THYROID & FERTILITY: Part 2 - Trying to Conceive, Fertility, Pregnancy and Miscarriage
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- เผยแพร่เมื่อ 11 ก.ย. 2024
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Board certified OBGYN and REI, fertility doctor Natalie Crawford, MD discusses thyroid disease, screening, and treatment for people who are trying to conceive, undergoing fertility treatments, or having recurrent miscarriages. Listen as she reviews latest guidelines and updates - hitting on information that is controversial or uncertain.
Reviewed in this video:
Should you screen for thyroid disease in pregnancy?
What is a normal TSH in pregnancy?
Should you test for thyroid in infertility?
What are thyroid antibodies?
When should you treat if you have positive thyroid antibodies?
Does thyroid disease cause recurrent miscarriage?
Is it safe to take thyroid hormone?
When should you test your thyroid?
*PART 1 video reviews the basics of thyroid physiology, TSH and hypothyroidism and hyperthyroidism
*This is not medical advice but education. Please ask your doctor your general medical questions.
Resources:
Dosiou C. Thyroid and Fertility: Recent Advances. Thyroid. 2020 Apr;30(4):479-486. doi: 10.1089/thy.2019.0382. Epub 2020 Feb 4.
Chen LM, et al. Associations between thyroid autoantibody status and abnormal pregnancy outcomes in euthyroid women. Endocrine 2015;48:924-8.
Lee SY, et al. Monitoring, and Treatment of Thyroid Dysfunction in Pregnancy. J Clin Endocrinol Metab. 2021 Mar 8;106(3):883-892. doi: 10.1210/clinem/dgaa945.
Negro R, Thyroid antibody positivity in the first trimester of pregnancy is associated with negative pregnancy outcomes. The Journal of clinical endocrinology and metabolism 2011;96:E920-4
Cleary-Goldman J, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstetrics and gynecology 2008;112:85-92.
Karakosta P, et al. Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. The Journal of clinical endocrinology and metabolism 2012;97:4464-72
Abbassi-Ghanavati M, et al. Pregnancy outcomes in women with thyroid peroxidase antibodies. Obstetrics and gynecology 2010;116:381-6.
Abalovich M, et al. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid : official journal of the American Thyroid Association 2002;12:63-8.
Vissenberg R, et al. Effect of levothyroxine on live birth rate in euthyroid women with recurrent miscarriage and TPO antibodies (T4-LIFE study). Contemporary clinical trials 2015.
Vissenberg R, et al. Live-birth rate in euthyroid women with recurrent miscarriage and thyroid peroxidase antibodies. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology 2015:1-4.
Yan J, et al. Thyroid peroxidase antibody in women with unexplained recurrent miscarriage: prevalence, prognostic value, and response to empirical thyroxine therapy. Fertility and sterility 2012;98:378-82.
Negro R, , et al. Euthyroid women with autoimmune disease undergoing assisted reproduction technologies: the role of autoimmunity and thyroid function. Journal of endocrinological investigation 2007;30:3-8.
Velkeniers B, et al. Levothyroxine treatment and pregnancy outcome in women with subclinical hypothyroidism undergoing assisted reproduction technologies: systematic review and meta-analysis of RCTs. Human reproduction update 2013;19:251-8.
Lepoutre T, et al. Reduction of miscarriages through universal screening and treatment of thyroid autoimmune diseases. Gynecologic and obstetric investigation 2012;74:265-73
Thyroid Disease in Pregnancy: ACOG Practice Bulletin, Number 223. Obstet Gynecol. 2020 Jun;135(6):e261-e274.
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Fertility doctor, Natalie Crawford, MD is a double board certified OBGYN and REI, and co-founder of Fora Fertility, a boutique fertility practice in Austin, Texas.
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Sharing fertility facts to educate women about trying to conceive, getting pregnant, ovulation, fertility treatments, IUI, IVF, becoming a doctor, life as a woman in medicine, and more.
