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mandymoo

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Saturday, May 15th 2010, 9:29pm

Worried about thyroid antibodies and upcoming IVF

I have been diagnosed with unexplained infertility, however my blood results 2 years ago showed a high level of thyroid antibodies which various doctors have said won't affect my fertility. I am really worried as I am starting my 1st cycle of IVF in the next couple of weeks and have read on number of posts that women with this issue are less successful. The reason I am posting this is because I would like to hear of other ladies experiences of fertilty, IVF and thyroid antibodies.

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Saturday, May 15th 2010, 10:29pm

Hi Mandymoo,
Lots and lots of luck for your upcoming iVF cycle. I hope its your first AND your last! xfingers
Is your IVF clinic aware of your antibodies? I wonder whether they would want a more recent value.
There are folks on here with thyroid issues who have been successful with IVF, hopefully some will come by soon.
M
x

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Sunday, May 16th 2010, 9:29am

Hi Mandy Moo



There is evidence that antibodies can affect implantation and carrying. Look on Thyroid Uk website at Dr Lowe. He has brought together research from Spain and Italy which suggests that by using steroids, aspirin and thyroxine this can be avoided.



My advice would be to research the subject before tx. Many drs don't understand the impact of thyroid antobodies on health or fertility. I have experienced this first hand. Thryoid uk and Stop the Thyroid Madness will help put it all together.

Lot of luck with your treatment :xxx3: :goodluck:
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Sunday, May 16th 2010, 9:39am

I would suggest that you get re-tested as your thyroid may have corrected itself. I had hypa-thyroid issues for a while 2 years ago but wasn't given medication and within 6 months it had corrected itself and on my second cyclei got pregnant :-)

Somy advice would be yo get down your focs and get your blood taken for thyroid again, before scaring yourself with information on the Internet unnecessarily.

:goodluck: with your ivf cycle Hun xxx


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Sunday, May 16th 2010, 10:16am

It is possibe to have hyperthyroidism due to factors other than antibodies. Usually when antibodies are present they don't disappear. That's not to say thyroid pateints with antibodies will be immediately symptomatic. But if antibodies are confirmed they should be considered if you are having treatment. It's important to educate yourself so you can be sure you're getting the right advice and treatment. xxxx
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IUI :BFP: 1998 gorgeous son :P
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Sunday, May 16th 2010, 12:01pm

Just to clarify everybody

hyperthyroidism = overactive thyroid = pretty uncommon, otherwise known as Graves disease.

hypothyroidism = underactive thyroid = common and the type of thyroid problem most associated with infertility.

Both types can be autoimmune so high antithyroid antibodies can be seen with both but when associated with fertility problems it is primarily HYPOthyroidism we're talking about.

Hope that clears up any confusion.

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Sunday, May 16th 2010, 1:05pm

Hi again

Ruthie you are correct to say that fertility problems tend to be associated with hypothyroidism (Hashimotos), however this tends to be the most common form of thyroid disease. There are also fertility problems associated with thyroid antibodies in Graves disease, not least their impact on menstruation. It would be useful to know which antibodies are present, therefore a more specific diagnosis, as both have their own particular monitoring requirements.
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IUI :BFP: 1998 gorgeous son :P
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Sunday, May 16th 2010, 1:51pm

Hi ladies,

You all sound very knowledgable about this. I have extremely high thyroid peroxidase antibodies but other blood tests seem to indicate that despite this my thryroid is still working 'normally'. This means docs are reluctant to see this as a cause of infertilty/my recent m/c. My consultant is willing to make some changes to the protocol for my next FET e.g. by doubling dose of clexane and introducing steroids (I'm allergic to aspirin so can't take it). Should I also be taking thyroxine? I worry that I won't be prescribed it as my T4 levels were fine...does that mean I don't need it?

sleepydumpling - just read your other post - so sorry that you are now suffering with anaemia. I hope the docs manage to control this soon so you can get on with tx xx



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Sunday, May 16th 2010, 2:23pm

Thank you Kay Jay



the anaemia has knocked me for six and what has upset me is that it is a common problem for thyroid patients and could have been avoided!



I hope I don't come across as too pushy but I really want to encourage ladies with thyroid antibodies to arm themselves with information. I and many others have found that the medical profession does not fully understand how to treat and care for those of us with this and so it is up to us to get what we need.



