News Article: New research indicates higher risk for miscarriage in pregnant women with high thyroid hormone level

Original Article: punchng . com

Pregnant women with thyroid function test results in the upper half of the normal range have an increased chance of miscarriage, even when they lack thyroid-harming antibodies, according to a new study. The results, which the authors say show the need to change screening practices for pregnant women, will be presented at The Endocrine Society‘s 92nd Annual Meeting, ENDO 2010, in San Diego on June 22 by Alex Stagnaro-Green, M.D., senior author and senior associate dean for education at The George Washington University School of Medicine and Health Sciences.


Past studies have reported an increased miscarriage rate in women with an underactive thyroid and in women with a positive thyroid peroxidase antibody test, indicating the presence of antibodies directed against the thyroid.


”This study is the first evidence demonstrating that the upper half of the accepted normal range on thyroid function tests is associated with miscarriage in antibody-negative women. This leads us to think that all pregnant women should be screened for thyroid function and any abnormalities treated,” said Dr. Stagnaro-Green.


Thyroid function is measured by the thyroid stimulating hormone (TSH) blood test, and anything above the upper limit is an underactive thyroid, called hypothyroidism. Since 2007, the recommended upper limit of the normal range of the TSH test for a pregnant woman has been 2.5 milli-international units per liter (mIU/L) in the first trimester and 3 mIU/L in the second and third trimesters. This recommendation was made by an Endocrine Society international guideline committee, of which Dr. Stagnaro-Green was a member. However, he said doctors have not universally accepted this guideline, and some use 4.5 or 5 mIU/L for an upper limit, the same as for nonpregnant women. Also, not every pregnant woman receives thyroid function screening.


To see if TSH on the high end of normal affects pregnancy outcomes, the researchers determined the pregnancy loss and preterm delivery rates of women who had TSH values between 2.5 and 5 mIU/L in their first trimester of pregnancy. They conducted the study at two community hospitals in Italy among pregnant outpatients who had a TSH level at or below 5 mIU/L during their first semester.


After excluding patients who had positive thyroid antibody tests, the investigators studied 4,123 women. They divided subjects into two groups based on TSH level (mIU/L): group A: below 2.5, excluding those who had an overactive thyroid, and group B: between 2.5 and 5.


There was no difference in the rate of preterm delivery between the two groups. However, the rate of miscarriage was significantly higher in group B (higher normal TSH) than group A (lower normal TSH): 6.1 percent versus 3.6 percent, respectively.


None of the antibody-negative women in the current study received thyroid hormone treatment. However, Dr. Stagnaro-Green said previous research shows that such treatment lowers the miscarriage rate in antibody-positive women.


[Emphasis in the article, added by me]


Since my thyroidectomy, starting a family has moved higher on my list of priorities. All the while I was hypER, and taking carbimazole, it was all but forbidden by every member of my medical care team. So articles like this are of increased interest for me, and hopefully of interest to others who may be in my position.


Interesting that the article specifically makes mention of the fact that there's still an increased risk, even for those who test within *normal* ranges...and hopefully provides further strength to the argument that many thyroid disease sufferers have with the doctors and endos, in that just being within 'normal' range is not necessarily good enough to be feeling well, and that the suggested target TSH level of 1 or below is becoming more and more important to achieve, and to be recognised by the medical profession in general.

Driving Miss Stiffneck

I drove out late this afternoon to collect my blood test results.

This is the first time I've driven since the op...and in hindsight, it was perhaps a little too soon. I still have very little neck mobility, so checking to the left & right at junctions and roundabouts was interesting to say the least. And because I drive ancient old German cars, with no power steering or other modern nonsense, sharp corners and turns were harder work than my neck & shoulders would like them to have been. I have a feeling I'm going to pay for my precocious driving adventures later this evening, and possibly tomorrow too...so, in anticipation of that, whilst I was out I stocked up on extra painkillers too ha ha!

I think I'd have just ploughed right through the middle if I'd had to deal with this set of roundabouts today...



With regards to my blood tests, I was little dismayed to see that I'm slightly hypO. I say dismayed, but lets be realistic...I guess perfect bloods, and the perfect Eltroxin dose, immediately after my thyroidectomy was impossibly optimistic.
My TSH came in at 4.07 (range 0.15-3.2), and my Free T4 came in at 21.8 (range 9.9-20.1). Only marginally hypo really, but with results like that, the labs obviously didn't bother testing the FT3 and T3.
I'm certainly not experiencing any major hypo symptoms, certainly nothing like I've experienced in the past when I've been hypo before...which I'm glad of, because those few months, back in 2009 were truly a living hell!

