TSH and shady grove

[Anonymous]

Recently went to an endo and was medicated for hypothyroid. Was told to get pregnant I need a TSH under 2.5. Mine was over 3

Looked back at lab results from when I was TTC and noticed it was over 3 then as well. Why did no one at shady grove flag this? I had unexplained fertility and first round of IVF worked for me.

[Anonymous]

Good question. My experience with Shady Grove is that they don't pay attention to thyroid issues. They never tested my TSH (they had my records showing I was on thyroid meds), and when I did get pregnant via IUI nobody at Shady Grove thought to mention I should get my thyroid tested right away. Pregnancy often increases need for thyroid hormones from the very beginning. Not paying attention to this can lead to miscarriage and pregnancy complications, so you'd think they'd be on top of it. The weekend after my BFP I read about this online and frantically emailed my OB. My TSH was already over 5 by the time I was 5 weeks pregnant. Fortunately was able to get my thyroid meds adjusted, but this is no thanks to Shady Grove.

[Anonymous]

Anonymous wrote:Good question. My experience with Shady Grove is that they don't pay attention to thyroid issues. They never tested my TSH (they had my records showing I was on thyroid meds), and when I did get pregnant via IUI nobody at Shady Grove thought to mention I should get my thyroid tested right away. Pregnancy often increases need for thyroid hormones from the very beginning. Not paying attention to this can lead to miscarriage and pregnancy complications, so you'd think they'd be on top of it. The weekend after my BFP I read about this online and frantically emailed my OB. My TSH was already over 5 by the time I was 5 weeks pregnant. Fortunately was able to get my thyroid meds adjusted, but this is no thanks to Shady Grove.

Same experience here. I have Hashimoto's, and I'm being seen by an endocrinologist who knows that I'm cycling with SG again (TTC#2), and he has requested that they run TSH with every round of bloodwork. I pass the results along to him, and he adjusts thyroid medication accordingly.
When I asked about this several years ago (prior to IVF for DC#1), I was told by one of the SG nurses that they would assume that any monitoring of TSH and changes to medication would be taken care of by whomever the prescribing physician was (i.e., your PCP, endo, OB, etc). My new endocrinologist has stressed to me the importance of monitoring TSH closely while cycling (according to him, some of the medications can negatively impact TSH), especially immediately upon confirmation of a BFP. I'm not sure how many women are aware of just how quickly TSH can rise in early pregnancy.

[Anonymous]

GW disregarded my TSH of 3, as well, when I went for my initial infertility workup after we'd tried for 9 months and only had 1 chemical pregnancy (in my late 30s). The RE tested me for anti-TPO antibodies, which I was negative for. She said since the anti-TPO test was negative, my TSH>3 wasn't a problem. I then had another chemical pregnancy and a 7-week miscarriage in back-to-back cycles. The RE didn't even consider revisiting my TSH when she outlined the tests she was ordering to assess recurrent pregnancy loss. After all the tests she ordered came back normal, I went to see a regular endocrinologist, who promptly put me on Synthroid. I moved to a new fertility clinic, and we were pregnant again within a couple of months. I had my TSH checked right after I hit 4 weeks pregnant and I already needed an increase in my dose.

[Anonymous]

Anonymous wrote:GW disregarded my TSH of 3, as well, when I went for my initial infertility workup after we'd tried for 9 months and only had 1 chemical pregnancy (in my late 30s). The RE tested me for anti-TPO antibodies, which I was negative for. She said since the anti-TPO test was negative, my TSH>3 wasn't a problem. I then had another chemical pregnancy and a 7-week miscarriage in back-to-back cycles. The RE didn't even consider revisiting my TSH when she outlined the tests she was ordering to assess recurrent pregnancy loss. After all the tests she ordered came back normal, I went to see a regular endocrinologist, who promptly put me on Synthroid. I moved to a new fertility clinic, and we were pregnant again within a couple of months. I had my TSH checked right after I hit 4 weeks pregnant and I already needed an increase in my dose.

Unbelievable.

