Could these test results explain multiple miscarriages?

[Trigger1]

Hello

I have a friend who has a family history of thyroid problems and miscarriage. She has not been diagnosed and is not taking any thyroid medication. She has just gone through her fourth miscarriage losing all the babies before 10 weeks.  She has one daughter who was born 6 weeks early. She doesn't feel the reasons for her miscarriages are being fully investigated having been told her thyroid results are 'normal'.  She has the following symptoms of hypothyroidism:

- tired all the time (hard to judge given she is a busy mum with a 2 year old)

- dry skin - started getting dry skin in the creases of her arms

- dry hair

- erratic menstrual cycle

- depression

- real trouble losing her baby weight after delivery of daughter - just not coming off

- 4 miscarriages and an pre-term labour

Her thyroid blood test results are -(she is not on thyroid meds):

Serum TSH - range 0.345 - 5.6

2008: 1.98 mlU/L

2010: 2.83 mlU/L

2012: 2.73 mlU/L

Serum free T4 level - range 7.5 -21

2008: 10.2 pmol/L

2010: 9.5 pmol/L

2012: 9.6 pmol/L

Bearing in mind she is not taking any thyroid medication, what do people think about these results alongside her family history and symptoms? Could she have a thyroid problem even though she has been told her levels are fine and could this contribute to her miscarriages? 

She has had other tests which rule out PCOS. She was given blood thinners before and with the last pregnancy which was obviously unsuccessful and will be posting her test results on HealthUnlocked Hughes Syndrome community for more advice. Her Hormone levels are o.k. She has low corrected calcium levels (very bottom of range) so is going to ask for vitamin D test. Other tests she is going to request are: Thyroid antibodies, FT3, Vitamin B12, Folates and Ferritin.

It would be very much appreciated if someone can help as she is naturally feeling very distressed at the loss of her babies and also feeling unwell from the symptoms. 

Thank you

[MaryF]

Hi there, I know thyroid issues can cause pregnancy problems.. and regarding the thinners for blood I am presuming something like 'fragmin' or similar... did they test her for Hughes Syndrome? the common name for Antiphospholipid Syndrome.. as this is often the cause of multiple miscarriages and indeed stillbirths, as if so, and something showed up she would need specialist care, and also perhaps the addition of aspirin as well, it is crucial to find out what the results of any blood test she had for Hughes Syndrome, which would be:

Anticardiolipin Antibodies (aCL)

Test

Sometimes referred to as Antiphospholipid

Positive in 80% of cases

Higher Levels = Higher risk of Thrombosis

Lupus Anticoagulant (LA) **

Test

Positive in 30-40% of cases

Cannot be used if patient is on warfarin

and also any other clues, such as history of migraines or strange rashes.. Also it is most common to have thyroid issues plus sjogrens if you have Hughes Syndrome, they often come as a trio, and some also have Lupus.

At times this disorder and can be poorly diagnosed: Also often other families will have other autoimmune disorders, but not neceessarily.

youtube.com/watch?v=3LXWT6C...(Not working as expected?)

Mary F x

**

[Trigger1]

Hello Mary - thank you so much for getting back to me so quickly. She has had a few tests for Hughes aCL and LA (results below) and also some tests for how fast her blood clots (which are all within the range).

aCL tests:

IgG anti-cardiolipin 2 u/mL (0-10)

IgM anti-cardiolipin 2 u/mL (0-10)

LA tests:

D11 Viper Venom Time 0.94 1/1 (0.8-1.2)

Silica clotting time 0.94 1/1 (0.8-1.2)

I'm new on this board, so perhaps I should be posting these on the Hughes Syndrome section. She was taking Heparin injections with the last pregnancy which ended in miscarriage-she believes she was put on heparin due to a slightly low protein S result.

[Trigger1]

Just to add - I don't believe she has had any rashes or bad headaches, but will certainly ask. I mentioned Hughes Syndrome to her and she looked it up, but seemed to believe her symptoms didn't match, although she is not dismissing anything at this stage and understandably wants to get to the bottom of it.

[MaryF in reply to Trigger1]

Ok well it is good to have ruled it out...as there is seronegative hughes which happenes with some ... but... I would be surprised if the had never had any of the symptoms... however it makes me very pleased that the medical team went looking for it as so often they do not. Best of luck with your continued search. Mary F x

[Trigger1 in reply to MaryF]

Thank you - not ready to write off Hughes just yet as I'm certainly no expert and don't know if her results rule it out. I will continue to search.

[MaryF in reply to Trigger1]

Most will have had episodes of severe migraines sometimes in childhood and teenager years which then go away and come back years later.. or a strange rash called livedo reticularis... and other symptoms..However maybe make them repeat the tests again!