I had difficulty TTC for 12 months with irregular periods. My doctor checked TSH and it was 7. I started synthroid and got pregnant on the same month 🥰🤗 I am now 5 months pregnant! I wish I could saw that video last year!! Well explained! Your patients are so lucky to have you.
This gives me so much hope! I just got the call today that I’m hypo thyroid. I’ve been trying for a year as well. My OB said with some medicine that should regulate it and I should be able to get pregnant. I’m currently sitting in a waiting room to get a pelvic ultrasound as well. I was worried about having to take pills but if that’s what I have to do to get my baby I’m more than happy to do so.
@@Cristina-wt3sr Did u get pregnant ? I have the same
Problem but ttc 3 years i was going to start ivf but then the doctor said i have tsh 6 …but i hope i get naturally pregnant i heard alot of
Women did after 3 months❤️❤️ baby dust to you
So lucky you are... I'm still struggling and we don't have such good doctors here...
I have 7 too and I'm pregnant
I’m believe you because I’m take it now I’m 4 days don’t see my period yet I’m waiting for july to see if I’m pregnant
THANK YOU, I have never gotten a normal period, I have always been told that I was a late bloomer and I had to go to a female fertility specialist in Iceland (where I'm from) to get answers that I could've been saved from infertility if my primary doctor had put me on hormonal replacement therapy, but I got put on the pill and felt instantly better since I wasn't making them on my own. So now I am doing egg retrieval in August and then freezing them cuz I need to get my relationship more stable before we do the rest and I need to get my financial situation better.
I am currently going through my second miscarriage. I was diagnosed with Hashimoto's a couple days before I found out I was pregnant this time, but my endocrinologist never put me on medicine nor said I would need to be medicated during pregnancy even though I told him we were trying to have a baby and had already experienced loss. My OBGYN is pretty upset because she said I absolutely need to be on levothyroxine when TTC and during pregnancy. She put me on it, but I was already almost 7 weeks along so I think it was too late. I feel like this loss was completely preventable and it's incredibly frustrating. No living children yet, but hopefully we will have a successful pregnancy soon.
I’m so sorry for your current loss and for your previous loss. I have had 2 losses in a row one last summer and 2nd during thanksgiving. Still in the process of figuring out a solution. I’m currently going to my doc to ask for thyroid antibodies and antibodies n hashimotos tests, I had TSH of 2.3 but I’ve heard those other things like t3 n t4 n antibodies can be the culprit that needs treatment. I’m happy you have found a solution but I’m so sorry you had to go through losses. I hope we will have our babies soon the weight on yhr heart is unbearable at times
I'm sorry for your losses! I went through something similar, here's my advice:
Make sure your tsh is below 2 before getting pregnant again and that your labs are in order (test for vitamins, minerals, glucose and insulin). You can get your tsh levels in order by taking sintetic thyroxine and the labs should be in order with proper nutrition.
Avoid gluten, all dairy, refined sugar, processed meats, vegetable oil except for olive oil and include moderate yet consistent exercise in your routine.
Meditation (or prayer), therapy and calming supplements or teas.
Wish you the best!
I loss too 3 miscarriage. This time I gonna use korteson medecine I hope gonna help for you too
I'm so sorry to hear about your miscarriages. I have the exact same story, hashimotos and 2 miscarriages due to my GP not realising that I should have had my medication increased. Two early miscarriages with my TSH levels at around 6.5 both times. It's really sad that some GP's aren't informed about any of this. So much pain could be avoided
(to be clear, I asked for my levo to be increased both times but a too-small increase and lack of blood monitoring meant that my TSH was too high both times)
Thank you so much for explaining so clearly and so insightfully what most doctors don’t have the time to explain at appointments. 🙏
Thanks for pointing out those studies. I've been resisting taking thyroid medication even though my TPO antibodies are >900 with a TSH that fluctuates between 2.4 and 3.1. Most of the time the TSH is 2.6. Your videos are so informative! 🔥 ❤️
Hi, my TPO are currently at 455, last year over 600, current TSH 2,55. The highest was 3.8. Possibly pregnant and my GP takes no action, any idea if l should be worried? Thank you ❤❤❤
@evamandri The main thing is to watch your TSH. Pregnancy can throw it off. I'm now 18 weeks with twins! My TSH briefly went up to 3.4 in the first month after finding out, and they put me on levothyroxine. It came down to 1.5, and I stopped taking it. There's not much to do about the antibodies except lifestyle changes like healthy organic whole foods. I did start selenium 200 mcg about 6 months ago, and it brought my TPO antibodies down from >900 to 450. Congrats and goodluck!