[Anonymous]

Anonymous wrote:

Anonymous wrote:GW disregarded my TSH of 3, as well, when I went for my initial infertility workup after we'd tried for 9 months and only had 1 chemical pregnancy (in my late 30s). The RE tested me for anti-TPO antibodies, which I was negative for. She said since the anti-TPO test was negative, my TSH>3 wasn't a problem. I then had another chemical pregnancy and a 7-week miscarriage in back-to-back cycles. The RE didn't even consider revisiting my TSH when she outlined the tests she was ordering to assess recurrent pregnancy loss. After all the tests she ordered came back normal, I went to see a regular endocrinologist, who promptly put me on Synthroid. I moved to a new fertility clinic, and we were pregnant again within a couple of months. I had my TSH checked right after I hit 4 weeks pregnant and I already needed an increase in my dose.

Unbelievable.

But so common. I think many women who end up in fertility clinics could be helped by proper management of their thyroid. It's an undertreated condition.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:GW disregarded my TSH of 3, as well, when I went for my initial infertility workup after we'd tried for 9 months and only had 1 chemical pregnancy (in my late 30s). The RE tested me for anti-TPO antibodies, which I was negative for. She said since the anti-TPO test was negative, my TSH>3 wasn't a problem. I then had another chemical pregnancy and a 7-week miscarriage in back-to-back cycles. The RE didn't even consider revisiting my TSH when she outlined the tests she was ordering to assess recurrent pregnancy loss. After all the tests she ordered came back normal, I went to see a regular endocrinologist, who promptly put me on Synthroid. I moved to a new fertility clinic, and we were pregnant again within a couple of months. I had my TSH checked right after I hit 4 weeks pregnant and I already needed an increase in my dose.

Unbelievable.

But so common. I think many women who end up in fertility clinics could be helped by proper management of their thyroid. It's an undertreated condition.

Why is this? Shady grove wants the money?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:GW disregarded my TSH of 3, as well, when I went for my initial infertility workup after we'd tried for 9 months and only had 1 chemical pregnancy (in my late 30s). The RE tested me for anti-TPO antibodies, which I was negative for. She said since the anti-TPO test was negative, my TSH>3 wasn't a problem. I then had another chemical pregnancy and a 7-week miscarriage in back-to-back cycles. The RE didn't even consider revisiting my TSH when she outlined the tests she was ordering to assess recurrent pregnancy loss. After all the tests she ordered came back normal, I went to see a regular endocrinologist, who promptly put me on Synthroid. I moved to a new fertility clinic, and we were pregnant again within a couple of months. I had my TSH checked right after I hit 4 weeks pregnant and I already needed an increase in my dose.

Unbelievable.

But so common. I think many women who end up in fertility clinics could be helped by proper management of their thyroid. It's an undertreated condition.

Why is this? Shady grove wants the money?

I think alot of doctors don't think thyroid can have that much of an impact. Or they think a tsh under 5 is okay. Or it will require too much monitoring, so they don't bother. It's fascinatingly difficult to get treated properly. I was on infertility internet boards for years back when I was trying, and it seemed to be a very common problem. After multiple rounds of ivf and years of trying, I begged my RE to bump up my thyroid dose to try to get my tsh below 2.5 (it was around 2.8 at the time). I got pregnant the month we did that (without ivf), and had my son as a result.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:GW disregarded my TSH of 3, as well, when I went for my initial infertility workup after we'd tried for 9 months and only had 1 chemical pregnancy (in my late 30s). The RE tested me for anti-TPO antibodies, which I was negative for. She said since the anti-TPO test was negative, my TSH>3 wasn't a problem. I then had another chemical pregnancy and a 7-week miscarriage in back-to-back cycles. The RE didn't even consider revisiting my TSH when she outlined the tests she was ordering to assess recurrent pregnancy loss. After all the tests she ordered came back normal, I went to see a regular endocrinologist, who promptly put me on Synthroid. I moved to a new fertility clinic, and we were pregnant again within a couple of months. I had my TSH checked right after I hit 4 weeks pregnant and I already needed an increase in my dose.

Unbelievable.

But so common. I think many women who end up in fertility clinics could be helped by proper management of their thyroid. It's an undertreated condition.

Why is this? Shady grove wants the money?

