Please help me understand my results - will this TSH level affect my fertility?

[Claudieg1993]

Hello all.

I have been on Thyreogland - an NDT comprised of 100mcg t4 and 25mcg t3, for the last 2 years. Recently, the dosage I normally take was not in stock! So I have been taking 125mcg t4 and respectively more t3 (I don't know the exact amount), I realise this was a bit stupid given that I felt fine before but I just tried it out. It made me feel extremely anxious and weird, so I have instead been just spacing out my doses. I had a blood test for the first time in 2 years too - also pretty stupid but there you go.

Since spacing out my dosage, I feel a bit better and less anxious/more normal.

FYI - I recently got pregnant twice - I am not trying for a baby, this was an accident. I had one miscarriage and one abortion. I would like to start trying for a family in about 4 years, but I am fearful that my TSH levels are so low that I wouldnt be able to have a healthy pregnancy.

I would be so grateful for any of your expertise - I know I need to raise my TSH levels so that when I want to have children I am in a good state to.

Please help!! Do I go and see an endocrinologist again to help me get back in range/adjust my dosage again?

10-Feb-2021 ! Serum free T3 level - (GM13764) - make tc

Serum free T4 level 11.6 pmol/L 9.00 - 19.00pmol/L

! Serum TSH level 0.01 mu/L 0.30 - 5.00mu/L

Serum free T3 level 5.7 pmol/L 3.25 - 6.21pmol/L

10-Feb-2021 Haemoglobin A1c level - (GM13764) - Normal - No Action

HbA1c level (DCCT aligned) 5.1 % 4.10 - 6.40%

HbA1c levl - IFCC standardised 32 mmol/mol 21.00 - 46.00mmol/mol

10-Feb-2021 HOLOTRANSCOBALAMIN - (GM13764) - Normal - No Action

Holotranscobalamin 75.7 pmol/L 35.00 - 1000.00pmol/L

10-Feb-2021 Liver function test - (GM13764) - Normal - No Action

Serum total bilirubin level 5 umol/L 0.00 - 17.00umol/L

Serum total protein 74 g/L 60.00 - 85.00g/L

Serum albumin 43 g/L 38.00 - 50.00g/L

Serum globulin 31 g/L 20.00 - 35.00g/L

Serum alkaline phosphatase 48 u/L 25.00 - 115.00u/L

Serum ALT level 11 u/L 5.00 - 40.00u/L

10-Feb-2021 Serum folate - (GM13764) - Normal - No Action

Serum vitamin B12 343 ng/L 200.00 - 1000.00ng/L

Serum folate 7.1 ug/L 4.00 - 18.00ug/L

10-Feb-2021 ! Thyroid function test - (GM13764) - Abnormal - Contact Patient

Serum free T4 level 11.2 pmol/L 9.00 - 19.00pmol/L

! Serum TSH level 0.01 mu/L 0.30 - 5.00mu/L

10-Feb-2021 Serum ferritin - (GM13764) - Normal - No Action

Serum ferritin 44 ug/L 9.00 - 120.00ug/L

10-Feb-2021 ELECTROLYTES + CREATININE - (GM13764) - Normal - No Action

Serum sodium 139 mmol/L 135.00 - 147.00mmol/L

Serum potassium 4.7 mmol/L 3.40 - 4.90mmol/L

Serum creatinine 56 umol/L 49.00 - 90.00umol/L

GFR calculated abbreviatd MDRD 123 mL/min

Comment

Ethnic origin NOT KNOWN

Please multiply eGFR by 1.159 if African or

Afro/Caribbean descent.

Comment

Estimation of GFR is not validated for use in ARF,

pregnancy, oedematous states, muscle wasting

disorders, amputees and malnourished people.

10-Feb-2021 Thyroid autoantibodies - (GM13764) - Normal - No Action

Thyroid Peroxidase antibodies 0 iu/mL 0.00 - 6.00iu/mL

10-Feb-2021 ! Full blood count - FBC - (GM13764) - Just out of normal range - OK

Haemoglobin estimation 123 g/L 115.00 - 165.00g/L

Red blood cell (RBC) count 3.96 10*12/L 3.80 - 5.8010*12/L

! Packed cell volume 0.36 L/L 0.37 - 0.47L/L

Mean corpuscular volume (MCV) 90.9 fL 80.00 - 98.00fL

Mean corpusc. haemoglobin(MCH) 31.1 pg 27.00 - 32.00pg

Mean corpusc. Hb. conc. (MCHC) 342 g/L 310.00 - 350.00g/L

Red blood cell distribut width 12.7 % 10.00 - 14.00%

Platelet count 361 10*9/L 150.00 - 400.0010*9/L

Total white cell count 6.6 10*9/L 4.00 - 11.0010*9/L

Neutrophil count 3.81 10*9/L 2.00 - 7.5010*9/L

Lymphocyte count 2.06 10*9/L 1.00 - 4.0010*9/L

Monocyte count 0.58 10*9/L 0.20 - 1.0010*9/L

Eosinophil count 0.11 10*9/L 0.00 - 0.4110*9/L

Basophil count 0.04 10*9/L 0.00 - 0.1110*9/L

absolute nRBC 0 10*9/L

Percentage neutrophils 57.7 %

Percentage lymphocytes 31.2 %

Percentage monocytes 8.8 %

Percentage eosinophils 1.7 %

Percentage basophils 0.6 %

[greygoose]