My Urea levels are above normal for the 2nd month in a row. Definitely something to mention to my Endo next Tuesday. This month they were 8.0 (range 2.5-6.7) and last month they were at 7.1. For the previous 2 years they have consistently been between 4.0 and 6.0 so definitely something I'd like to investigate further. It may just be because I've rediscovered my love for filter coffee, and I'm not being as disciplined regarding my water intake these days.

Delighted to see that my WBC count is higher this month, higher than they've been since almost forever. Up to 7.8 (range 3.9-11.1) from last month's 6.1 my WBC has never been out of lab ranges, but there has been a definite downward trend since I started taking the Carbimazole, something I've been keeping an eye on even if neither my doctor nor my Endo have been too worried about it when I've drawn it to their attention. And I hope that is because I'm no longer taking Carbimazole, a side effect of which for some people is lower WBC counts.

I'm meant to be heading off camping with some friends tomorrow night, but I really am going to have to wait and see how much of a fuss my neck makes after driving today...I hate to admit it, but I may just be trying to do too much too soon :(

Hospital food, and TV wars!

[posted retrospectively & not necessarily in order - 1st June, day after the op]

At some point in the afternoon I was moved to a semi-private room, where I shared with another girl. She'd just come back after developing some problems a week after tonsil surgery.
She proceeded to hog the TV remote control, stuck it on mute, then when Desperate Housewives came on later that evening I had to endure it at top volume (when she was discharged the next morning, the very first thing I did was grab the remote control from the side of her bed!)
I was still too tired & spaced to bother with resurrecting any sense of fairness over the TV availability, so I just plugged the iPod into my ears, and watched the moving pictures until Mum and Hubby turned up during visiting hours.

I still wasn't eating very much. I'd forced down a yogurt for breakfast, under great duress from stern-looking nurses. I accepted some soup for lunch, but couldn't get past one mouthful.
Don't get me wrong, I know hospital food doesn't generally have a great reputation world-wide, but I was pleasantly surprised by the variety, tastiness and quality of the hospital food I was given. When my appetite did return I really enjoyed each and every meal. But for now, I just wasn't hungry.

At some point during the morning they emptied the vacuum pump on my surgical chest drain. Overnight it had sucked lots of blood & goo out of me, and I was now becoming more aware of this hose sticking out of the front of my chest. They kept calling it a tube, but it certainly felt like a ruddy great hose! And it was really starting to be a very sore pain-in-the-arse. I had a little clip on the container, so when I went off for walkies ( the nurses were adamant that I should be marching laps of the hospital on a very regular basis - what happened to rest & recuperation?) I could clip the vacuum container-thingy onto my clothing...and thus I could march about, with my lovely container of blood and goo on full public show, hanging off the lapel of my dressing gown...nice!

My surgeon came around at some point in the morning, to tell me how pleased he was about how it had all gone. He apologised for the size of the scar, but said it was as small as he could manage, given the size of the goitre.

Roughly every 6 hours, day & night, a vampire came visiting (different one each time) stealing lots of blood from my poor right arm, and disappearing off with a swish of their cape.
On the strength of these visits I was kept informed of the fact that despite being a Grave's Hyper patient my calcium levels hadn't dipped at all, but that they would continue to monitor them, We all concurred that this can only be due to the sterling work I had been doing with my Endo's Senior Registrar over the last few months, chipping away at my carbimazole dose, ever so slowly, so that for the first time in over 2½ years my blood levels not only come down into range, but had also stayed in range for over 6 weeks. My surgeon had explained to me that the more Hyper I was at the time of the operation, the more my calcium would crash as my body went into instant withdrawal. So thanks to Dr. R and his endless patience and gentle ways, we were pretty much as good as it gets on the day of the operation. But also many thanks to my surgeon, for having a steady hand and not harassing my parathyroid glands whilst he was in there digging about with his scalpel, as that was another common cause of a calcium crash.

Late in the afternoon new girl moved into the bed next door. She was brought in with stomach pains, and put on our ward for observation as there were no beds available on the general wards. We got on great, and came to a mutually beneficial agreement over the TV Remote. She made me laugh so many times, and listened carefully when my mother joined the nurses in nagging me to go walking. She made it her mission to take me off for random walks around the place, as and when she'd decided I'd been laying around too long. If you ever read this, and recognise yourself as that girl, well, thanks J, you were a star!

Meanwhile mum and hubby, when they weren't being doting relatives beside my bed, and listening to my alternating mumbling, croaking & whingeing, were amusing themselves between the 2 shifts of visiting hours, by shopping lots in the local shopping centre and sampling all the muffins in the coffee shops they found!

A friend of mine worked on a neighbouring ward, so she kept me sane too, by popping in whenever she got a chance to make sure I was OK and had everything I needed. She helped break up the long, slow mornings between drug rounds, vampire visits and blood pressure checks. Thanks N, you rock too!

