TPO Antibodies & Fertility Problems : Hello, just... - Thyroid UK

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TPO Antibodies & Fertility Problems

DaisyChain22 profile image
20 Replies

Hello, just wondered peoples thoughts or experiences? I have never been diagnosed with a thyroid issue but after near 2 years of TTC and 2 miscarriages I do wonder if things could be better in the TSH/TPO antibody side of things. My GP has never shown a concern with it I have basically had to beg her for more blood tests after my last miscarriage, never had a face to face appointment just sends me for blood test then I read the results online...

I want to be sure there is nothing being missed that could be affecting my fertility anyone any experience with this?

Here are my results over the past year:

Feb 2023 (Private) - TSH 7.79

April 2023 (GP) - TSH 3.2

July 2023 (Private) - TSH 2.46 and TPO 110

Sept 2023 (Private) - TSH 3.45

Nov 2023 (GP) TSH 3.2 and TPO 86.8

Thank you for reading

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DaisyChain22 profile image
DaisyChain22
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20 Replies
greygoose profile image
greygoose

Hi DaisyChain22, welcome to the forum.

Do you have any sort of diagnosis? Hashi's? Hypo? Because that's what you've got. The high antibodies are saying you have Hashi's - Autoimmune Thyroiditis. And the high TSH is saying you are hypo and should be on thyroid hormone replacement - if you aren't already. And, being hypo will most definitely affect your fertility. And, if your doctor doesn't know all that, then he should be struck off! To conceive and carry a pregnancy to term your TSH should be below 2 at least, and preferably below 1.

That said, it's not the TSH or the antibodies stopping you conceiving, but a high TSH indicates that your thyroid hormones are too low. And that's what's causing the fertility problems.

I don't know how much you know about thyroid, so don't want to over-burden you with info you already know. But if you have any other questions, please ask them. :)

DaisyChain22 profile image
DaisyChain22 in reply to greygoose

Thank you for your reply, No I do not have any Diagnosis. Only 2 of the above blood test were taken by my GP (April 23 & Nov23) and as both of these were below 4.2 they were noted down as 'Normal No Action' via the NHS App and as for the the positive antibody result there was a note next to it saying 'Positive TPO antibodies, however TSH currently OK'.

I had to really beg for the Antibody test as I knew from taking a private test that positive antibodies (also high cholesterol despite a very healthy lifestyle...? ) but my surgery wont look at private results. My Dr told me that the lab will only test this if TSH is high, but she said for the sake of reassurance she would put a note on to request this (This was a telephone conversation after my second early loss).

I received the results via the NHS app shortly after and have never had any contact with my GP since she requested the final blood test, I guess I felt stupid and like I was over reacting as no one else seemed concerned so I haven't done anything about it but these last few weeks I have been feeling so tired despite making sure I get good rest and it making me think about it again, I'm tempted to do another home test to see where I am at currently..

SlowDragon profile image
SlowDragonAdministrator in reply to DaisyChain22

and as both of these were below 4.2 they were noted down as 'Normal No Action' via the NHS App and as for the the positive antibody result there was a note next to it saying 'Positive TPO antibodies, however TSH currently OK'.

TSH is far too high to consider TTC

Likely low vitamin levels too especially with autoimmune thyroid disease

Strongly recommend you get FULL thyroid and vitamin testing

Improving low vitamin levels essential as low vitamin levels tend to lower TSH

greygoose profile image
greygoose in reply to DaisyChain22

high cholesterol despite a very healthy lifestyle...?

Cholesterol levels have nothing to do with lifestyle. High cholesterol is a hypo symptoms.

Cholesterol is made in the liver - because the body needs it! - and the liver keeps levels steady by making more when you consume less, and vice versa. However, when T3 is low, the body cannot process cholesterol correctly, and it builds up in the blood. It is a symptom, not a disease.

I guess I felt stupid and like I was over reacting as no one else seemed concerned

Well, we're concerned, I can assure you of that! But, then, we know more about thyroid than any doctor. Our hive-mind is full of experience and knowledge gained from many, many hours of reading and talking to each other. Doctors spend about half a day on the whole endocrine system during their seven years in med school, so you can imagine how little time is spent on the thyroid itself. And, most of what they do learn is wrong, such as 'hypothyroidism is easy to diagnose, easy to treat). Well, it's not rocket science, it's true, but it's beyond their capabilities. So, that's why they're not concerned.

Wouldn't hurt to do another home test - when was the last one?