@@l.ashleypalmer Huge congratulation and thank you for the tip 😘 wishing you all the best ❤️
I have Hashimotos and have been put on NP Thyroid and Low Dose Naltexone (LDN). My husband and I have not been able to get pregnant the 10.5 years we have been together. Hoping that my TPO Antibodies will work themselves down so we can finally have our baby.
How long are you taking the medicine?
Hi, I have been diagnosed with Hashimotos for over 3 years now only ever been prescribed levothyroxine. Do you find that NP Thyroid is better and do you think LDN helps you? Can you take LDN while trying to conceive?
This gives me so much pain, as it is the confirmation that I have been neglected by the health system of the country I live in! And I am still paying the consequences of it.
I am glad I have done a lot of research, and know that my daily dose of levothyroxine have to slightly be adjusted as it is better to be a little hyper than hypo.
Found out 2 weeks ago that I am pregnant for the 6th time and increased by 25mg twice a week (until doctor checks and revise).
Thank you Doctor for this video ❤️
Ive been struggling ttc for over 5 years. I do have Hypo, they just up'd my dosage to 137mg, my cycles are always on point, i can tell when my body ovulates. im fairly healthy, i do exercise. My life has been tough, especially with no answers as to why. Oh yeah, my husband is perfectly fine too. I've visited a fertility clinic in San Antonio just to be left in the dark, no further testing.
hey girl! sorry for your experience, were you able to change to a different clinic that's more helpful? did you check your FSH level? i have a 3.3 TSH (been rising since Feb 2022), and FSH 8.5 on day 3 (supposed be lower than 7)
I’m actually 6 months pregnant now. We did nothing knew, all God.
@kadiekeeks937 Look at God! How were your thyroid levels? Did you have to up your medicine while pregnant from 137? Thanks in advance
You described my life situation 🤣🤭
Thanks this is really helpful. I’ve been struggling to conceive for more than a year. My periods are regular but when my TSH was checked it was 6.17. I’m now taking 50mcg levothyroxine and will get my TSH re-checked soon. Do you think the reason I haven’t got pregnant is because my TSH is so high? My periods have always been regular. I’m 40 years old. Thanks so much for your videos 🙏
YES. I am on the same boat. I went from 25 mg... to 50mg... to 37mg... Its definitely a process.
@@krystabell675 me too… I started on 25mcg which brought my TSH from 6.17 to 3.44. I’m now on 50mcg and will have another blood test soon. It takes time to figure the dose out I think 😕
Hey any update?
I just had a miscarriage at 13 weeks , my thyroid tsh was 85. I didn’t know I had hypothyroidism. I have an appointment to get me started on a thyroid treatment, how long should we wait until trying again? Should I wait until my levels are ideal for pregnancy. I had no weight gain no period issues , I did feel tired but not to warrant 85! My doctor said she doesn’t know how I’m even functioning and it’s a miracle I was even able to get pregnant let alone keep it for 13 weeks. I’m just devastated, if I would have gotten my blood work sooner the baby could have survived 😞
i hope you are ok
I accidentally hit dislike but changed it so hopefully that doesn’t show up!
Thank you for these Thyroid videos. They are very helpful! 😊 TTC for a year and a half and was diagnosed with PCOS in August 2021. Recently just got put on Levothyroxine because my TSH was 5.77. Do you see that thyroid issues with PCOS are common? Thanks!!
I did too accidentally 😫
My doctor won’t treat my hypothyroidism, even at 5.6.. because my free T4 is normal.