And just for the gore-fans amongst you, here are some pics of my neck and chest drain, taken less than 24 hours after the operation...absolutely no idea what I had to smile about....I was sore, woozy, uncomfortable & grumpy - it must have been a morphine-induced smile, is all I can say! :)

Endo takes my Goitre seriously!

When I was getting my bloods done the other day, in preparation for today's Endo appointment, I mentioned to my doctor that nobody at the hospital had been too concerned, or even interested in my goitre, no matter how often I mentioned it. I also showed her how much the right hand side had swollen up in recent weeks. She laughed and said "one look at that, and they'll be *VERY* interested this time, trust me!"

She wasn't wrong.

Once again, I was given a consultation with another fresh-faced young intern, but I didn't stay with him for long. One look at my goitre sent him scurrying for the Consultant Endo, and the rest of my appointment was with the boss himself.

He has decided to refer me for a CT Scan to check out the goitre, and also to an ENT consultant...just to make sure they have that covered. He mentioned the possibility thyroid surgery again, but also reminded me of the RAI option - essentially the decision is mine, I just need to do my homework and make the decision, if it comes down to it, but in the meantime it was worth setting the wheels in motion in case I decide to opt for surgery. I guess the goitre is what is worrying them, more than than my malfunctioning thyroid. He reassured me that it all still could come under control with the meds, and all this is purely speculative, but bearing in mind waiting lists for referrals etc we may as well go ahead and make a start.

My bloods are still out, my TSH is too high, and my Free T4 is too low - indicating that I'm very firmly in the Hypo camp right now. So we've dropped my Carbimazole from 30mg/day to 15mg/day.

Back Once Again

Seems I disappeared for longer than intended.

We had a weekend away camping, and that was disrupted by an emaciated stray dog who entered my life the day before we were due to leave.

So I've been very busy looking after her (still ongoing - and looking like a long term project) and learning all about greyhounds and greyhound mixes and their specific care needs. (She's approximately half the weight she should be)

She's gained 1.36 kilos in weight already though so I'm pleased with her progress...if only she and I could participate in a little weight swap ha ha! I'd gladly donate all of my spare weight to undernourished dogs!

Still off the smokes, and still giving the scales slightly less to hold up each week, so there are two positives already.

My new meds seem to be OK. They cut my Carbimazole back down to 30mg, and I finally relented on my BP Meds Argument, and consented to starting on Centyl-K, a diuretic. I bought a cheapo blood pressure monitor from my local pharmacy, and I've certainly noticed my BP coming down a little, so hopefully my doctor will concur. Maybe I shouldn't have fought against BP meds for all this time after all...?

The walking has slipped though, and I'm cross with myself for letting that go...need a kick up the bum and the discipline to get out there every morning again!

Second Endo Appointment

Well I have to say that I wasn't waiting around very long this time. If anything, they rushed me through as if scared to leave me waiting at all...perhaps throwing a tantrum is the answer to getting seen on time?

They sent me for another ECG, because although I was assured the last one was in the 'OK' range...it must also have been in the 'check again' range.
This time I knew exactly where to go, I was definitely less stressed, and took time out to pause and do some deep breathing exercises before entering the hallowed ECG room. This time my results were deemed 'excellent'! :-)

Upon returning to the outpatients waiting area I was ushered in to a consultation room almost straight away.

I was with a really friendly young intern, and very impressed with her. The appointment went OK - we discussed how I was feeling, if I feeling any different to last time I was in, and why that might be. She suggested a slight dose change because, despite my TSH being within range,, albeit at the high end, my T3 and my Free T4 have gone from being too high to too low. So we dropped my Carbimazole from 40mg/day to 30mg/day.

The consultation all went well, until she checked my blood pressure...she went white with shock, and spent ages peering into my eyes, presumably checking them for any damage. She reckoned that my blood pressure dangerously high, and didn't believe me when I kept insisting I felt totally fine. She claimed that she was almost tempted to admit me there and then, and expressed concern at allowing me to drive home. I continued to insist that I was fine, and that it was most probably White Coat Disease, but she wasn't having it. She conferred with the senior consultant, and they were querying my blood pressure medication...to which I sheepishly had to confess that I hadn't been taking it. Felt pretty stupid, having to confess that if I'm honest. I explained that our money was extremely tight at the moment, and the extra prescription costs were more than I could cope with right now. They gave me some freebie samples of the Centyl-K to go home with, and made me promise to fill that prescription before they ran out. And do you know, something about the abject fear in that young interns face as she checked and re-checked my blood pressure, made me determined to find the money somehow....she was really truly scared by what she was seeing, and was acting as if expecting me to drop down dead any second. That made me feel very bad for ignoring their advice.

