Thyroid and Miscarriage| Dr Richard Hagmeyer D.C Naperville Institute For NeuroMetabolic Solutions.
Thyroid and Miscarriage
28 separate studies find increased risk of miscarriage (180% to 390%) with thyroid autoantibodies.
Of the 31 studies evaluating miscarriage, 28 showed a positive association between thyroid autoantibodies and miscarriage. Meta-analysis of the cohort studies showed more than tripling in the odds of miscarriage with the presence of thyroid autoantibodies (odds ratio 3.90). For case-control studies the odds ratio for miscarriage was 1.80). There was a significant doubling in the odds of preterm birth with the presence of thyroid autoantibodies (2.07). Two randomized studies evaluated the effect of treatment with levothyroxine on miscarriage. Both showed a fall in miscarriage rates, and meta-analysis showed a significant 52% relative risk reduction in miscarriages with levothyroxine (relative risk 0.48). One study reported on the effect of levothyroxine on the rate of preterm birth, and noted a 69% relative risk reduction (0.31).
Conclusion: The presence of maternal thyroid autoantibodies is strongly associated with miscarriage and preterm delivery. https://www.ncbi.nlm.nih.gov/pubmed/21558126
Thyroid antibodies boost miscarriage risk by 273%
A clear association between the presence of thyroid antibodies and miscarriage was found with an odds ratio of 2.73 in eight case-control and ten longitudinal (odds ratio, 2.30) studies. This association may be explained by a heightened autoimmune state affecting the fetal allograft, of which thyroid antibodies are just a marker. Alternatively, the association can be partly explained by the slightly higher age of women with antibodies compared with those without. A third possibility is mild thyroid failure, as thyroid-stimulating hormone levels in antibody-positive but euthyroid (normal thyroid function) women are higher than in antibody-negative women: difference, 0.81. Randomized clinical trials with l-thyroxine (aiming at TSH values between 0.4 and 2.0 mU/l) and with selenium (to decrease antibodies against thyroid peroxidase) are clearly needed to elucidate further the nature of this association. http://www.eje-online.org/content/150/6/751.full.pdf
Thyroid autoimmunity increases miscarriage risk 231% to 255%
A clear association between thyroid autoimmunity and miscarriage was observed with a pooled odds ratio of 2.55 in 8 case-control studies, and a pooled relative risk of 2.31 in 14 cohort studies. Women with thyroid autoimmunity were found to have slightly higher age [age difference, 1.29 years] and thyroid-stimulating hormone (TSH) levels [TSH difference, 0.61 mIU/l] compared with those without thyroid autoimmunity.
Conclusion: Based on the currently available evidence, it appears that the presence of thyroid autoimmunity is associated with an increased risk of spontaneous miscarriage in euthyroid (normal thyroid function) women. https://www.ncbi.nlm.nih.gov/pubmed/21198746
TSH is higher in repeat miscarriage vs controls (2.1 vs 1.3)
The mean basal TSH serum levels were higher in repeat miscarriage women [2.1 μIU/ml] compared with the controls (1.3 μIU/ml). Establishing serum TSH at an individual level, a large overlap was observed and the receiver operating characteristic curves did not allow us to find an optimal cut-off point with an adequate sensitivity/specificity ratio.
Therefore, we suggest a novel statistical model, the ‘iTSHa index’ (available on www.afar.it/tsh-trh-miscarriage), that is capable of identifying women with repeat miscarriage due to transient thyroid function impairment of the early pregnancy, in particular when baseline serum TSH is less than 1.5 μIU/ml, i.e. well below the conventional upper cut-off indicated as ‘safe’ in those who want to conceive. https://www.ncbi.nlm.nih.gov/pubmed/21429952
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TSH is higher in miscarriage than controls (1.48 vs 1.11)
Women with overt thyroid dysfunction were excluded. The mean TSH and FT(4) level in the women with miscarriage was 1.48 mU/l compared with 1.11 mU/l in women without child loss. The incidence of child loss increased by 60% (OR=1.60) for every doubling in TSH concentration. This association remained after adjustment for smoking, age, parity, diabetes mellitus, hypertension, previous preterm deliveries, and previous preterm stillbirth/miscarriage (adjusted odds ratio=1.80). This was not true for FT(4) concentrations (OR=1.41).https://www.ncbi.nlm.nih.gov/pubmed/19273570
Fertility is lower, and miscarriage higher, in women with thyroid autoimmunity
Oocyte fertilization, grade A embryos, and pregnancy rates were lower in women with thyroid autoimmunity than in negative controls, while early miscarriage rate was higher. Anti-thyroid antibodies were measurable in follicular fluid in all affected women and were strongly correlated with serum levels. No significant changes in thyroid hormone levels were recorded in any women.
