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TSH

This post is more for advice, or perhaps just for me to think out loud, as we’re obviously in a holding pattern until my ultrasound on April 7th. Yes, more waiting. It actually occurred to me today that I started at the University almost a year ago now… Wow, another year and still not pregnant. Sometimes life is so unfair, and really, a trip to Walmart is just the thing to confirm that! Don’t even get me started on the number of children without coats on when I stopped there yesterday. Keep in mind it was 27˚F here yesterday, I had my winter coat on!

Okay sorry, back to the advice part… So TSH. Now that I think of it, I have little idea what it’s function is, and when I asked Eric, I didn’t understand his response. He was talking about the molecular chains or something, you know, like in those inserts you get with your Rx that you throw away. You do throw them away, right? Please don’t tell me you study them???

So here is what I found at http://www.pregnancy.com.au/resources/topics-of-interest/preconception/is-poor-thyroid-function-impacting-your-fertility.shtml

The thyroid gland is located near the front of the throat, just below the voice box & just above the collar bones. Every cell in the body depends upon thyroid hormones for regulation of the body’s metabolism, blood calcium levels, energy production, fat metabolism, oxygen utilization, balance of other hormones & weight maintenance.

Hormones involved with thyroid function include Thyroid Releasing Hormone (TRH) released from the hypothalamus in the brain, which stimulates the pituitary gland at the base of the brain to release Thyroid Stimulating Hormone (TSH) which in turn stimulates the thyroid gland to produce Thyroxine (T4) & Triiodothyronine (T3). Much of T4 is converted to T3 (the active form) in the liver. Thyroid hormones are synthesized from iodine and the amino acid Tyrosine (from protein), and the conversion to the active form is reliant on the trace mineral Selenium.

Healthy Thyroid function can be affected by:

  • Exposure to environmental toxins – electromagnetic radiation, chemicals, pesticides, heavy metals e.g. mercury & fluoride
  • Genetic susceptibility
  • High levels of stress
  • Nutrient deficiencies
  • Autoimmune disorders
  • Infections
  • Other hormone imbalances e.g. estrogen dominance, high prolactin levels

How Does Hypothyroidism (Low) affect fertility? (High TSH Level)

  • Anovulatory cycles – not releasing an egg / ovulating. This makes pregnancy impossible.
  • Luteal Phase Problems – With a short second half of the menstrual cycle a fertilized egg can’t implant securely and ends up leaving the body at the same time that menstruation would occur (very early miscarriage) & is often mistaken as a regular period.
  • High Prolactin Levels – due to elevated levels of Thyroid Releasing Hormone (TRH) and low levels of Thyroxine (T4) resulting in irregular ovulation or no ovulation.
  • Other Hormonal Imbalances – reduced sex hormone binding globulin (SHBG), estrogen dominance, progesterone deficiency, all of which interfere with proper reproductive hormone balance.

Your check list for thyroid assessment

1. Do you have any of the common signs & symptoms associated with low thyroid function?

  • Inability to conceive / infertility – Um, yes.
  • Miscarriage – Possibly very early and thus I haven’t been aware.
  • Menstrual irregularities – Sort of, my cycles are fairly consistently 28 days, although my luteal phase varies, which I’m told is abnormal.
  • Period pain – No
  • Low libido – Yes, but don’t all women??
  • Lethargy & fatigue – Yes, I’m always tired.
  • Susceptibility to the cold / cold hands & feet – Sometimes
  • Inability to lose weight – Well, I’m gaining, is that the same thing??
  • Changes in texture of skin, nails, hair, hair loss – Not that I’ve noticed.
  • Recurrent infections – No
  • Constipation – I go like once a week, so what do you think?

2. Is your basal temperature consistently below 36.5°C? Take your oral temperature at rest first thing in the morning before moving out of bed for 7 -10 days in the first 14 days of your cycle. Your temperature should be between 36° and 37° C but ideally above 36.5°C. – I believe this would be 97.7°F and if this is the case, my temperature doesn’t reach this until after ovulation. Mine seems to average closer to 96.9°F during the first 14 days of my cycle.

3. Blood Tests – For full thyroid assessment you require readings for TSH, T4, T3, rT3 & Thyroid Antibodies. TRH may also be required. For optimum fertility, your TSH level should be between 1 and 2. Your doctor or naturopath can order these tests for you. – I’ll discuss these results later in this post.

