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Old 01-25-2013, 05:15 PM   #1
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Normal Thyroid, High TPO Antibody - cause of miscarriage?

Hi all,

My wife just suffered a miscarriage at 5w3d and we are trying to figure out if she may have a health problem that contributed to this happening. (There are some questions at the end, but a quick story first).

She has had her TSH, T3, and T4 tested several times over the last few years due to fatigue issues and they have always turned up within the normal range. However, during one of those tests (about a year ago) they also looked for thyroid antibodies and the numbers showed up through the roof, with the TPOs being at the max category of >6500. However, that doctor said that since her thyroid gland tests were fine, she didn't want to start any treatment as the antibodies were a "hornet's nest" waiting to pounce on the thyroid, and the other numbers indicate her thyroid is ok for now.

Last week, my wife turned up positive for a pregnancy test and had it confirmed with a blood test at the doctor's office. We were very excited! During that blood test they also checked her thyroid (of course, they only checked for TSH, T3, and T4, not antibodies - doh!) and the numbers were all normal.

Yesterday (at just over 5 weeks pregnant) she said her pregnancy symptoms suddenly stopped and she had light spotting. We were concerned but hoped for the best. This morning she woke up with heavy bleeding and chunks coming out of her. We went to the hospital and they confirmed it was a miscarriage.

Of course, we know that some miscarriages happen due to random chromosomal issues. However, we can't help but wonder if it was the antibodies that killed the embryo.

So, the questions are, if anybody is able to help:

1) Is it possible that the antibodies were the cause of the miscarriage, despite the fact that all of the other thyroid tests were normal? We've read a lot about thyroid issues being the cause of miscarriages, but it's usually a combination of high TSH, T3, or T4 and the presence of antibodies. Can just the antibodies cause the miscarriage? Also, is the fact that the number is so exponentially high (>6500) make it more likely that she would miscarry?

2) I've read in a few places that although thyroid levels can be adjusted with treatment, antibodies are here to stay, and can maybe at best be reduced, but not eliminated. Is that true? Is there no way to get rid of thyroid antibodies?

Overall, this all very harrowing. The idea that A) my wife has astronomically high thyroid antibodies, B) high antibodies will likely result in miscarriage, and C) there is no way to eliminate antibodies, makes us fearful that it will be difficult for her to have a successful pregnancy.

She has an appointment with an endocronologist, but it's not for a few weeks. In the meantime, does anyone have any answers or thoughts to the questions above? It would be greatly appreciated.

Also, one last bonus question (yes, you get a bonus question) - does anyone have any thoughts on something nice I could do for my wife this weekend? She is having a really hard time, in both physical pain and especially emotional anguish. Once again, much, much appreciated.

James

 
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Old 01-26-2013, 12:56 AM   #2
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Re: Normal Thyroid, High TPO Antibody - cause of miscarriage?

I realize I've probably scared people off from responding with such a long-winded, heavy-handed post. And I'm sure it's clear I know little about the complexities (or maybe even the basics) of thyroid issues.

But - to boil it down - if anyone knows anything about the effects of extremely high thyroid anti-bodies (with otherwise normal TSH, T3, and T4 levels) on pregnancy, it would be much appreciated to hear it. Finding stuff on the internet relating to that unique situation has been hard.

Also, if anyone knows if it is actually possible to reduce or even eliminate thryoid antibodies using treatment, it would also be much appreciated.

Thanks again - James

 
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Old 01-26-2013, 01:39 AM   #3
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Re: Normal Thyroid, High TPO Antibody - cause of miscarriage?

Dear James,

let me start by saying you how sorry I am for the miscarriage for the both of you!

As for what to do for her this weekend? I don't know, it's hard to suggest anythign on a person I don't know and everybody is kinda different on such stuff, but I'd say just be there for her, let her know you love her. make her breakfast on bed. is there a special dish she likes, might be an idea to make (or get :-) ) it for her. does not have to be anything big, sometimes things do need it's time and sometimes being there is the biggest thing a person can do.

ok that being said now to thyroid stuff, must be my years on the board but when I read 'normal' labs I don't necessarily assume they are normal. If you'd have any labsresults (including the reference ranges since those can be different) please feel free to share.
It's possible that your wife's labresults are good indeed, but it's also possible they are normal like within ranges which is not good enough when it concerns thyroid.