It isn't just SG. Thyroid issues are written off by many doctors. I'm the PP with Hashimoto's, and my former PCP never saw it as a concern, despite the fact that I had hair loss and was tired all the time. The referral to an endocrinologist actually came from a midwife at my yearly gyno checkup.

[Anonymous]

Their attitude is that the research is at best mixed and TSH/thyroid has not been shown to make a difference. I got the impression that at least one doc there thinks it’s the endo doctors trying to get a piece of the lucrative fertility business.

[Anonymous]

Similar experience here. Doctor at SGF said anything under 4 was normal. My TSH got up to 3.4, had an epic fail cycle then endo medicated me. TSH went down to 1-2 range and BFP plus some frozens. We have mild MFI so that could’ve been all the difference too but I felt (and my endo felt) that lower was much better. She also warned me to let her know ASAP if I’m planning on trying again since my level is back up to 2.8.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:GW disregarded my TSH of 3, as well, when I went for my initial infertility workup after we'd tried for 9 months and only had 1 chemical pregnancy (in my late 30s). The RE tested me for anti-TPO antibodies, which I was negative for. She said since the anti-TPO test was negative, my TSH>3 wasn't a problem. I then had another chemical pregnancy and a 7-week miscarriage in back-to-back cycles. The RE didn't even consider revisiting my TSH when she outlined the tests she was ordering to assess recurrent pregnancy loss. After all the tests she ordered came back normal, I went to see a regular endocrinologist, who promptly put me on Synthroid. I moved to a new fertility clinic, and we were pregnant again within a couple of months. I had my TSH checked right after I hit 4 weeks pregnant and I already needed an increase in my dose.

Unbelievable.

But so common. I think many women who end up in fertility clinics could be helped by proper management of their thyroid. It's an undertreated condition.

Why is this? Shady grove wants the money?

NP - Shady Grove doesn't really care about immune issues (though there was a poster on here recently who miraculously managed to get them to prescribe a few immune type meds and I was shocked).

[Anonymous]

Anonymous wrote:Their attitude is that the research is at best mixed and TSH/thyroid has not been shown to make a difference. I got the impression that at least one doc there thinks it’s the endo doctors trying to get a piece of the lucrative fertility business.

Dr. Braverman, an RI, believes that issues with egg quality are often mitochondrial and that egg quality can be improved post-lap (with a qualified doctor doing the lap). A lot of women who don't suspect endo end up having it, and then go on to have success (this is more so anecdotal from a group of women I'm in who suffer from immunological issues). There really is something to excising endo and having success later, IMO.

[Anonymous]

Anonymous wrote:Their attitude is that the research is at best mixed and TSH/thyroid has not been shown to make a difference. I got the impression that at least one doc there thinks it’s the endo doctors trying to get a piece of the lucrative fertility business.

I'm not sure there's a lot of controversy that high TSH increases the risk of miscarriage, pregnancy complications and impaired fetal neurological development goes up if your TSH is above a certain level. Or that TSH often rises significantly in very early pregnancy. That alone should be enough to make sure TSH is controlled while undergoing fertility treatments. Not to mention that levothyroxine is not an expensive drug.

https://academic.oup.com/jcem/article/99/10/3895/2836616

[Anonymous]

Anonymous wrote:

Anonymous wrote:Their attitude is that the research is at best mixed and TSH/thyroid has not been shown to make a difference. I got the impression that at least one doc there thinks it’s the endo doctors trying to get a piece of the lucrative fertility business.

I'm not sure there's a lot of controversy that high TSH increases the risk of miscarriage, pregnancy complications and impaired fetal neurological development goes up if your TSH is above a certain level. Or that TSH often rises significantly in very early pregnancy. That alone should be enough to make sure TSH is controlled while undergoing fertility treatments. Not to mention that levothyroxine is not an expensive drug.

https://academic.oup.com/jcem/article/99/10/3895/2836616

I think the controversy is regarding what level starts the concern. I agree with you that it should be monitored and more closely controlled than it is for many women. Even brand name synthroid is pretty cheap when compared to the literal tens of thousands of dollars people spend on ivf.