Pillow Talk

I don't have any trouble getting to sleep, its always been a running joke in my family that I could fall asleep on a clothes line.

But for the last 3 weeks or so I have trouble staying asleep. I wake up constantly, all night long....1am, 2am, 3am, 4am
I drop back to sleep almost immediately...but still seem to wake up on an almost hourly basis.
The longest stretch of uninterrupted sleep I've had in the last 3 weeks or so was *once* when I managed to go from around 2am to 8am...bliss!

This may or may not be thyroid (or thyroid meds) related in my case...but if anyone has come across this before and has any ideas how to restore my sleep pattern I'd be extremely grateful

Cycling, without a bike!

Monthly cycles again, this time an observation....

Been splitting my carbimazole for the last week, half dose in the morning, half dose in the evening - and not noticed any major change in the way I feel....BUT, the hugely maddening (driving me insane) 14-day cycle appears to be on the blink, however, SSSHHHHHHH! Don't tell it, I don't want to wake it up!

So, the way my cycle has been behaving in the last couple of months I should have started in the middle of last week, and currently be in the middle of hell on earth, and be house-bound to all intents and purposes....but I'm not, its late, its nearly a week late (and NO, *that* is not even worth considering, my libido has been through the floor for weeks, it'd be an immaculate conception ha ha!)....
So...is it possible that something as simple as splitting my dose to 12 hour intervals was enough to scare my cycle back into *normality* ??? (yay if its true!)

Does anyone like this theory? Experienced something similar?

Or is it possible that my cycle likes to keep me guessing and is simply changing its own rhythm yet again, ho hum :-(

Let's Talk Symptoms

I have no clue as to what is going on right now!

I feel awful, I feel grumpy, I'm snappy, my blood pressure has gone haywire, my monthly cycle has gone stupid, and is now a 14 day cycle!! I have the hands of a lizard. My hair is disgusting, its gone brittle and is falling out again.

I find my brain has once again gone to total mush. I forget what I'm saying half the time, I struggle to find simple words in conversation, which is very frustrating. I have the same conversation over and over again with my (very patient) husband, because I've forgotten that I've already told him something, sometimes I'm telling him again less than 5 minutes later. And at other times I swear blind I've told him stuff, only for that particular conversation to have actually only taken place in my own head. I forget many basic things, eg locking the door when I go out. What I've even gone shopping for when I get there.

Yesterday, even with a shopping list in my hand, I found myself wandering totally aimlessly around the supermarket, in a total dreamland. When I got to the checkout it took several minutes before I registered the fact that the girl on the check-out was asking me a question?

For the first time in years my hands and feet are constantly cold....and I'm the girl with the reputation for never getting cold feet, for wearing my flip-flops all year round, even in the snow and frost.

My right eye gets sore occasionally, a dull pain in behind the eye, and I've noticed in the mirror that the pupil in my right eye *sits* slightly differently to the left. If I'm reading a book and I close one eye, my left eye will focus on the text, but my right eye can't.

Once again I'm the pyjama-wearing slob, who just 'can't be bothered' with anything.

According to my latest bloods I'm now firmly in the hypO camp...and I'm hating it. I don't get to see my endo for another few weeks, and my doctor made me promise not to self-medicate and not to reduce my meds until I have discussed it with my endo. Which makes the morning ritual of pill taking very depressing, as I know with each pill I swallow I am making myself worse not better.

I don't know what advice I need from you all, or even what discussion I'm looking to provoke...but just being able to pour all this out to folks who might understand is very probably therapy enough. (My husband tries his best, and is an utter saint to put up with me, especially at this time, but he doesn't really understand what I'm going through)

Currently no-one seems too bothered by my goitre? There has been no further investigation since the ultrasound scan in 2004, by a different medical 'specialist'. My current endo has barely mentioned it, although its bigger now than it was 4 years ago. And the other side has started to grow a little too. Should I be pushing harder to get it investigated. Sometimes my throat hurts (aches) and often its hard to swallow, like pushing food past a brick in my throat...I'm concerned about this, heck I'm very worried about it, but seemingly neither my doctor or my endo are, so should I just relax and ignore it?

And one more thing...my hubby and I *would* like to start a family. I fully understand that while I'm on carbimazole that's a complete no-no...and I also understand that because of my thyroid problems it might not even be possible. I also need to lose a significant amount of weight. But as I'm 35 this year, we'd obviously like start trying sooner rather than later. So anyone been in that position. How long am I likely to stay on the carbimazole? What are the long term med options. Do I just give up on the dream of ever having children?

If you've made it this far, thanks for reading.