Mary F

[Trigger1 in reply to MaryF]

I understand - i will report this back to her and ask again about symptoms and see if her gp will repeat the tests. Can see from the video you posted that miscarriage aside, it is a condition you would want diagnosed anyway. Many thanks again.

[Moggie]

Tell your friend to ask for a parathyroid test as well - it is what controls the calcium in our bodies and when it goes "wonky" can cause all sorts of problems.

stopthethyroidmadness.com/p...

The above link gives a list of symptoms and some useful advice.

Moggie x

[Trigger1 in reply to Moggie]

Hello Moggie - just thought I'd say thank you. I did reply below, but hasn't realised I needed to click the 'reply to this' button and accidentally answered instead. Thank you again. Natasha

[Trigger1]

Thank you Moggie - that is very interesting and I came across parathyroid when looking up her calcium results, but it is a minefield. Great article on stopthethyroidmadness and I will definitely send this to her.

Thank you also to Mary F for the YouTube clip on Hughes - all very helpful.

[Trigger1]

Just a final question, I will of course continue to look at Hughes and parathyroid, but I just wondered if anyone could give any advice on her TSH and FT4 results considering she is not on any thyroid medication. They are "in-range" but from my research I have learned that "in-range" does not rule it out. Can anyone give any advice or opinion on whether they believe her FT4 is too low? could there still be a thyroid problem.

She is asking for thyroid antibody tests, which will hopefully provide an answer. Is it possible to be negative for thyroid anti-bodies, but still have a thyroid condition?

Thanks in advance.

[Hidden in reply to Trigger1]

I have very low thyroid antibodies 22.0 (0-60) and am hypothyroid. This test was done at diagnosis. I recently asked about these levles on this site and got some interesting replies - you can see the evry useful answers here;

thyroiduk.healthunlocked.co...

On 25mcg levo my TSH went up to 18.63 (0.35-5.5). Levo was increased and several months on I'm now feeling much better (don't know current TSH). I still felt undermedicated at TSH 3.88 so I'm sure current TSH is lower still. It does take a while for T4 levels to build up it seems.

At times, I've been 'in range' and really not been well. I've continued with taking the levo then a few weeks on and things have settled down.

I hope your friend is able to get some answers and some help. And what a lovely friend you are to have.

Best wishes

[Trigger1 in reply to Hidden]

Thank you Lizasahara - this is exactly what I wanted to know. It just gives me a bit of confidence I'm telling my friend the right thing, that although "in-range" she should still continue to investigate as this does not mean she isn't hypothyroid. After all, no matter what any doctors say e.g. It's an unexplained miscarriage, there is definitely a reason for 4 consecutive miscarriages and just because its unexplained, does not mean there isn't an explanation. I will remain careful though not to discount other conditions because of my hypothesis that it's a thyroid condition. Many thanks again.

[Hidden in reply to Trigger1]

Yes Trigger, you're right to keep expecting more from the medical world and to keep an open mind about it all.

There's also the possibility that her TSH is 'in range' but the active hormone T3 isn't getting into her cells, so she's still starved of the hormone.

There are so many variables.

Best wishes.

[Trigger1 in reply to Hidden]

Yes I've been reading up on FT3, because I was also being investigated for hypo as there is a strong family history - my TSH was 4.26 "normal", but the labs refused to test my FT4 and FT3 - I am however negative for thyroid antibodies so maybe I'm ok.

Anyway, back to my friend - her GP has agreed to test her FT3, but I suspect when she goes to tick that blood test box for FT3 that it won't let her, or the lab will refuse. May look at private tests for her - particularly if she is positive for thyroid antibodies. Thanks again for your advice and info. This site is fantastic and I so appreciate your help. Natasha

[Hidden in reply to Trigger1]

Hi Natasha

Keep a check on your TSH levels too - 4.26 may well be ok for some, and they'll feel ok with this level but not others. Many people need a much lower TSH. In America, anyone over 3 is considered hypo (I think this is correct).

And as I already said, my antibodies are classed as negative, but I'm definitely hypo and it's getting worse as my TSH levels were much higher this year than a year ago. Luckily, I respond well to T4 and a small increase in levo is all it takes, given time, to get back to feeling well.

I don't want to alarm you - but just be aware! Everything about this is so complicated!

This site is fantastic - it's been such a help to me too!

[Trigger1 in reply to Hidden]

Thanks for your response - it's much appreciated. I will take on board what you are saying and will definitely keep an eye on my symptoms - which are very mild at this stage. I'm probably only aware because if my family history. Like many others I have low vit D and low in-range B12 -203. So am also keeping an eye on this. I am pleased you are receiving treatment and hope you are feeling well. Many thanks again for the advice and the advance warning of what a minefield it is. Always good to be prepared. Natasha

[PR4NOW]

You might find some useful information here. PR

hypothyroidmom.com/miscarri...