Conclusion: The presence of anti-thyroid antibodies in ovarian follicles, as demonstrated for the first time in this study, may play a critical role in female infertility related to thyroid autoimmunity.https://www.ncbi.nlm.nih.gov/pubmed/21241400
Higher TSH level (over 2.5) increases risk of miscarriage by 69%
Women were divided into two groups based on their initial TSH: group A,TSH level below 2.5 mIU/liter (excluding hyperthyroid women), and group B, TSH level between 2.5 and 5.0 mIU/liter. The rate of miscarriage was significantly higher in group B as compared with group A (6.1 vs. 3.6% respectively). There was no difference in the rate of preterm delivery between the two groups. The increased incidence of pregnancy loss in pregnant women with TSH levels between 2.5 and 5.0 mIU/liter provides strong physiological evidence to support redefining the TSH upper limit of normal in the first trimester to 2.5 mIU/liter.https://academic.oup.com/jcem/article/95/9/E44/2835150
Low free T4, but not antithyroid antibodies, associated with miscarriage after 13 weeks
Thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine, anti-thyroperoxidase antibody, and anti-thyroglobulin antibody at 11-13 weeks of gestation were measured in 202 singleton pregnancies that subsequently resulted in miscarriage or fetal death, and the values were compared with the results of 4318 normal pregnancies. RESULTS: In the fetal loss group, compared to the unaffected group, there was an increase in median TSH multiple of the normal median (1.133 vs. 1.007 MoM), decrease in median FT4 MoM (0.958 vs. 0.992 MoM), and increase in the incidence of TSH above the 97.5th percentile (5.9% vs. 2.5%) and FT4 below the 2.5th centile (5.0% vs. 2.5%). Logistic regression analysis demonstrated that in the prediction of fetal loss there were significant contributions from FT4 MoM, maternal black ethnic origin, history of chronic hypertension, and use of ovulation drugs. The prevalence of antithyroid antibody positivity was not significantly different in the fetal loss group compared to that of normal pregnancies (15.3% vs. 16.8%).
CONCLUSIONS: Impaired thyroid function may predispose to miscarriage and fetal death.https://www.ncbi.nlm.nih.gov/pubmed/20718684
Recurrent miscarriage not associated with abnormal thyroid function test.
Thyroid disfunction associated with miscarriage, low birth weight and some birth defects
Clinical hypothyroidism was associated with increased miscarriage, low birth weight, and congenital circulation system malformations; the adjusted odds ratios were 13.45, 9.05, and 10.44, respectively. Subclinical hypothyroidism was associated with increased fetal distress, preterm delivery, poor vision development, and neurodevelopmental delay; the adjusted odds ratios were 3.65, 3.32, 5.34, and 10.49, respectively. Isolated hypothyroxinemia was related to fetal distress, small for gestational age, and musculoskeletal malformations; the adjusted odds ratios were 2.95, 3.55, and 9.12, respectively. Isolated hyperthyroxinemia was associated with miscarriage; the adjusted odds ratio was 6.02. Clinical hyperthyroidism was associated with hearing dysplasia; the adjusted odds ratio was 12.14.