I am seeing a gynecologist soon, hopefully they can help. I also have a gluten sensitivity and I heard thyroid pills are coated with something that contains gluten. That scares me, because I get very sick when I consume gluten 😢
Have you found it not helpful to look at other thyroid numbers, T3, T4, reverse T3? Or only TSH matters?
My doc also had the idea that over treatment is better. I took 75 micrograms of Eltroxin daily and suddenly I had no balance, bad vertigo, double or blurred vision, sweaty palms and feet, migraines, nausea and extreme anxiety. I think I was bumped into Hyperthyroidism or I experienced severe side effects from this medication. I fell so ill and could not function at all. Completely debilitated. What to do in a case like this? I cannot take these meds, it makes me so ill. Any suggestions?
Hi Docter Crawford, my mom and grandmother have hypothyroidism. I have never been tested but I have had 2 miscarriages and am currently 5w3d pregnant. Should I bring this up to my OB and have her check my levels? I don't want to lose another baby.
According to what she said in the video, yes
Hi Doctor,
Your videos are super helpful! I just have a question about thyroid and Clomid. My obgyn said everything in pelvic exam and bloodwork is normal, however, I do have Hypothyroidism and irregular and sometimes absent cycles. Would my obgyn prescribe me Clomid when I'm ready to conceive?
Thanks so much for your time!
What about clinical hyperthyroidism and trying to conceive? Do you treat it at all?
My endocrinologist is giving levothyroxine for my thyroid problems &my high prolactin levels. They are now normal. But my TSH is still low ): I have been treated since a year& idk why my TSH is still low.. I am trying to conceive my first baby I am 30 years old.. but is difficult to get pregnant & I am afraid to lose my baby with low TSH levels... its scary& idk what to do... boost up my TSH levels):
I have hypothyroidism, haven’t been diagnosed with autoimmune disease yet. I have miscarried twice my TSH is 1.4 . If I am diagnosed with Hashimoto disease would my Endo increase my levothyroxine to prevent miscarriage? Or how would my thyroid be treated differently after diagnosis for prevention of miscarriage?
my TSH is 3.3 and FSH is 8.5 on day 3, is it common to see that, having TSH and FSH abnormal at the same time|? should i concerned about pituitary gland tumor or anything to do with the pituitary gland?
Thank you doctor!!
What if you have regular periods with subclinical hypothyroidism?
What are your thoughts on dessicated thyroid hormone for Hashimoto’s? My endocrinologist refused to increase my 25mcg even though my TSH is 3.24 and he knows I’m TTC. My cycles are less 31-34 days with light bleeding and lots of spotting.
I saw a naturopath and she prescribed my NP Thyroid 30mcg with a lab slip to do labs in 8-10 weeks. Should the dose be higher? I haven’t had TPO checked in 2 years but last time it was over 300 and the endocrinologist said it doesn’t matter. How often do you recommend levels be check during pregnancy?
My endocrine dr took me off the same med you are taking about said no T3 while pregnant..or TTC will negatively effect the baby
Even though that's what I need she put me on levothyroxine..I just started this 2 days ago ..
What counts as positive TPO antibodies? I’ve seen different cut-off points in literature vs. the one my clinic uses. I’m getting treated anyway, (because I wanted to and they said ok), but before treatment I was at 16, which was right at the cut-off point in some studies. My clinic said it was normal (i.e. not positive).
I’ve had graves and was hyper, had 2 x rai treatments and now hypo since October 2019 and on levothyroxine since, not even a sniff of pregnancy and it’s seriously affecting my mental health
Have you been changed for any other auto immune disorders? Are your cycles normal?
I have graves too, and went through a bunch of treatments for missed periods (becuse my labs had been normal at that point), and it turned out I had celiac disease which was the actual culprit of my issues.
They say if you have one ai disease, you probably have more.
