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.

All Systems Go!

A couple of days late with this weekly Xenical update...don't know where my time is going these days?

Warning, its a long one...grab a cuppa and make yourself comfy!

Anyway...1 pound down this week....which is OK. I'd like to have seen more, but I'll happily take any loss on my scales...looking back over my diet for the previous 7 days, and it seems OK, so I can only conclude its all down to my laziness regarding water intake, and not being as disciplined regarding exercise.

Monday was spent in hospital (routine appointment, not an emergency!)
First up was my dietitian who I see every 2 months (and can chat on the phone to at any time if I'm having a crisis). She weighed me in at 300lbs, whereas my scales weighed me that morning at 295lbs...which is OK...at least now I know the margin of error for my scales (hers are calibrated regularly!), and as I use mine weekly, and only get to sit on hers every 2 months, I will continue to use the figures on my own scales for my weigh-ins. Also, my weigh in at home was in my jim-jams...and in her office I was fully clothed...not 5lbs difference I'm sure, but still.

Then after my appointment with her, I then headed to the ENT department, for my appointment with the consultant surgeon who's doing my op. And had a very interesting session there...which involved a conference call, in my presence, with both my dietitian and my Endocrinologist...and the conclusion that they have now officially drawn is that I am, for definite, one of those 4%ers who actually gain weight whilst hyperthyroid, instead of more typically suffering dramatic weight loss, despite increased appetite.
So...they have decided to go ahead with the op now, regardless of how much I weigh...and the deadline for my pre-op consultation is 9 months (that's when I'll finally be put on the surgery waiting list - so fingers crossed could be on the operating table before march 2011...which is excellent news.
Not only because I will no longer feel like *such* a huge failure every time I go into hospital and get weighed by the nurses in the ENT & Endo departments...who do absolutely nothing to hide their disdain and tut loudly as they update my patient records each time.
And secondly, because for the last 18 months I feel like my life has been on hold waiting for a decision on my surgery...initially they were adamant they wouldn't do it until I was below 200lbs, and now they have conceded that it just needs to be done, sooner rather than later, regardless of my weight.
Until I have this op we have virtually no control over my thyroid function, and I'm not allowed to start a family...so although its only a pin-prick in the far distance, I do finally feel there is some light at the end of the tunnel...rather than treading water, and spending another couple of years trying to shift weight that won't move, whilst the ticking of my body clock gets louder and louder until it finally gives up and I'm too old to realistically start a family.
I am so delighted to have finally had a definite decision from my Endo regarding my status as one of the rare 4%ers - its something he has mentioned in the past, but previously refused to confirm it for definite. But it really does seem like the more I try and tickle my metabolism into working for me rather than against me, the more my thyroid fights back and suppresses my metabolism even more.

However, despite the relief of being recognised as a 4%er it doesn't let me off the hook...I still have to keep going, popping the blue pills, and watching my diet like a hawk...it just means my journey will be more difficult...and still the pressure is on to drop the weight, because despite the fact that they are now going ahead with my operation, regardless of my weight, I do also recognise that the heavier I am the harder it is for the anaesthetist, and the higher the risk for me....so it is in *my* own interests to get as much weight off as I can, and to get as 'heart-fit' as I can, before the anaesthetist comes at me with his cocktail of drugs...

I'm trying to walk every day (not just the daily dawdle with the dogs - but a proper, get puffing walk out)...but the Irish weather is so unpredictable its just not always possible.
I'm also trying to cycle more...in fact after my hospital appointments on Monday I drove down to the Shannon, and cycled for about an hour down the river path...felt great afterwards, really chuffed with myself! But cycling locally is reserved strictly for the brave, our local lanes are populated with speeding local lads in their rice-racers, of half blind monks from the local monastery who probably don't have driving licences but who are generally ignored by the local Gardai...despite going out decked in all the hi-viz gear I can find, and looking like some safety fanatic I've had my pedals clipped a couple of times in the last few weeks...so am now limiting my cycling to when I have the time to drive out and find a properly designated cycling trail off the road...or when I'm out bikejoring with my dogs.
So, yesterday I purchased a Nintendo Wii and Wii Fit Plus....I collect it tomorrow...and I just hope I'll be disciplined enough to do it daily.
Would welcome comments from any of you guys regarding the use of Wii Fit to help keep you fit and get the weight off...have absolutely no idea what to expect, but both my GP and my Dietitian have recommended it.

I also really need to get on top of my water intake though, I truly feel that is the key!

Oh, and as of Monday, I'm 10lbs down from my start weight of 305lbs...so that's the first part of my personal 10 x 10 in 2010 Mission done! Yay!!!

Blimey....that was a long post...almost a stream of consciousness spewing from my keyboard! If you've got this far, thank you x

Blood Test Results - July 2009

Picked up my blood results this morning....and for the first time in several years my Thyroid Stimulating Hormone (TSH) and Free T4 (FT4) are actually within normal ranges, and my TSH, at 0.65 is not far off the optimum of 1.0. All well and good, but then shy do I still feel so shit? I can't help wondering, and hubby is of the same opinion, that these blood test results are merely a lucky snapshot in time, catching me as I swing through the *normal* ranges, on my way from being hypO to HypER yet again....I guess next month's results will prove or disprove that particular theory.

