Can I have a safe pregnancy with hypothyroidism at 36?

Question

Hi doctor,

I am 36 and have been dealing with hypothyroidism for six years, but my levels are all over the place since I started trying to get pregnant 18 months ago. My TSH keeps bouncing between 2.8 and 6.2, even though my endocrinologist keeps adjusting my Levothyroxine dose. I am currently taking 125 mcg daily. had two miscarriages in the past year at eight and 10 weeks, and the fertility doctor thinks the thyroid problems might be causing them.

My periods have gotten really heavy and irregular, lasting eight to nine days with terrible cramping. I am also gaining weight, having put on 25 pounds in the past six months, despite eating less and exercising more. The worst part is I am exhausted all the time, and my hair is falling out in clumps, which is really depressing. My anti-TPO antibodies came back at 180 (normal is under 35), and the doctor mentioned something about Hashimoto's thyroiditis. Free T4 was 0.9, which is on the low end of normal. Can hypothyroidism really cause recurrent miscarriages, and will I ever be able to have a healthy pregnancy?

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

What is actually happening is Hashimoto’s thyroiditis. Your laboratory tests show that your TSH (thyroid-stimulating hormone) levels fluctuate between 2.8 and 6.2, free T4 (thyroxine) is low-normal (0.9), and anti-TPO (anti-thyroid peroxidase) antibodies are high (180).

Symptoms, including heavy periods, fatigue, weight gain, and hair loss, strongly show a hypothyroid pattern. Hashimoto’s causes your thyroid to burn out slowly and unpredictably, meaning your Levothyroxine dose often needs to be increased, especially when trying to conceive. The fact that your TSH is still above 2.5 at times means it is not adequately controlled for pregnancy.

Yes, hypothyroidism causes miscarriage. Hypothyroidism increases the risk of early miscarriage, infertility, irregular periods, failure of embryo implantation, placental problems, and ovulatory dysfunction. Your TSH has been going above 4 to 5 mIU/L, which is linked to miscarriage. So yes, your thyroid is almost certainly contributing.

Also, when trying to get pregnant, your body naturally raises thyroid hormone needs by 30 to 50 %. So even if your dose used to work, it often becomes insufficient when trying to conceive. Most women with Hashimoto’s eventually need Levothyroxine 1.6 to 2.0 mcg/kg/day, but it varies.

Therefore,

TSH must be consistently between 0.5 and 2.5 for at least two to three months. It must be stable.
Re-check thyroid levels every four to six weeks. This is essential because your dose may need multiple adjustments.
Dose likely needs a slight increase at 125 mcg; you are still under-treated. Your endocrinologist may increase to 137 or 150 mcg, depending on your next laboratory reports.
Take levothyroxine on an empty stomach with water. Wait 45 to 60 minutes before eating. Avoid calcium and iron supplements for four hours. Avoid taking them with coffee. These can make a huge difference.
Check for other contributing issues, such as weight gain, heavy periods can also reflect low iron (from heavy periods), low vitamin D, mild insulin resistance, stress, and poor sleep. Your doctor may check iron stores, ferritin, vitamin D, and fasting insulin.

You can have a healthy pregnancy. Women with Hashimoto’s have completely normal pregnancy outcomes once thyroid levels are controlled. Your situation is fixable. Once TSH is stable at less than 2.5, fertility improves, miscarriage rate drops to normal, hair and weight issues often improve, and cycles become more regular.

Anti-TPO antibodies themselves can increase miscarriage risk, even if TSH is normal. This is why your TSH needs to be kept lower (0.5 to 2.0), not just normal. Some fertility specialists also use low-dose Levothyroxine even in euthyroid women with high TPO, Selenium 200 mcg/day.

Your symptoms, such as heavy periods, indicate untreated hypothyroidism. Hair loss indicates hypothyroid autoimmune inflammation. Weight gain indicates a slowing metabolism, fluid retention. Exhaustion means low thyroid levels, possibly low iron. These are not permanent, as they improve strongly once the thyroid is properly replaced.

I hope this information will help you.

Thanks.