In 1990, a significant correlation between high levels of thyroid antibodies and an increased rate of miscarriage was first reported in the scientific literature. Where are we at a generation later? Despite the 20 years of compelling research confirming and expanding upon the initial finding, many doctors do not test a pregnant woman for thyroid antibodies, and few patients know to ask for proper testing.
Hashimoto’s disease is an autoimmune condition in which the body attacks and destroys its own thyroid gland. In a healthy immune system, antibodies act as the body’s army to detect and destroy invaders not normally present in the body, such as bacteria, viruses, fungi, and parasites. In the case of Hashimoto’s disease, a defective immune system wreaks havoc on the body by directing antibodies against its own thyroid gland as if it is a foreign invader. Although Hashimoto’s is the number one cause of hypothyroidism in the United States, it is a tragically overlooked disease in the health care system.
You may have Hashimoto’s disease and not even know it.
According to the American Thyroid Association, 10 to 20% of all pregnant women in the first trimester of pregnancy are positive for Hashimoto’s antibodies, but they are euthyroid. Euthyroid means they have normal thyroid functioning based on their TSH (thyroid stimulating hormone) level, the most common measurement of thyroid function. Their thyroid function in early pregnancy appears to be normal and they may even feel well, all the while their body is silently attacking and destroying their own thyroid gland. A significant percentage of these women will however develop a TSH above the trimester-specific pregnancy reference range by the third trimester, endangering the life of their fetus.
By testing TSH alone, thyroid antibodies in Hashimoto’s may be missed, and your doctor may have no idea your baby is at risk.
The number one issue is that many traditional doctors do NOT test for thyroid antibodies. In mainstream medicine TSH rules, leaving millions of Hashimoto’s patients around the world undiagnosed and untreated. You must be an advocate for yourself and insist on the following two thyroid antibody tests.
Thyroid Peroxidase Antibodies (TPOAb)
Thyroglobulin Antibodies (TgAb)
If your doctor refuses to test your thyroid antibodies, you have the option to order your own thyroid lab tests. True Health Labs is a trusted place where you can order comprehensive thyroid testing including thyroid antibodies and more. The advantage of True Health Labs is that they offer one-on-one results review with one of their Functional Medicine doctors so that you understand your lab test results and next steps. Use coupon code Limited_5 for 5% off an order.
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Comprehensive Thyroid Assessment Kit for Canada (this kit can also be used in the USA except in NY, helpful if you are not near a Quest draw center, reside in a rural area, or live in Canada)
Comprehensive Thyroid Assessment for Europe
Thyroid Antibodies and Miscarriage
Researchers in a 2011 study published in the British Medical Journal conducted a systematic review of 31 studies involving 12,126 women that assessed the association between thyroid autoantibodies and miscarriage. Of the 31 studies, 28 separate studies found thyroid antibodies increased the risk of miscarriage by 290%. According to researchers:
In the developed world, thyroid autoimmunity is the main cause of hypothyroidism, which itself results in poor obstetric outcomes. Even in women with biochemically normal thyroid function, studies have reported an association between the presence of thyroid autoantibodies, particularly thyroid peroxidase antibodies and adverse pregnancy outcomes, including miscarriage, preterm birth, and adverse neurodevelopmental sequelae in children.
The Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and Postpartum recommend:
Women with Hashimoto’s who are not receiving thyroid treatment require monitoring for hypothyroidism during pregnancy. TSH should be evaluated every 4 weeks during the first half of pregnancy and at least once between 26 and 32 weeks gestation. TSH levels above the trimester-specific pregnancy reference range should be treated (first trimester, 0.1-2.5 mIU/L; second trimester, 0.2-3.0 mIU/L; third trimester, 0.3-3.0 mIU/L).
According to Dr. David Clark, DC Functional Neurologist:
- As a mother, if you have TPO antibodies that means you have a real risk for becoming hypothyroid. Hypothyroidism itself can cause miscarriages and premature birth.
- If you have TPO antibodies, you have ONE autoimmune disorder, and your immune system is attacking ONE tissue…it can now easily attack something else, like a developing fetus.
The lack of awareness about Hashimoto’s disease is pervasive. Do not assume your doctor is aware of the dangers of Hashimoto’s in pregnancy. Take charge of your thyroid health and insist on thyroid antibody testing.
I learned the hard way that when it comes to thyroid disease in pregnancy we must be our own advocates. Not all doctors are informed enough about proper testing and treatment of women with thyroid issues during pregnancy. Under my award-winning New York City doctor’s care, my TSH soared far above the recommended range for pregnancy and I miscarried my child. I can’t go back no matter how much I wish and change things for my baby but what I can do is make sure this never happens again to another baby.
I co-authored this book with Mary Shomon, Your Healthy Pregnancy with Thyroid Disease: A Guide to Fertility, Pregnancy, and Postpartum Wellness, so that every woman will know the lab tests, optimal ranges, medications, supplements, dietary recommendations and more so that she will know more than even her doctors about having miracle babies with thyroid disease including Hashimoto’s.
1. Stagnaro-Green, A., Roman, S.H., Cobin, R.H., el-Harazy, E., Alvarez-Marfany, M., Davies, T.F. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. Journal of the American Medical Association 1990 Sep 19;264(11):1422-5.
2. Stagnaro-Green, A. Thyroid Antibodies and Miscarriage Where Are We at a Generation Later? Journal of Thyroid Research 2011 May 12;2011:841949.
3. Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E.N., Soldin, O.P., Sullivan, S., and Wiersinga, W. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Retrieved from http://thyroidguidelines.net/pregnancy.
4. Thangaratinam, S., Tan, A., Knox, E., Kilby, M.D., Franklyn, J., Coomarasamy, A. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. British Medical Journal 2011;342:d2616.
5. Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E.N., Soldin, O.P., Sullivan, S., and Wiersinga, W. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Retrieved from http://thyroidguidelines.net/pregnancy.
6. Dr. David Clark, DC. Thyroid Antibodies and Risk of Miscarriage, Premature Birth. Retrieved from DallasThyroidDoctor.com: http://drclark.typepad.com/dr_david_clark/2011/11/thyroid-antibodies-and-risk-of-miscarriage-premature-birth.html.