Hypothyroidism, Hashimoto’s and pregnancy

[Treesandleaves]

Hi everyone, I’m new here and hoping to ask for some guidance on my situation.

I have high Thyroid Peroxidase Antibodies which were diagnosed when I was pregnant back in 2022. I was only sent for thyroid tests because I had developed a salivary gland infection which required an ultrasound and the sonographer noticed an unusual texture of my thyroid. I didn’t have any symptoms that I was aware were from my thyroid.

My TPAs were around 900 but TSH,T3 and T4 were all within the normal ranges. I was advised by the doctor to get blood tests every 6 weeks to check my TSH remained below 5. Several GPs told me that it’s not possible to reduce TPA levels.

No one seemed to be too worried about the thyroid results, so I didn’t think it was a big deal, and luckily gave birth to a healthy baby at full term in summer 2022.

Earlier this year my TSH went above 5 so my GP put me on 25 mg levothyroxine which helped to reduce my TSH below 5 again. I had mentioned to the GP earlier this year that I was going to be trying to have a second baby and he said to get my TSH levels stable first, and that prescribing levothyroxine was like ‘bread and butter’ to GPs. This all made me think there was low risk to future pregnancies.

We are now trying for a second baby. I had a miscarriage a few months ago and think that I am miscarrying again now. The earlier miscarriage stopped growing at 6 weeks, and my current pregnancy is meant to be 8 weeks but is showing very slow growth so I am expecting it to also miscarry.

I have recently been reading more about how thyroid issues can affect pregnancy. Over the last couple of weeks though I’ve found all this research and anecdotal stories about how TSH should be much lower than 5 and closer to 2/2.5 in the first trimester or it can cause pregnancy issues. I’ve also read that high TPAs can cause miscarriage, and that there are potentially ways to reduce TPA levels.

I had bloods done last week, my TSH was 6.43 and my T4 was 13.2, TPAs were 1100 (No T3 result - not sure why) I spoke to a different GP about these results and she said that we should get the TSH to be lower in pregnancy, so has increased my levothyroxine dose to 75mg. She also said that even though my TSH was high, my T4 was still within the normal range which meant that my body was just working extra hard to produce the T4.

I’m now feeling a bit lost, because I feel like maybe the high TSH and/or the high TPAs might be causing the miscarriages, but the GPs are saying I can’t do anything about the TPAs.

Does anyone have experience of this and could offer any advice? I’ve got an appointment booked with an endocrinologist in December so want to be as prepared as possible.

Thank you.

[HealthStarDust]

Welcome to the forum.

I want to make sure I have understood this correctly:

2022 - pregnant, TPA 900, TSH, T4 and T3 within range. No Levothyroxine and carried pregnancy to full term.

2023- not pregnant, one TSH result above 5 and started 25mcg Levothyroxine (presumably as GP was aware that you wished to have a second child and wanted to bring down TSH ?)

2023 - miscarriage, presumably you was still on 25mcg levothyroxine at this time? Was TSH and FT4 and/or FT3 tested at all during this time either before pregnancy or at start of pregnancy?

2023 - pregnant again currently, last week TSH was 6.43, T4 13.2, TPA 1100, so Levothyroxine increased to 75mcg

Realistically we need to see ranges for those tests, but I think it’s fairly safe to assume you are Hypothyroid with Hashimoto.

You are also correct assume that generally in pregnancy a TSH levels needs to be between detectable and 2.5 during the first trimester but allowing for variances in any local pregnancy reference ranges. This is also the case for preconception. However, it’s important to note that this range is for people who have been diagnosed and with established hypothyroidism and taking Levothyroxine. Which I think applies to you when you started Levothyroxine while you wasn’t pregnant earlier in the year?

I am sorry you are going through this. Something similar happened to me and I’m sure many others before us, and sadly will after us. For now, I hope you and your baby will be OK.

Many women in this situation have gone on to have a child.

Sending you hugs 🫶🏽

[greygoose]

Hi 456456456, welcome to the forum.

I'm not convinced that antibodies do cause miscarriage. I've never seen convincing proof, and there's a lot of rubbish written about antibodies out there.

As to reducing them, I've never seen proof of that, either. And I don't know how you would prove it unless you tested every day, because antibodies fluctuate all the time, and just because they're lower today, doesn't mean they will be next week.

The important thing to know about TPO/tg antibodies is that they don't attack anything, as some people think. They are the result of the Hashi's, not the cause of it. And, they come along to clean up the blood after an immune system attack on the thyroid. They have a job to do, so I'm not even sure it's desirable to reduce them. But attacking thyroids and foetuses is not within their remit.

As for TSH, that doesn't have much of a role to play, either. It is just a rought guide to to the levels of the thyroid hormones, T4 and T3. It doesn't cause symptoms or do damage whatever its level. But, important to know that a truly euthyroid (normal) TSH is around 1. If it goes over 2 then your thyroid is struggling to make the required amount of thyroid hormone - TSH (Thyroid Stimulating Hormone) is a pituitary hormone that tells the thyroid when to make more hormone.

So, not just pregnant women, but everybody should have a TSH around 1.

Starting you on just 25 mcg levo was a big mistake on the part of your doctor. His second mistake was not increasing it after six weeks and telling you that you needed to get your TSH 'stable' before trying for another baby. Quite how he thought you were going to do that on 25 mcg levo, I don't know, and I don't suppose he did. But, it's not the TSH stopping you conceiving and it's not the TSH causing the miscarrages. It's the low Thyroid hormones - T4 and T3. And just being 'in-range' is not good enough. It's where they are with-in the range that counts. There's a huge difference between 'in-range' and 'optimal'.

So, seems to me that what you need to do next - if you haven't already - is get print-outs of your past thyroid blood test results, and post all the numbers on here - TSH/FT4/FT3, results and ranges. Also nutrients - have you had them tested: vit D, vit B12, folate and ferritin. When we're hypo we often have nutritional deficiencies due to low stomach acid, and to sustain a healthy pregnancy we need them to be optimal.

Once we've seen all the data, we might be able to give you better advice.