[Trigger1 in reply to PR4NOW]

Hello PR4NOW - this is a fantastic link. Very useful - thank you very much. As with most people on this site, I am aware that convincing the doctor will most likely be the next step.thanks again.

[Princesspea]

I have very similar TFT results and symptoms, low vit d, low b12 and have been diagnosed by a private doctor as hypo. I am current trialling T4 due to low ft4 and above optimal TSH. Whilst pregnant with my daughter I had a bad bleed between 5-8 weeks which looked like it was going to be a miscarriage but she held on in there, I then gave birth 16 weeks early due to severe preeclampsia. My private doc, who started off as an ob&gyn has since confirmed this is all highly likely to have been caused by undiagnosed hypo and surrounding issues.

[Trigger1 in reply to Princesspea]

Hello Princesspea - thank you so much for your reply and sorry to hear of your experience. It is reassuring to know that we may be on the right route of investigation and that even if the GP disagrees, then it may still be sensible to seek diagnosis/treatment privately. Thank you for taking the time to reply - it's much appreciated.

[Princesspea in reply to Trigger1]

If u need any more details please feel free to PM me - no need to be sorry, we were very fortunate and my baby girl is now a happy, healthy 2.5 year old my GP won't entertain me in any way, shape or form about thyroid issues as I fall into all the 'normal' ranges, the more research you do the more you will realise they are not normal at all!!

[Trigger1 in reply to Princesspea]

That's really kind of you thank you - I may well take you up on that offer once we have her next set if results - I am envisaging her GP also refusing to treat, but we'll see. And I'm so pleased your little one is well - I can't imagine the hell you must have gone through with a 16 week early delivery. Many thanks. Natasha

[Williamsmum]

Hi there

I suffered 2 miscarriages and saw a specialist doctor privately. My TSH was 2.49 and T4 I think around 14/15. He sad this was suboptimal for fertility and pregnancy and put me on 25mg levothyroxine.

I felt much better within hours and conceived first month of trying (had been like that with my son but had been taking longer and longer).

My advice would be find the cash and go private, but do you homework, some are better than others! Unfortunately miscarriage is another area the NHS doesn't take seriously.

TSH should be about 1 to be sure it's not the cause of her losses.

Hth x

[Trigger1 in reply to Williamsmum]

Wow Williamsmum! That is very interesting and very helpful. I had no idea TSH should be that low and FT4 much higher! I will definitely pass this information on to her. My strong feeling is that she needs medication. If my friend is in agreement, ill definitely look into finding a good private doctor for her. Thank you for your reply and sorry to hear of your miscarriages. With a TSH of 4.26 post-preg I'm amazed I got through two pregnancies myself - feeling very lucky right now.

[Williamsmum]

You're welcome . T4 should be 20ish ideally I believe but it changes later into pregnancy.

Some people (I guess most) are fine within the GP ranges - I think this is the point Thyroid UK make about 'normal for you'.

The doc I'm seeing is a miscarriage specialist.

[Trigger1 in reply to Williamsmum]

Thanks Williamsmum - I have PM you - I hope you don't mind. Really appreciate your help

[lynmynott Partner Thyroid UK]

I think her t4 is probably too low. Some fertility specialists are aware of this but gp's aren't always....

[Trigger1 in reply to lynmynott]

Hi lynmynott - thank you very much for replying - very helpful to know what other people think of her levels. Much appreciated.

[janiebell]

I don't know where you live but there is a recurrent miscarriage clinic at St Mary's Hspital, Paddington, London. It is world famous and is always doing masses of research, etc. You can go private and also be referred on NHS. Xx

[Trigger1 in reply to janiebell]

Hi Janiebell - we live near Portsmouth in Hampshire, so this is definitely a possibility for her - I will let her know. Thank you so much. Natasha

[Poppy03]

I had an undiagnosed underactive thyroid and had 2 miscarriages before I had my little girl. I would say that her test results are not good and I would recommend her being sent to an endo in the hope that combined with the miscarriages he will consider treatment.

[Trigger1 in reply to Poppy03]

Hi Poppy03 - I'm so sorry to hear that. Thank you for your reply to my question. I think with all these replies co firming it is not only possible, but entirely likely that it is related to her thyroid. Will see what her antibody tests come back with and find an endo who would consider treating with thyroxine - hopefully this will help. Thanks again

[Poppy03 in reply to Trigger1]

I am not sure where you live but my cousin was treated by an endo because of under going IVF and having thyroid issues. Her GP did not recognise thyroid problems but the endo was insistent that she needed to be treated or she didn't stand a chance at IVF. She lives in St Albans so I am assuming her endo is around there or London.

I was lucky that I managed to carry my little girl no problems and she is a healthy, intelligent girl. I was diagnosed when she was 8 months old.