@@saramations I don’t, my son has vitiligo and I also have arthritis, currently changing to the AIP diet to help improve my health
You had your son while having thyroid? @@lindseycurry8321
It’s been two months take throid I’m 4 days don’t even see my period I’m waiting to see if I’m pregnant
Can you have your period without ovulation, Dr pls reply me
get your doctor to check your progestrone on day 21, it says everything :) hope that helps :)
Dr.Crawford, is it important to lower your TSH level (=4.1) to normal before freezing your eggs? Meaning will this hormonal imbalance affect the number and/or the quality of eggs?
I need to make a decision before turning 40 in 4 month. Thank you in advance.
What if I have been on thyroid medication for over a year and the T4,T3, and TSH are all in normal ranges but the antibodies are still 2.5 IU/mL? I have been trying to getting pregnant for over 7 months and nothing.
Answer your dokter for kortesone medecine
Can you talk about invocell and your opinion on it please 🙏🏻
Hi Doctor , My wife(29 yrs) is 10 weeks 4 days pregnant and her TSH is 7.29, T4 : 0.86 ng/dl. Blood Group B-, BP-120/70, B.W - 59 Kg. Hemoglobin : 9.80 gm/dl. ICT - negative. This is our first pregnancy, and we are worried about her elevated TSH levels. She was prescribed Thyroxine 25 mcg/day. Is this the right dosage? (cause we googled 2 mcg/kg/per is avg requirement), As we mentioned it is our first pregnancy we are really worried, So we would be really appreciate more insight on this issue.
i hope is everything ok with your wife
Dr. Crawford, would you please help me interpret these results? TSH is low 0.31, T4 is 14 and T3 is 4.2 and a high Thyroid Peroxidase Antibody of 126. Thank you so so much for your response. Also on 0.075mg of Synthroid.
My insurance is covered for next two years I am taking a serious look into my fertility this year at 35 I have thyroid taken z50mcg and my period came skin cleared I went 9-13 months no periods and finally got it right now but now periods r heavy w clots it’s very bad and the bleeding 🩸 long
If someone has a regular period, but TSH of 3.1 when on synthroid, should they be consulting their doctor about medication adjustment?
No. Its within the normal range.
Possibly. It's a simple blood test.
You’re undermedicated. TSH should be close to 0 while medicated.
I’ve had thyroid’s for years and years and have had 6 children all perfectly healthy babies and pregnancy’s and am from the uk and have always been told thyroid’s are fine and not dangerous, so I really don’t know what she is talking about
U are lucky my sis.. unlike us who are struggling to find answers despite try n try
Everyone has a thyroid. What are you talking about?
I REALLY don't want to have to add levo/synthroid for lifelong medication. Does anyone have recommendations on how to lower TSH/TPO antibodies naturally? My TSH is 5.306mcU/mL and TPO antibodies is 26.97IU/mL. Thank you!
From what I could find online, the standard range for TS is 0.4-5.5, while the optimal range is 0.5-2. TPO antibodies standard range is
What does a negative tpo antibodies mean in a pregnancy ?
You said that people with unregulated thyroid, don't get pregnant due to menstrual problems. You mean women, right ?
Perhaps she was just trying to incorporate more gender-neutral language.
@@cassidybrewer This is not a scientific approach though.
@@nefelh83 In science we use individuals, persons, patients, or participants in the study. Differentiation of SEX is only relevant for specific analysis.
@@Carolbulanger we are talking about fertility and pregnancy. This only happens to women no matter how they identify. Science and specially medicine is not a field of wokeness and political agenda. Nor it should be. Men are male humans and women are female humans. End of story.
@@nefelh83 It’s not wrong though. It’s not incorrect to say people instead of women - just less specific. It could be a way to not exclude trans men, but it could also just be choosing one word that works rather than another one that would also work. For instance, I sometimes refer to my SO as my partner and sometimes as my boyfriend (most often I call him my ”sambo”, which is a Swedish word for ”partner I’m living with”). Some words are gendered and some are not, but they all work.
Thanks for the video, very helpful. It would have been great to add a note for those of us with full thyroidectomy 🥲