Thyroid Disease and Recurrent Pregnancy Loss

Dr. Braverman discusses the contribution of thyroid disease in patients with recurrent pregnancy loss.

We have many patients that come to our practice with some sort of history involving their thyroid gland. Some report histories of underactive thyroid, some are overactive and some have autoimmune diseases such as Hashimoto's or Graves' disease and some are only told that they have thyroid antibodies but no act of thyroid disease but surprisingly most are incorrectly told these reasons are not the reason for their recurrent miscarriages or failure to conceive. We have learned that there are receptors on the developing follicles for thyroid hormone and even small variations, high or low, can affect the follicles growth, egg quality and ability to conceive.

In fact, new studies have actually found thyroid antibodies inside the follicular fluid and the antibodies themselves may affect the egg quality. Well, some of these variations in thyroid hormone are even more pronounced in women with polycystic ovarian syndrome. This is one of the reasons why we micromanage our patients with thyroid dysfunction during any treatment cycle. Any patient with autoimmune thyroid disease is at risk for recurrent pregnancy loss and there are at least two mechanisms at play here.

First, the embryos need to develop immune tolerance so they can properly implant. This is assisted by a healthy and correctly functioning maternal immune system. The same defect in the mother's immune system that allows her to start attacking her thyroid gland also deters the embryo's ability to create immune tolerance for itself. If this immune tolerance by the embryo is not correctly initiated, the mother's immune system will attack the embryo much the same way it attacks her own thyroid gland.

Second, the anti-thyroid antibodies – even when there is no active thyroid disease – have been shown to directly bind to the invading trophoblast portion of the embryo. This binding activates another part of the immune system called the complement system and leads to a very strong immune response against the embryo, as well as an increase of blood clots in the developing embryo that also leads to recurrent pregnancy loss. So you can see that any abnormality in thyroid testing can have a strong association with recurrent pregnancy loss or failure to conceive. Here at Braverman IVF & Reproductive Immunology our patients with thyroid abnormalities are carefully evaluated and treatments are tailored to account for the endocrine immunologic and the thrombophilic blood clotting components of this disorder.

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