As far as antibodies and fertility are concerned one important fact that seems to have come to light is that it is the PRESENCE of the antibodies and not the presence of thyroid symptoms that need addressing. In other words you may have normal bloods (euthyroid) and be symptom free. Dr Lowe puts the research together simply and easy to read. He suggests that in the presence of antibodies steroids, aspirin and THYROXINE should be given. This increases success of implantation and reduces m/c.



Thyroid uk has this info on their website. They are a recognised and accepted support for thyroid patients. Even if they're euthyroid!



Personally mine has been a long, painful and joyous journey. I was diagnosed with POF in 1995, this took 8 years! I adopted my beautiful daughter in 1996. I then became a research subject for UCH and during this I ovulated and had IUI. I have a gorgeous son. I married in 2001 and want to give my husband a child. So I had IVF x with ED but failed. We now think this is because of the antibodies. There is also a link between POF and thryoid disease and I have noticed that since starting the thyroxine I have been experiencing activity in my ovaries!



We're off to Spain for ED soon. I'll be having the drugs recommended by Dr Lowe for this. I hope this information helps others take control and achieve BFP blowkiss
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Sunday, May 16th 2010, 4:34pm

I will be watching this thread closely because I have high antibodies and high TSH, although I have also been told this is not affecting my fertility. With years of trying, 9 months of clomid and 2 failed cycles something is def amiss, so I am investigating this closely. Even if the Dr's say your thyroid is fine and that you don't need medication at the moment it should still be getting closely monitored. My antibody level doubled from July 09 - November 09. However, my TSH had gone down slightly, but is still at 4.96, which thyroid uk and Dr Beer would say is too high for optimum conception.

It is frustrating when different doctors are saying different things!!

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Sunday, May 16th 2010, 4:37pm

The problem comes because it is difficult to diagnose thyroid problems anyway. The blood tests are not clear cut and a lot of different values have to be looked at together. As SD suggests some doctors recommend tx with thyroxine even for patients with normal thyroid hormone levels if their antibodies are high.

Basically there are 2 issues with abnormal thyroid antibodies:

1. these can indicate thyroid disease per se so it is important to have the other thyroid tests (usually T4, T3 and TSH) to assess thyroid function.

2. High antithyroid antibodies indicate recent attack of the thyroid gland by the immune system. This doesn't necessarily mean that the thyroid is malfunctioning, it just means that it has been attacked by the immune system.

To my mind the most interesting issue regarding patients with high antithyroid antibodies but normal thyroid function is that it may well be an indication of other immune system problems which obviously can have an impact on fertility and particularly implantation. This is where tx like steroids comes into play.

I think the reason a lot of doctors are unsure about giving thyroxine to patients with normal thyroid function is precisely because hyperthyroidism can also cause fertility issues as well as many other problems. In that situation the thyroid function needs to be extremely closely monitored. I speak from indirect experience in that my cousin was placed on thyroxine even though she was euthyroid (for fertility reasons) and ended up with a cardiac arrythmia which eventually needed cardioversion to fully resolve. However I know that more and more fertility clinics are taking thyroid issues more seriously and with good thyroid monitoring giving thyroxine should cause no problems. Also bear in mind that hyperthyroidism carries an increased risk of miscarriage.

As far as I'm aware there is no distinction between the antibodies that cause hyperthyroidism and hypothyroidism. The antibodies attack the thyroid gland itself. The only way to tell what is going on with thyroid function is to test as above. Hypothyroid patients classically have low T4 and high TSH, hyperthyroid patients classically high T4 and low TSH. However there are variations here too.

Ultimately KayJay, noone can tell whether you need thyroxine or not. In terms of your thyroid function itself if your thyroid function is normal then you don't need thyroxine. However in terms of the impact on fertility then maybe you do. It would be good to see some trials on this stuff. The only relevant study I've been able to find used prednisolone and aspirin as well as thyroxine on patients with high antithyroid antibodies. It's not possible therefore to know whether the thyroxine made the difference, or the steroids, the aspirin or the combo of all 3.

All of this isn't to say don't take the thyroid issues seriously but I think the jury is still out on whether thyroxine itself improves outcome, or whether addressing the immune issues that are indicated by high antithyroid antibodies is what helps.

mandymoo

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Sunday, May 16th 2010, 5:37pm

I suppose the answer for me is to have treatment and hope it's successful because the clinic know about my thyroid antibodies but dont feel it is an issue. I suppose if the cycle fails then I will shove the thyroiduk article under their noses to see if they can give me some medication. I'm just really worried about more dissapointment.

ruthie

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Sunday, May 16th 2010, 6:12pm

I would definitely raise the issue with them again. Go armed with whatever info you can and ask again if, having read that, they still think it isn't an issue. Ultimately, if they don't think it's relevant you then have to decide whether to go ahead anyway, or whether to seek other advice. There are doctors like Paul Armstrong in London who see lots of patients who are having tx at other clinics. Generally these issues would come light after a few failed cycles or a few m/c so PA deals with women like that. The alternative would be to seek advice from a fertility clinic that deal more with immune issues and raise the issue with them.