4. Urinary Iodine – Iodine is a key component of thyroid hormone. Excessive iodine as well as a deficiency of iodine can result in low thyroid function. Your doctor or naturopath can order this test for you. – Not sure this test was ever completed for me.

5. Diet & Lifestyle – Our modern western diet is a major contributor to increasing thyroid health problems. Foods detrimental to thyroid health include refined grains, simple sugars, soy products, peanuts & peanut products, caffeine, hydrogenated oils, cigarette smoking and alcohol. Excessive consumption of vegetables such as cabbage, broccoli, turnips, Brussels sprouts have the ability to block the absorption of iodine. – Well, I tend to live on carbs, sugar, and caffeine, but don’t even get me started on needing to change my diet to have a baby. Look at everyone else having babies and not eating well!

6. Exposure to heavy metals e.g. mercury (amalgam fillings) and fluoride (water supply, toothpaste) may also be detrimental. – No clue how much of this I’m exposed to.

7. Stress management is imperative. Stress results in elevated levels of cortisol, the main hormone released by the adrenal glands. Increased cortisol will inhibit the conversion of T4 to the active T3 hormone. – Um, we all have stress!

8. Exercise is beneficial as it will stimulate thyroid hormone secretion and increases tissue sensitivity to thyroid hormones. – Woohoo, something good I’m doing!

So I’ve had my TSH level tested twice so far…

The first time was on June 24, 2013 when we were just getting ready to be referred to the RE. A ton of tests were ordered, including this one, as it seemed one of the standards at that time. My level came back at 2.52, within the overall normal range I was told by the ordering physician, my regular OB/GYN.

Then on January 9, 2014, after our second failed IUI, when we were discussing the start of our first IVF cycle, my RE suggested I start on Synthroid to lower my TSH level. He liked to see his infertility patients at 2.50 or less, although up to 4.0 he considered normal for the population at large, and thus I was just borderline for needing the medication. First though, a recheck. That level came back at 1.06, so much lower and therefore I didn’t need the Synthroid.

So… How often does this level change? And who is to say that just because on January 9th it was low enough, that it’s low enough now? Should I be requesting this test be repeated from time to time? And why the drop to the much lower level now? The only thing I changed is the amount of my exercise, as I started Kosama in August 2013. I’m not really sure what to think…

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5 thoughts on “TSH

  1. When I first went to my GP after 1 yr of TTC she ran a bunch of bloodwork, and my thyroid came back a bit wonky, so I got sent to a specialist. Turned out my thyroid basically had a virus which made it appear out of whack but all was good. But then when I started seeing my RE I guess there was one thyroid test my other Dr’s hadn’t run so he got it done and it showed I had extremely high antibodies (predisposition) for hypothyroidism (TSH too high). Previously they thought I had hyperthyroidism (TSH too low) due to the virus suppressing it. I have hypothyroidism in my family so my RE started me on synthroid because he said it is only a matter of time before my TSH got too high, he’d rather just get it artificially controlled now, rather than waiting for it to become a problem. So, in any case, I don’t know if that helps you but if your TSH is going down, it would be hyperthyroidism (which is thyroid over functioning, the opposite of the little questionnaire you have up there). Hopefully that makes sense!

    1. But isn’t it going down better from an infertility standpoint? My main concern was it being too high at one point or possibly going back up… I guess I wasn’t clear on how much it can fluctuate and how long it takes to change. So much to learn! Thanks for the info!

      1. Not if it goes too far down then you have the same problems on the other end of the spectrum. I’m not sure how much is normal for it to fluctuate though. As long as it is within the normal range you should be good, whether on the low end or high end. It is a lot to figure out!

  2. Ok, if your highest value was more than 2.5 (which is fine) I’d be concerned, but since you went down to 1.06 (which is great) I don’t think you have anything to worry about.

    Too much TSH is just as bad as not enough, and if you’re fluctuating between 1.06 and 2.5, you are (in my self-educated but non-medically trained opinion) in perfect shape to get and stay pregnant. Once you have confirmed pregnancy, for peace of mind I would demand they test your TSH right along with your betas and progesterone, to make sure (because pregnancy causes an immediate and dramatic spike in my TSH). And then periodically as they suggest.

    You can read my ‘about’ page if you want to know my experience with TSH, Hypothyroid, and Pregnancy. Good luck! XO

    1. Thank you!

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