Conclusions: Thyroid dysfunction in the first 20 wk of pregnancy may result in miscarriage and dysplasia and some congenital malformations. https://www.ncbi.nlm.nih.gov/pubmed/21832110
Presence of antibodies – without abnormal thyroid function – increases risk for preterm birth by 250%
The present study compared maternal and neonatal adverse outcomes in 245 women who were euthyroid (TSH < 2.5 mIU/liter normal thyroid hormone levels) but thyroid peroxidase positive in the first trimester to 3348 women who were euthyroid and thyroid peroxidase negative in the first trimester. Results: The main result was an increase in very preterm delivery (<34 wk gestation at delivery) (4.5 vs. 1.8%) and respiratory distress (3.3 vs. 1.2%) in women who were thyroid antibody positive. Conclusions: The present study provides further evidence of an association between thyroid antibody positivity and very preterm delivery in euthyroid women. The association with respiratory distress should be considered preliminary and awaits further study.https://www.ncbi.nlm.nih.gov/pubmed/21411559
The presence of thyroid antibodies boosts risk of preterm birth by 67%
Background: about 10% of women in childbearing age are positive for thyroid antibodies. The presence of such antibodies has been associated with adverse obstetrical outcomes, in particular miscarriage and pre-term delivery, even though the strength of these associations varies widely from one to another study. Aim: to evaluate from the available data of the literature, the association between thyroid autoimmunity and pre-term delivery. Results: seven studies, collecting about 23,000 patients were selected. Meta-analysis of the studies showed an association between thyroid autoimmunity and pre-term delivery (odds ratio =1.67).
Conclusions: the results of meta-analysis confirmed the association between thyroid autoimmunity and pre-term delivery. https://www.ncbi.nlm.nih.gov/pubmed/21422804
Fertility lower in hypothyroidism
Overall and spontaneous pregnancy rates were highest in women with normal basal and stimulated TSH, high T4 and low microsomal antibodies. Women with normal thyroglobulin antibodies or high thyroxine binding globulin experienced the highest delivery rate (77 versus 30%), while in women with low thyroglobulin antibodies or high microsomal antibodies miscarriage and tubal pregnancies were most frequent.https://www.ncbi.nlm.nih.gov/pubmed/1955537
Fertility lower in Hashimoto’s
The prevalence of thyroid autoimmunity in women with unexplained infertility and implantation failure was significantly increased in comparison to those with recurrent miscarriage. There was also a trend towards a higher prevalence of thyroid autoimmunity in the unexplained infertility and implantation failure groups than in the control group. Thyroid autoimmunity is strongly related to unexplained infertility and implantation failure. https://www.ncbi.nlm.nih.gov/pubmed/18070829
Thyroid and Birth Defects
Children born to mothers who test positive for thyroid antibodies have a 10.5 point lower IQ
In a prospective study of a cohort of 293 pregnant women, the occurrence ofTPO-Ab during gestation, thyroid dysfunction, and depression was investigated. Five years after delivery, child development was assessed in230 children of the original cohort using the Dutch translation of theMcCarthy Scales of Children’s Abilities. Children of women with TPO-Ab during late gestation (n = 19, with normal thyroid function) had significantly lower scores (by t test) on the McCarthy Scales of Children’sAbilities than antibody-negative women. The difference on the GeneralCognitive Scale, which reflects IQ scores, was substantial (10.5 points; t= 2.8). After correction for possibly confounding variables,maternal TPO-Ab during gestation was found to be the most important factor related to the scores on the General Cognitive Scale (odds ratio = 10.5).
We conclude that children of pregnant women who had elevated titers of TPO-Ab but normal thyroid function are at risk for impaired development.
T3 is vital to fetal growth
T3 has profound effect upon the developing embryo and infants. It affects the lungs and influences the postnatal growth of the central nervous system. It stimulates the production of myelin (important for nerve to nerve communication), the production of neurotransmitters, and the growth of axons (nerve tissue). It is also important in the linear growth of bones. https://en.wikipedia.org/wiki/Triiodothyronine
Conclusion:As you can see a common error in the management of woman who suffer with thryoid problems is the neglect of optimizing immune function and eliminating the triggers that stimulate the immune system. Simply taking Thyroid Hormones is not enough if you want to be well.
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