Antibodies can cause miscarriage indeed.
Yet please do keep in mind it's perfectly possible for people with thyroid issues to get pregnant and deliver a healthy baby. Yet it is important that the thyroid issue is properly managed for that to happen.

As such there is no medication which will make the antibodies drop, yet selenium is known to have a beneficial effect on the antibodies (200 mcg is a good starting dosage, after a month or so alternating to 100 mcg daily - please do check that out). 2) proper thyroid treatment might lower thyroid antibodies

hang in there and sending you both my best wishes!

 
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Old 01-26-2013, 01:56 AM   #4
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Re: Normal Thyroid, High TPO Antibody - cause of miscarriage?

Thanks, Lisa. Your condolensces and thoughts are much appreciated. I am trying to be there for her as best I can. And breakfast in bed is a great idea. I will do that tomorrow

Here are the numbers from the last two tests:

March 2012 -

TSH: 1.951 (.3 - 2.5)
T4, Free: 1.17 (.75 - 1.76)
T3, Free: 3.2 (2.3 - 4.2)
Anti-thyroglobulin: 169 (<60)
Ant-TPO: >6500 (<60)


January 2013-

TSH: 1.950 (.45 - 4.5)
T4, Free: 1.35 (0.82 - 1.77)
T3 Total: 97 (83-200)
No antibodies tested in 2013


If the TSH, T3, and T4 numbers meet your criteria for normal, is it still possible for the antibodies on their own to cause miscarriage and also potentially be the cause of my wife's fatigue issues? Can the thyroid antibodies be causing damage although it's not showing up in the thyroid level numbers? I know the embryo/fetus lives on the woman's blood, so it's hard for me to imagine that such high antibodies in the blood wouldn't attack it. Then again, my understanding of medical issues and how the human body works is really poor (as I continue to demonstrate), so I honestly have no idea.

Anyway, thanks so much again for answering my questions. This is all very helpful.

Last edited by James465; 01-26-2013 at 02:23 AM.

 
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Old 01-26-2013, 03:24 PM   #5
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Re: Normal Thyroid, High TPO Antibody - cause of miscarriage?

James, I hope you and your wife will accept my sympathy as well.

TPO antibodies are strongly connected with miscarriage and premature labor, even in so-called "euthyroid" women. PubMed is full of published studies that find it so. These ABs don't "attack" the embryo, exactly. But they do complicate the attachment of the placenta to the uterus. It's been a while since I read the studies, but I seem to recall it has something to do with clotting in the umbilical attachment. The whys and hows are not so important to the layperson, I guess. Especially if it's not in our control.

But that doesn't mean there's no hope of a successful pregnancy. I wasn't diagnosed until I was well past menopause, but I now suspect - after all I've learned about thyroid disease - that the process leading to my hypothyroidism started in my 20s. At 22, I delivered a son 2 months prematurely due to "placental abruption"... Premature detachment of the placenta. I didn't learn until 10 years ago that TPO ABs are known to sometimes cause placental abruption. Of course, I can't help but now think they could have been implicated in that pregnancy difficulty. But... I went on to have another, perfectly normal, healthy delivery 2 years later. It's important that you know that and take hope from it.

Your wife's TSH is high for a healthy person, even if it is technically within range. The first free T4 would be considered low-normal, as well. Her second set of tests shows mid-range free T4, which is "normal" for some people, lowish for others. The fluctuation of her T levels could indicate a pattern of early thyroid failure due to the antibody activity she's experiencing. With AB titers that high, it won't be long before her gland fails to meet her body's thyroid needs.

There are MDs who would attempt thyroid supplementation for her now, based on high AB titers alone and her desire to become pregnant. It can be a challenge to find one so open-minded, but that doesn't mean it isn't worth the effort.

Perhaps she could enlist the help of a good reproductive specialist. If I were she, I'd begin supplementing selenium as Lisa says. It can't hurt and well could help.

Hugs to you both.
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Last edited by midwest1; 01-26-2013 at 03:25 PM.

 
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Old 01-27-2013, 03:05 PM   #6
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Re: Normal Thyroid, High TPO Antibody - cause of miscarriage?

I agree you need to see a specialist in this scenario.

 
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