DaisyChain22 profile image
DaisyChain22 in reply to greygoose

thank you for your message, my last test was at the GP in November so I am going to do a medichecks at home test which also includes some vitamins etc to see where things are at, just trying to get as informed as I can at the moment before I next try tackle the doctors…

I have recently re-looked at my previous gp test results and I have noticed that my in my liver function my Serum alkaline phosphatase was actually low both in April and November last year, it was 25 and then 26 (the range is 30-130) do you know much about this and if this should be a concern? I googled it and there was mention of hypothyroidism being a potential cause amongst other things? But this has never been acknowledged by the doctor

greygoose profile image
greygoose in reply to DaisyChain22

Don't suppose the doctor knows anything about it. They are very vague on all things thyroid and have little idea what it does to the body. But I'm afraid I know nothing about it. Sorry.

SlowDragon profile image
SlowDragonAdministrator

Very sorry for your loss

Your high thyroid antibodies and TSH over 5 shows you are hypothyroid

Likely low vitamin levels likely too

You need FULL thyroid and vitamin testing

Low iron/ferritin often linked to miscarriage

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

SlowDragon profile image
SlowDragonAdministrator

Before even considering TTC levels need to be stable and TSH below 2.5

verywellhealth.com/infertil...

.

Pregnancy guidelines

thyroiduk.org/having-a-baby/

NICE guidelines that if hypothyroid or subclinical you should see endocrinologist BEFORE TTC

cks.nice.org.uk/topics/hypo...

See pages 7&8

btf-thyroid.org/Handlers/Do...

Also here - dose increase in levothyroxine as soon as pregnancy test confirms conception

cuh.nhs.uk/patient-informat...

thyroidpharmacist.com/artic...

Low ferritin, low thyroid levels and miscarriage

preventmiscarriage.com/iron...

Low iron and hypothyroid

endocrineweb.com/news/thyro...

Folate and B12 and Neural tube defects and autism

healthunlocked.com/thyroidu...

ec.bioscientifica.com/view/...

DaisyChain22 profile image
DaisyChain22 in reply to SlowDragon

Thank you for the information and taking the time to reply,

Unfortunately I feel a bit helpless as my GP's test have always come back under 4.2 they deem this to be in range and therefore I do not have a diagnosis of a Thyroid disorder and do not receive any medication. I try to lead as healthy a lifestyle as possible but not sure this is enough

SlowDragon profile image
SlowDragonAdministrator in reply to DaisyChain22

So next steps

Has GP tested vitamin levels recently

Please add any results

Low vitamin levels are extremely common/inevitable with struggling thyroid

Especially with high thyroid antibodies

You need to maintain OPTIMAL Vitamin levels

Vitamin D at least over 80nmol

Serum B12 over 500

Active B12 over 70

Folate towards top of range

Ferritin at least over 70

Exactly what vitamin supplements are you taking

Stop any supplements that contain biotin 3-5 days before any blood tests as biotin can falsely affect results

If GP unhelpful

Get FULL thyroid and vitamin testing via Medichecks or BH

Ensure you test early morning, before 9am, only drink water between waking and test

Come back with new post once you get results

When thyroid is struggling this results in low stomach acid and this leads to low vitamin levels

Multiple miscarriages also highly likely to deplete iron/ferritin levels

DaisyChain22 profile image
DaisyChain22 in reply to SlowDragon

Thanks for your reply, I do take vitamins, a multi vitamin(proceive) started about a year or so ago on vitD as kept catching lots of illness also take omega 3 and take and iron tablet for about 9months. feritin was 39 in April (so in range) then has increased to 66 in Nov after taking ferogloblin supplement (iron,folic and B12)

I will be doing a medichecks test which also includes vitamins to see where things are currently at.

can I ask, my TSH has fluctuated over the year, starting at 7.79 last Feb then towards the 3’s, is this level of fluctuation normal with TSH or could the decrease be down to me introducing more vitamins etc

SlowDragon profile image
SlowDragonAdministrator in reply to DaisyChain22

can I ask, my TSH has fluctuated over the year, starting at 7.79 last Feb then towards the 3’s, is this level of fluctuation normal with TSH or could the decrease be down to me introducing more vitamins etc

A mix of everything probably

With high thyroid antibodies…..Hashimoto’s…..thyroid levels hop around

Thyroid is attacked by autoimmune disease…..thyroid cells break down and release excess thyroid hormones, this can cause temporary excess thyroid hormones. After each attack thyroid likely to become more damaged

Improving low vitamin levels can help thyroid function better and better conversion of Ft4 (storage hormone) into Ft3 (active hormone)

DaisyChain22 profile image
DaisyChain22 in reply to SlowDragon

Good Afternoon, Just had my Medichecks Advanced Thyroid Test results back, all was within range except for TSH which was 4.9 and Thyroid Peroxidase Antibodies which were 131

SlowDragon profile image
SlowDragonAdministrator in reply to DaisyChain22

Please add actual results Ft4, Ft3, vitamin D, folate, B12 and ferritin

See GP again, or different GP at practice with these results

Request starting on levothyroxine

If they still refuse

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations

thyroiduk.org/contact-us/ge...