Still no sign of any testing for Free T3 and T3. My T3 levels haven't been tested since April 09, and my Free T3 hasn't shown up on any results since September 2008....I don't know why the labs don't test these two any more....last time they were tested they were both well out of range, and I'd really like to see where they are now, in relation to my TSH and my FT4

On analysing the rest of my results it seems that my LDL-cholesterol is coming down, and my cholesterol is well within range, despite minimal changes in my diet and my (lack of) exercise routine. My LDL-Cholesterol is still slightly above normal at 3.53 (range 2.6 - 3.38) and my Cholesterol reading is well in range at 5.3 (range 4.0 - 6.7) So I wonder if my increased LDL cholesterol/cholesterol is linked to my hypO status? When I was very hypER, back in February of last year, my cholesterol levels, if anything, were at the low ends of the normal range. And when I went hypO, my cholesterol levels went up for no apparent reason.

Another thing of note is that longer I'm staying on Carbimazole (current does is 5mg/day), the lower my white blood cell count is going. Since starting on CBZ my WBC count has gone from 9.4 to 6.4. And also of note, my neutrophils have dropped from 6.08 to 4.52 Something else to definitely keep an eye on, as one of the most serious side effects that has been recorded with the use of CBZ is agranulocytosis, when your WBC and neutrohpils drop suddenly, you suffer bone marrow depression, and you become very ill very quickly with a raging sore throat and high fever.

This time around, due to a patch of dark skin and dark hair under my chin, my doctor requested that my hormone levels were tested...but the amount of information I get back from these is negligible to say the least, as its hard to decipher the lab ranges on the report sheet. As far as I can tell, my follicle stimulating hormone (FSH) levels are OK at 12.7, my Leutenising Hormone (LH) levels are good, at 2.7, and I think my Estradiol (oestrogen?) levels are low, at 98...but as I said, instead of plain old lab ranges on the report sheet there is instead a paragraph of gobbledegook, so this is pure guesswork on my part. There was no note from my doctor when I collected my copies, so I assume all is OK, or at least 'on plan'. Will try and discuss my hormone levels with my Endo on Tuesday if I remember to ask him, maybe he can explain the gobbledegook to me?

After an idle hour or two, playing on MS Excel, here are some graphical representations of my blood results to date...I find it handy to do these up and print them off for every Endo appointment. That way, if I meet yet another new intern, we don't spend wasted time going over my case history from the beginning each time...

Routine Bloodtests 14th July 2009

I should have done these yesterday, but figured a trip to the hospital to see the ENT surgeon was enough excitement for one day. I'm currently on a monthly blood test schedule, as requested by my Endo, and as I'm due to visit him next week I normally schedule tests one week before my Endo appointment, in order to get the results back in time for him.

Was due to work in the shop today, so headed down to the doctor's surgery bright and early to be first in the queue....but no matter how early I get there (8.50am this morning) the car park is always already full when I get there, ho hum!

For some reason the needle really hurt going in this morning, and I'm truly not a wimp about these things....but my arm has remained sore all day!

I mentioned the strange patch of dark skin and dark hair under my chin (about the size of a 50c piece), and we joked that with everything else going on the last thing I need is to be growing a beard! She took an extra vial of blood and said she'd get my hormones checked this time around too.

She checked my blood pressure, and for the first almost the first time ever she was pleased with the result. When it came in at 150/80 even I cheered! Its always consistently lower when I check it at home, and after checking the accuracy of my personal BP monitor against her own sphygmomanometer in the surgery a while back, we concluded that I can occasionally suffer from white coat syndrome (Google it!) when it comes to checking my BP in the surgery. So, it seems we've finally found a blood pressure medication that seems to suit me. I did ask if there was a cheaper, generic alternative....my current BP medication (Omesar Plus) comes in at €1.24 per daily dose....and she raided her 'Sample Cupboard' and gave me 6 weeks worth, totally free of charge...result! She's done this for me in the past, and it really helps when my cash flow is so miserable.

She tried to ring the hospital x-ray department to see if she could do a 'hurry-up' on my CT Scan appointment, but all the phones were engaged, so she promised she would try again for me later, if only to make sure that a request had indeed been put in by my endo for an appointment on my behalf.

I weighed myself in my pyjamas this morning, and came in 13 lbs lighter than yesterday....amazing what a full set of clothes, and a pair of steel toe-cap boots can weigh!

Hopefully my blood results will be back on Friday, if not Monday at the latest, so I can update my graphs for whichever clueless intern gets to deal with me on Tuesday...watch this space!

RAI or Thyroidectomy?

Hoping this remains a hypothetical question for me, but I'm curious to hear other folks opinions on it...

Its becoming more and more clear that my thyroid gland is becoming more and more unstable. The latest set of bloods have me very hypO, even more than I was a couple of months back.
TSH is 18.3 range 0.15-3.2
my FT4 is apparently "below absolute low"...which is interesting, surely the lab should be able to detect it somehow, no matter how low it has dipped.

I've had noticeable goitre on the left side of my neck for years, with nothing to show on the right hand side. But, suddenly, in the space of 7-10 days the right hand side has now swollen to larger than the left, and is incredibly uncomfortable...breathing, swallowing, neck movement, all compromised.
My neck looks like a bullfrog, and my voice is so hoarse I sound like bullfrog too!

Due to see my endo on the 19th of May, but my GP has advised me to think about the fact that my Endo will now very likely suggest either surgery to remove it completely or RAI treatment.
For the record, I'm 35, married, no kids, but would like to think about having children in the reasonably near future, if I can only get this thyroid to behave itself.

So, throwing this 'hopefully' hypothetical question out to blog-land...if you were given the choice of surgery to totally remove the thyroid gland, or RAI treatment which one would you go for, and don't forget to say why?

Thanks in advance

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.