Advice please - high antibodies and miscarriage

[Molliemoo1]

Hi all I'm looking for some advice

I've suffered 2 miscarriages since November 2015, both at 6+5 weeks.

I have had my thyroid function tested as my mom has Hashimoto’s disease.

My results are as follows :

Serum TSH 3.4 (normal range 0.3 -  4.2)

Serum free T3 4.6 (normal range 4 - 6.8)

Tpoab 339 (normal range 0 - 34)

I haven't had T4 tested.

I'm waiting for a referral to the recurrent miscarriage clinic but in the meantime I think I'd like to see an endocrinologist privately.

I took the NICE guidance to my doctor (tsh under 2 for ttc) but gp says that this only applies to someone who has already been diagnosed and is already on treatment.

Please can anyone recommend a consultant that will be willing to look into treatment for ttc and pregnancy even though my TSH is normal? Or if you haven't been through something similar, I'd also welcome recommendations for consultants that have helped you with your thyroid during ttc or pregnancy.

I'm in the Midlands but willing to travel.

Thanks

[Clutter]

I'm sorry for your losses, Molliemoo1.

It is known that high TSH makes conception difficult and increases the risk of miscarriage which is why the NICE recommendation is that women planning conception and newly pregnant should have TSH in the low-normal range 0.4-2.0.

cks.nice.org.uk/hypothyroid...

I would write to the senior GP at the practice and ask for a second opinion. You may be prescribed Levothyroxine for the duration of your pregnancy and it may be withdrawn post-partum if thyroid levels normalise.

In the meantime you might try 100% gluten-free diet which may help reduce Hashi flares and antibodies.

chriskresser.com/the-gluten...

thyroiduk.org.uk/tuk/about_...

Email [e-mail] for a list of member recommended endos.

_______________________________________________________________________________

I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

[Molliemoo1 in reply to Clutter]

Thanks.

I've already been for a second opinion with a partner at the practice and she said that my tsh is fine so I should stop worrying.

Think I'd better start saving the pennies!

[Clutter in reply to Molliemoo1]

Molliemoo, I'd make a written complaint saying the practice is not observing NICE recommendations and you have subsequently miscarried twice. I'd also consider changing GP practice.

[Molliemoo1 in reply to Clutter]

Really? Do the NICE guidelines definitely apply to me as I haven't been diagnosed with an underactive thyroid and the guidelines talk in terms of tsh needing to be below 2 for women who have pre existing hypothyroidism or Subclinical Hypothyroidism and my doctor says that I have neither.

[Clutter in reply to Molliemoo1]

Molliemoo, the recommendations apply to TSH in women attempting conception or pregnant, not whether you are already diagnosed.

[Molliemoo1 in reply to Clutter]

I found it difficult to argue the case with my doctor because all the recommendations come under the heading :

"Scenario: Preconception or pregnant

Scenario: Subclinical or overt hypothyroidism in the prenatal or antenatal period"

[Clutter in reply to Molliemoo1]

Molliemoo1, This is the salient point:

Aim for a TSH concentration in the low-normal range (0.4 mU/L to 2.0 mU/L) and an FT4 concentration in the upper reference range.

If there is any uncertainty about what dose to prescribe, seek immediate specialist advice so that there is no delay in the woman receiving an adequate dose of levothyroxine.

It shouldn't matter that you aren't currently prescribed Levothyroxine. High TSH can make conception difficult and does increase the risk of miscarriage. You've miscarried twice with TSH above the 0.4-2.0 recommended so it would be logical to start you on Levothyroxine to bring TSH into the loww-normal range, increase Levothyroxine by 25-50mcg when pregnancy is confirmed, and hopefully you'll go to full term.

[Molliemoo1 in reply to Clutter]

Thanks for your advice clutter I really appreciate it. I really hope I can persuade the doctors. Maybe I will try seeing another partner at my practice.

[Hidden in reply to Molliemoo1]

Brilliant advice from clutter. Lets hope we both can persuade then and keep eachother updated. I'd rather not waste money if they can do this for us.

[shaws in reply to Molliemoo1]

You might have to do more than that. You have to research because it seems that doctors have lost the skill that is needed for hypo patients. Some links which might help too:

hypothyroidmom.com/about-da...

web.archive.org/web/2010103...

thyroiduk.org.uk/tuk/testin...

[Hidden in reply to Molliemoo1]

Yes that's what I would like to know before I go the GP again. I'm in the same situation . So frustrating isn't it

[shaws in reply to Hidden]

See the links I've posted above.

[Hidden]

I've been referred to endo in NHS but appointment timescale was 3 months! Most likley to miscarry again in that time then going on my history . I was thinking privately but then thought might be waste of money if they say the same thing. Hmm

[Molliemoo1 in reply to Hidden]

That's the difficult thing. Ideally I'd like to find someone thats been in a similar situation and have found an endocrinologist that is willing to treat x

[Molliemoo1 in reply to Hidden]

3 months is a long time to wait, especially because they advise 3 months of treatment to get tsh levels stable.

No idea how much private will cost, do you?

[Hidden in reply to Molliemoo1]

Don't exactly know how much. However, these doctors take around £100 plus just for their consultations. Then you have to do the bloods which is another £100 plus and monitoring and prescriptions. Probably nearer to £500 I'm just guessing as I went to a private fertility expert last year.

[kayaktime]

Molliemoo, I'm so sorry for your losses.

My old GP said exactly the same thing when my tsh was 4.5 and I brought up the NICE guidelines. However, an endocrinologist linked to my fertility clinic said it was too high (regardless of status of subclinic or overt hypothyroidism) and made my GP prescribe thyroxine to bring it back under 2.5. You would think that GPs would draw the logical conclusion that all women need to have a tsh of between 0.5 and 2 for fertility, but no...

A lot of people with Hashimotos have raised NK levels too which are also linked to early miscarriage. Worth having a look at some fertility forums for more information and doctor recommendations.

Wishing you the very best of luck in the future.

[Molliemoo1]

Just come across this clinic birminghamthyroidclinic.co....

Is there any feedback on this clinic?

[Clutter in reply to Molliemoo1]

Molliemoo, post it as a new question. It won't be seen by many people otherwise.

[Molliemoo1]

I find it strange that neither doctor has ever felt my thyroid to see if it's enlarged. I'll ask them to do that as well next time.

[catrich in reply to Molliemoo1]

Mollimoo - sorry to hear your pregnancy experiences. Very sad. I wonder if your GP has looked at your progesterone/oestrogen situation? There was a post here in the last few days where a woman mentioned how she had needed progesterone in pregnancy to avoid miscarriage. Too little and we miscarry. I had 2 blighted ovums and 2 miscarriages within the space of 4 years. No-one suggested any reason - not even the gyno - but when I look now at blood test results from that time I was hugely low ( if you get my meaning!) in progesterone. And TSH somewhere between 3 and 4 ( similar ranges to yours).

[Molliemoo1 in reply to catrich]

I haven't had my progesterone tested but I'm waiting for an appointment at the recurrent miscarriage clinic. X x

[Molliemoo1]

Would an endocrinologist recognise and understand the nice guidelines on trying to conceive and pregnancy?