SlowDragon profile image
SlowDragonAdministrator in reply to DaisyChain22

once you have got FULL thyroid and vitamin testing done

Assuming you need to work on improving low vitamin levels ………then retest thyroid and vitamin levels in 2-3 months

Your GP is being obtuse not treating you

Go see THYROID specialist

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations

thyroiduk.org/contact-us/ge...

Meanwhile get coeliac blood test done BEFORE trialing strictly gluten free diet

Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

A trial of strictly gluten free diet is always worth doing

Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential

A strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and may slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first as per NICE Guidelines

nice.org.uk/guidance/ng20/c...

Or buy a test online, about £20

Assuming test is negative you can immediately go on strictly gluten free diet 

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially) 

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial

With loads of vegan dairy alternatives these days it’s not as difficult as in the past

Post discussing gluten

healthunlocked.com/thyroidu...

HealthStarDust profile image
HealthStarDust

I am sorry for your losses.

Your TSH is much to high for pregnancy. Some GPs do prescribe in these situations irrelevant of having a diagnosis to bring that TSH down.

CountryMidwife profile image
CountryMidwife

I highly recommend looking up Dr Elizabeth Bright and booking a private consult so that you can’t get optimal and be at a point where you can conceive, carry to term and then make enough breastmilk once baby comes.

a_86 profile image
a_86

Hi DaisyChain, I’m so sorry to hear of your losses. We have very similar stories so I thought I should post.

Like you I had three miscarriages in 2 years and was referred to a consultant for the usual recurrent miscarriage checks which includes testing for TPO antibodies and thyroid checks. I came back with results that I had high antibodies and believe my TSH was around 3 and the consultant said this was higher than he’d have liked and was the only potential factor they could link to my miscarriages (all my previous losses went through genetic testing etc). So I was discharged and a letter sent to my GP for a repeat thyroid function blood test 8 weeks later. For this test, I wasn’t given the result however the GP simply stated by text(!) that I was within normal levels and that was that. I also had a thyroid function test prior to TTC with my GP which came back at borderline levels far higher than then NICE suggested 2.5 and the GPs shrugged off my symptoms of weight gain/tiredness/cold and so the advice of GPs treating wasn't straight forward in my experience.

It was only until my consultant called back a couple of months after my follow up GP blood test for a phone review and I said oh yes I’ve had the test but the GP said all was within range but I don’t know the result. It turns out I was at 3.9 so my TSH had risen in 8 weeks and the NICE guideline is to treat from 4.0…although they knew I was trying to conceive so not I’m sure why neither the GP nor the consultant treated as I had been over 2.5 for years . I pretty much pleaded on the phone and said with having thyroid antibodies and a family history of hypothyroidism it was inevitable I was going to need thyroxine at some point and thankfully they saw sense and I was prescribed the starting dose.

I fell pregnant again perhaps 3 months later but that unfortunately resulted in an ectopic pregnancy (bad luck and now an endometriosis diagnosis to contend with) however very long story short - I’m now 17 weeks pregnant and things look to be progressing well. All my previous losses were prior to 12 weeks so I’m feeling hopeful for this one. I have consultant led care due to being hypothyroid which just means extra blood tests in each trimester to ensure all is within range (the irony…)

You for sure need to push the GP for thyroid medication. Also with your history, when you fall pregnant again make sure to push for a prescription for progesterone. It’s a new NICE guideline which GPs potentially don’t know about but the EPAU prescribed to me after my first scan at 6 weeks (due to my prior ectopic) and they wrote a letter to my GP to tell them to follow up with another prescription to cover up to 16 weeks gestation.

Lastly, once you’re pregnant again and on thyroxine, ensure you inform the GP you’re pregnant straight away as you’ll need upping by 25 micrograms to help your pregnant progress and get you to the end goal.

It’s an uphill battle but good luck and don’t back down!!!

DaisyChain22 profile image
DaisyChain22 in reply to a_86

Thank you for your reply and sharing your story, I am sorry to hear what a difficult time you have had and of your losses. Its so great to hear things are looking up for you now, Congratulations! It has brought me hope for the future that with the right treatment it could be possible if I am able to get it... I just feel a bit trapped as I'm not considered bad enough to receive medication but my results also by the sounds of it are not good enough to realistically fall and stay pregnant which leaves me feeling helpless right now

a_86 profile image
a_86

I was in exactly your position only 13/14 months ago so definitely have hope for yourself.

Get booked in with another GP asking them to review your latest blood results and have the NICE guidelines printed and to hand to put under their nose. You’ve been left in an unfair situation and hopefully you find a logical and sympathetic doctor to hear out your health concerns.

Wish you all the luck!

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