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Pregnancy with Graves Disease

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expecting-babyPregnancy with Graves Disease

I’ve been asked many times by clients via email about how Hyperthyroidism or Graves’ Disease may affect their ability to get pregnant, to stay pregnant, to deliver a healthy baby and what are the possible consequences.  I tried to research this subject, to the best I can, even though I don’t have very much personal experience. I had my daughter before I got sick with Graves’ disease.

It is considered that you can get pregnant if your test results- TSH, FT3 and FT4 are normal. By normal I mean in the normal ranges- TSH- 0,3- 3,0 mIU/L (mU/L), FT3 = 230-420 pg/d, FT4 = 0.8-1.5 ng/dl (as defined by the Amercian Thyroid Association). However, this is not the only requirement. Your Thyroid Antibodies (anti-thyroid peroxidase and anti-thyroglobulin antibodies (collectively referred to as anti-thyroid antibodies (ATA) should be in the normal range as well. 

In 1990 the scientists Stagnaro-Green demonstrated in a prospective analysis that thyroid antibodies were markers for “at-risk” pregnancies.  So said, you can get pregnant, even if your tests results are not normal, but the risk of miscarriage is greater than in other women- about 50%. This of course is very individual, my experience shows- I’ve had clients who had 2 or ever 3 successful pregnancies while being hyperthyroid.

It can be presumed that infertile patients who demonstrate ATA (anti-thyroid antibodies) can be classified as having the reproductive autoimmune failure syndrome (RAFS).

Possible Solution: Treatment for Antithyroid Antibodies

In IVF (in vitro fertilization) patients for example, antithyroid antibodies (ATAs) are treated with intravenous immune globulin (IVIg) before the IVF transfer. The intravenous immune globuline (IVIg) therapy is also used for treating people with Thyroid Eye Disease. Check with your doctor if this could be a solution for you as well.

Other reasons for thyroid patients’ infertility

1. Anvulation (no ovulation, or release of an egg) and menstrual irregularities. With no egg to fertilize, conception is impossible.

2. Short luteal phase. The luteal phase is the time frame between ovulation and onset of menstruation. The luteal phase needs to be of sufficient duration — a normal luteal phase is approximately 13 to 15 days — to nurture a fertilized egg. A shortened luteal phase can cause what appears to be infertility, but is in fact failure to sustain a fertilized egg, with loss of the very early pregnancy at around the same time as menstruation would typically begin.

Pregnancy Laboratory Testing that should be done (preferably), if you are trying to get pregnant

mother-and-baby-on-the-beach-

Blocking Antibody level (by flow cytometry)
  T cell IgG
  B cell IgG
Antiphospholipid Antibody Panel
  Anticardiolipin antibodies     IgG,IgM,IgA
  Antiphosphoglycerol antibodies     IgG,IgM,IgA
  Antiphosphoserine antibodies    IgG,IgM,IgA
  Antiphosphoethanolamine antibodies     IgG,IgM,IgA
  Antiphosphatidic acid antibodies     IgG,IgM,IgA
  Antiphosphoinositol antibodies     IgG,IgM,IgA
  Activated partial thromboplastin time (APTT)
  Lupus anticoagulant (LA)
  VDRL
Antinuclear Antibody Panel
  ANA Titer
  Double stranded DNA

  SSA
  SSB
  RNP
  SM
Antihistone Antibody
HLA Tissue Typing
  ABC
  DR,DQ
DQA1 DNA fingerprinting
DQB1 DNA fingerprinting
Chromosome analysis
Immunophenotype
Natural Killer Cell Activation Assay
Natural Killer Cell Activation/IVIg Assay
Intracellular Tumor Necrosis Factor (TNF) Alpha Assay
Quantitative Immunoglobulin
Factor V Leiden Gene Mutation
Factor II (Prothrombin) Gene Mutation
Methylene Tetrahydrofolate Reductase (MTHFR) Gene Mutation

Don’t get overwhelmed by the above list. Not all of them are absolutely necessary, depending on your individual situation, but  your doctor can decide which of them need to be conducted.

There are a few more investigations on pregnancy and Graves’ disease.

 Pregnancy, Graves’ Disease and Hyperthyroidism 

In 2002, the G.E. Krassas Department of Endocrinology & Metabolism “Panagia”, Thessaloniki, Greece & P. Perros Endocrine Unit, Freeman Hospital, Newcastle upon Tyne U.K.,  measured progesterone levels, a fertility parameter, in the middle of the luteal phase of the cycle in 74 women of reproductive age, 37 of whom had Graves’ disease and 37 of whom were euthyroid (normal thyroid function). They  found that progesterone levels were decreased before treatment in comparison with control  group (i.e with normal thyroid) and were unrestored 4 months after carbimazole therapy. Which means that women with Graves’ disease have remarkably lower levels of progesterone- a hormone, necessary for successful pregnancy. Even though they were treated with Cabimazole (a medication for Graves’ disease) for 4 months these levels remained unchanged. May be this is why women with Graves’ disease may have problems with getting pregnant or staying pregnant. It is not clear though if these patients became euthyroid after 4 months of medication.

Male fertility problems and Graves’ Disease

Hyperthyroidism appears to cause sperm abnormalities (mainly reduction in motility), which reverse after restoration of euthyroidism. Which generally means that when the normal thyroid function is restored, the sperm returns to normal condition.

RadioIodine therapy  (RAI) for thyroid cancer may cause transient reductions in sperm count and motility, (i.e less sperm, slower movement), but there appears to be little risk of permanent effects provided that the cumulative dose is less than 14 GBq.

Bottom line- men also can be affected negatively by RAI treatment, but Graves’ Disease can also affect their fertility levels.

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