I would speak to your current clinic again though as you're already in the system there. The problem is though that it isn't that clear cut, and doctors generally are fairly conservative and like a lot of data before they change their minds.

Here's a link to a paper which may be worth showing them.

http://ukpmc.ac.uk/articlerender.cgi?acc…&tool=pmcentrez

I think the significant paragraph from a doctor's point of view though is

Conclusion
These observations suggest that euthyroid ATA+ patients undergoing IVF could have better outcome if given LT+ASA+P as adjuvant treatment. This hypothesis must be verified in further randomized, prospective studies.


That's the crux of it. With immune issues, thyroid issues, whatever we need proper trial data to help us make decisions!

xxx

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This post has been edited 1 times, last edit by "Flic" (May 18th 2010, 3:03pm)


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Sunday, May 16th 2010, 6:50pm

antibodies are present when the immune system has gone wrong and attacks the thyroid. Doctors often don't do all the tests. The antibodies are;

TPO Ab - Hashimoto's disease (hypo)

TSI Ab - Graves disease (hyper)

TG AB - Thyroiditis

you can have some or all present. I have Hashimotos but have had an episode of thyroiditis where it has to be treated as hyper !!! There exists studies in Spain, Italy and Iran which can be accessed through Thyroid UK. The studies have been conducted by fertility specialists rather than endocrinologists.

I would definately gather some info and talk to your clinic.

Ruthie I'm sorry to hear that your cousin had such a bad experience. I hope she has recovered.

:xxx:
:hello:

Me 45 DH 32

POF 1995
1996 adopt gorgeous daughter [zx127]
IUI :BFP: 1998 gorgeous son :P
Egg donation 2005 :BFN: ;(
Embryo donation 23.6.10 :BFN: ;(

MY DIARY

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Sunday, May 16th 2010, 7:51pm

My cousin is fine now luckily, it was 3 years ago when she had her experience and she has 2 lovely children now and can put it all behind her but it was v scary at the time.

Sleepy Dumpling, can you send me details of the studies if poss? Thyroid disease is one of my big interests as I have so many family members with issues. My understanding was that TPO was the most sensitive assay, but shows positives in both hypothyroid and hyperthyroid patients. I think about 85% of hyperthyroid patients have raised TPO, that TSI was pretty selective for hyperthyroidism but v rarely done by doctors and that Tg Ab again can be present in both hypothyroid and hyperthyroid patients but is much less sensitive that TPO, with fewer patients testing positive.

That would be lovely if you could as I try to keep up with my reading but things get missed!

Just read your anaemia news in the other thread SD. You must be mightily annoyed at the minute!

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Sunday, May 16th 2010, 8:53pm

This thread has been very very interesting and useful for me. I'm going to see my GP again on Thursday and will ask for a referral to an endocrinologist. I will also need some additional blood tests so will ask if I can get the thyroid ones repeated - I wonder if my recent m/c is what has caused my immune system to go into overdrive and perhaps this is why my thyroid antibodies were so high?!

Ruthie - your reply to me above has really helped me sort a number of thoughts in my head. I will probabably go ahead with my doctors new protocol and hope that the steroids will do the trick. We're not rushing into our next tx so will wait for my next round of bloods to see if they make the picture any clearer...also want to get some advice from an endocrinologist on the thyroxine as I don't want to end up with the opposite problem and become hyperthyroid!

Wow! It's amazing how much we learn about our bodies on this journey!!!


This post has been edited 1 times, last edit by "KayJay" (May 16th 2010, 8:56pm)


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Monday, May 17th 2010, 3:14pm

:hello:

Me 45 DH 32

POF 1995
1996 adopt gorgeous daughter [zx127]
IUI :BFP: 1998 gorgeous son :P
Egg donation 2005 :BFN: ;(
Embryo donation 23.6.10 :BFN: ;(

MY DIARY

This post has been edited 1 times, last edit by "Flic" (May 18th 2010, 3:02pm)


ruthie

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Monday, May 17th 2010, 4:01pm

Thankyou!

xxx




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