRAT! That is happy news. You should start a thread. HypoT and pregnant.. my trials and tribulations. That way we can hear all your news and check on you.

Sincerely,
MG
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Old 03-27-2008, 10:06 PM   #15
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Re: thyroid peroxidase and miscarriage

Quote:
Originally Posted by fruitloop1024
I'm keeping my fingers crossed that everything goes ok.
We'll be keeping ours crossed, too!
Congratulations!

 
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