The TSH itself has no effect on fertility - or anything else much, come to that. It's not a thyroid hormone, it's a pituitary hormone: Thyroid Stimulating Hormone.

When the pituitary senses that there is not enough thyroid hormone in the blood, it releases TSH to stimulate the thyroid to make more. When it senses there is enough thyroid hormone in the blood - especially T3 - it reduces production of TSH, because you don't need it.

What is important for fertility is the thyroid hormones themselves: T4 (storage hormone) and T3 (active hormone). And, your levels of those seem ok.

To raise the TSH, you would have to cut down on your dose considerably. That would lower your FT4 and FT3, and that would affect your fertility! And, sometimes, if the TSH has been suppressed for some time, it never will rise again, even if you stopped the thyroid hormone replacement completely. So, if I you, I'd leave well alone and stay on that dose if it makes you feel well. And, don't allow yourself to be bullied by doctors who are scared of a suppressed TSH! It's your health, not theirs.

[Claudieg1993 in reply to greygoose]

Thank you greygoose for your commentary, I have looked at online articles about it though and it seems one does require TSH to have a healthy pregnancy, is this not the case? Let me know your thoughts!

[greygoose in reply to Claudieg1993]

Are you sure about what you read? Does it say why, exactly, you need TSH to have a healthy pregnancy? I'm by no means an expert, but I cannot for the life of me see what TSH has to do with it.

I know they say that your TSH shouldn't be more than 2 - or 2.5, depending on who you talk to - but that is because a TSH of 2 is indicative of a healthy level of thyroid hormones. But, that doesn't mean that anything lower than 2 is not good. In fact, lower than 2 is better, because a totally euthyroid TSH is around 1, never higher than 2. And, what a TSH of 1 means is - normally - that you have good levels of FT4 and FT3, the actual thyroid hormones.

Decent levels of thyroid hormones are necessary because the developing foetus, once you actually get pregnant, won't have its own thyroid for the first few weeks, and therefore takes thyroid hormone from the mother. So, the mother needs to provide thyroid hormones for two. She won't be able to do that if she is hypo - i.e. TSH over 3.

I would be interested to read any links you might have where it says that the presence of TSH is actually necessary for a healthy pregnancy.

[Claudieg1993 in reply to greygoose]

Sorry and one more thing - my thyroid antibodies are 0 - what does this mean? And if my FT3 is on the slightly higher side and my FT4 is on the slightly lower side of the healthy window, what does this mean?

[greygoose in reply to Claudieg1993]

It means that it is very unlikely that you have Autoimmune Thyroiditis - aka Hashi's.

Your FT4 and FT3 levels reflect the type of thyroid hormone replacement you are taking. When taking T3, the FT4 level drops below the level of the FT3. The level of the FT3 reflects how much thyroid hormone replacement you're taking.

[Claudieg1993 in reply to greygoose]

Is it therefore possible that i might ever be able to wean off thyroid replacement hormones and hope my body starts producing normal thyroid hormone levels naturally? I have secondary hypothyroidism as a result of being very underweight for years, I am now a very normal weight and have been for 2 years.

[greygoose in reply to Claudieg1993]

I'm afraid I can't answer that question. And, I doubt if anyone else could, either. As a general rule, once the thyroid starts to malfunction, it is highly unlikely that it will ever function normally again. And, the only way to find out would be to stop your thyroid hormone replacement and see what happens. But, that's taking rather a risk.

Who told you that being under-weight caused your hypothyroidism? And, how did they know? Were you anorexic? Most anorexics end up hypo, and as far as I know, stay that way for life. Sorry if that's not what you want to hear, but that's my understanding. I could be wrong. I have Hashi's, myself.

[Claudieg1993 in reply to greygoose]

My endocrinologist and my doctors told me that. I was a model for years and even though I wasnt anorexic I was severely underweight for a long time, and didnt have periods for 7 years. Thanks again for your insight

[greygoose in reply to Claudieg1993]

Ah, I see. Well, I have to say that just because a doctor says it, doesn't mean it's actually true. Doctors are not known for their knowledge of thyroid. They do have a tendancy to blame the patient in any way possible, for what happens to them. It's so much easier than actually looking for the cause.

Take care and let us know how you get on.