Thyroid Disease and Pregnancy Loss The thyroid gland is primarily involved in the control of metabolism. Abnormal thyroid function directly and indirectly affects reproduction as well. Infertility and adverse pregnancy outcomes are more common when the thyroid gland is hypo- or hyperactive. Higher miscarriage rate, more frequent preterm deliveries, increased hypertension, diabetic complications, higher risk for placental abruption, and adverse fetal effects have all been reported with thyroid dysfunction in pregnancy. At least half of implanted embryos will not survive to delivery, and on average 20% of clinical pregnancies are lost. Most pregnancy losses occur in the first trimester. Various factors (genetic, endocrine, anatomic, infectious, immune, hematologic, etc) are responsible for these losses. By correcting the treatable causes, we could make a positive impact on pregnancy outcome. Hypo- and hyperthyroidism are both associated with increased pregnancy loss. In addition, it has been shown that women with normal thyroid-stimulating hormone (TSH) levels, but with evidence for thyroid autoimmunity, are at approximately a 2-fold increased risk for pregnancy loss. Women are more likely than men to have antibodies against the thyroid, and with age the frequency increases. Those with antithyroid antibodies are more likely to develop abnormal thyroid function later on. Patients who are diagnosed with subclinical hypothyroidism (normal free thyroxine levels and slightly elevated TSH levels) are at an increased risk of developing hypothyroidism. During pregnancy, a 30%-40% increased need for thyroid hormones is the result of increased placental uptake, higher thyroid-binding globulin levels, and greater blood volume. Those with subclinical hypothyroidism and/or high-normal TSH levels at the beginning of pregnancy may not be able to meet these needs and may show signs of thyroid insufficiency during pregnancy. This study evaluated whether women who have higher TSH levels during early pregnancy have any evidence for adverse pregnancy outcome. Study Summary The study reports pregnancy outcomes in 4123 women who had their TSH levels measured at the first medical visit during pregnancy. Only women who had no thyroid antibodies were included. All pregnancies were singleton and spontaneously conceived. Two groups were created on the basis of TSH levels: < 2.5 mIU/l (n = 3481) and 2.5-5.0 mIU/l (n = 642). Age and parity were comparable. The mean gestational age for the first prenatal visit was also similar (between 8-9 weeks). The pregnancy loss rate was 3.6% in women with a TSH level of < 2.5 mIU/l, and 6.1% in women with TSH levels between 2.5 and 5.0 mIU/l. This difference was statistically significant. Within the 2 TSH groups, age, obstetric history, and thyroid function test did not differ between those who miscarried and those who did not. The risk for miscarriage increased by 15% for each 1 mIU/l elevation of the TSH level on the basis of logistic regression analysis. The risk for preterm delivery and very preterm delivery did not differ on the basis of TSH levels. At Rockwood Natural Medicine Clinic, I treat patients facing infertility. Recently I had a patient who had 3 cycles of IVF without success. While ordering comprehensive blood work, I look at Thyroid Panel in detail. I like to not only look at TSH but also the Thyroid Antibodies, Free Thyroid hormones along with Total Thyroid hormones. By getting these 6 baseline numbers combined with patient symptoms, I prescribed Thyroid treatment which includes Natural thyroid prescription along with protomorphogen treatment to reduce Thyroid antibodies. So far I have had a very successful treatment outcome. The patient has started to menstruate naturally with a positive ovulation test. No doubt the patient feels better and has lost weight after correcting the thyroid function.I enjoy practicing the way I do because I am able to follow the principle of Naturopathic Medicine and treat the cause of the problem. Thus by correcting her thyroid disease, I am hopeful that she will naturally conceive and have a healthy baby. Reference: medscape
Posted on: Mon, 05 Aug 2013 21:51:40 +0000