Hashimoto's, Hypothyroidism and Risk of Miscarriage

Author: Martin Rutherford

- Hi, I'm Dr. Martin Rutherford. Certified functional medicine practitioner and chiropractor. - Dr. Randall Gates, board certified chiropractic neurologist, also a chiropractor.

- Today's topic, Hashimoto's, hypothyroidism and risk of miscarriage. It's interesting for those of you who watch us, most of the time, much of the time, I'll kind of lay out the lay of the land relative to the fact Dr. Gates is a board certified functional neurologist. I am a certified functional medicine practitioner and that we have a chronic pain practice.

And I emphasize it kind of developed on its own from starting out with fibromyalgia and then going to peripheropathy and then those people had chronic fatigue and then it just kind of kept pulling the string. Dr. Gates is a discipline functional neurologists are extremely conversant in dizziness, vertigo, balance, migraines, concussions, things neurological. The function of medicine practitioners do, get into different systems of the body. Gut systems and they do certainly get into the endocrine system and female systems.

But that's not where we headed. We headed towards, we equally merged those two to address chronic pain because it became apparent that those of us who were trying to take care of all of the organs of the body and the immune systems of the body and stuff were hitting huge brick walls and they seemed, and those people who were doing the brain work were getting kind of sporadic, you know, success with what they were doing. But what we each realized that what was sabotaging those of us that were trying to do the endocrinology stuff with the brain and that we were doing the brain started to realize that what was sabotaging them was inflammation and blood sugar and oxygen delivery to the brain. We put the two together and started seeing pretty consistently successful results in properly screened and selected patients by putting the two of them together. So having said that we had to morph into gut problems, we had to morph into immune problems. We had to morph into those things that we saw was going on. And suddenly we started having people who were being able to get pregnant who didn't get pregnant before. I even saw in chiropractic, I still haven't figured that one out.

Hashimoto's, Hypothyroidism and Risk of Miscarriage

(laughing) I don't, haven't practiced chiropractic in a while but people who couldn't get pregnant forever, and some people, some people would get their backs adjusted suddenly would be able to get pregnant. Was it a coincidence, maybe, I don't know. I think there's discussions on that but that's not where we're going.

So this discussion here is Hashimoto's, hypothyroidism, and miscarriage and risk of a miscarriage. And one of the things we had to become conversant with was the thyroid. What the heck is going on with the thyroid. Why is everybody that comes in here seem to have one when you finally investigate it, and you use the properly developing norms to evaluate it and so thyroid became very, very core to maybe the three or four or five core issues that we realized were contributing to chronic pain and eventually everything. And so Dr. Gates has done, my mentor was, if you heard of anybody say oh my thyroid checked but I realize they don't really look at everything.

That was my mentor, Doctor Datescrozzi. But I will say, like Dr. Gates, has done an enormous amount of fine tuning the understanding of Hashimoto's does and its relation to Hypothyroid and its significant relationship to types of things that cause miscarriages and frankly, even inability to conceive. So that's kind of how we got to this topic. So he's gonna talk about hypothyroidism, he's gonna talk about Hashimoto's, and he's gonna talk directly to its relationship to the inability to conceive and the inability to carry to term and I think it's quite an interesting topic.

One of the things we've found is that a lot of the menstrual issues that people come in here with, too heavy, too light, too frequent, too long, too crampy, whatever it is, if they're not pathology, they all seem to be secondary to something else. Dr. Gates is about to talk to you about what one of the big something elses is. - Okay, just to review thyroid physiology really quick, that way there are no gaps when we're talking about this. Most of the time, when someone has hypothyroidism it's secondary to the immune system killing the thyroid, that's called Hashimoto's thyroiditis. But also know that Hashimoto's can happen independent of low thyroid hormone function. So you can have normal thyroid hormones but you can have Hashimoto's thyroiditis.

And that can cause a number of really negative side effects. And you can go back and watch our Hashimoto's broadcast on that. Also know that the thyroid makes an active thyroid hormone called T4, circulates throughout the body to become active, called T3, and the T3 primarily feeds back to the brain to tell the brain how much thyroid hormone is in circulation and from that, kind of our thermostat so to speak is a hormone called TSH, it's comes from the brain to the thyroid and when the thyroid is low, TSH goes up. Those are the basic clinical points that you need to know.

Now, we started doing broadcasts on Hashimoto's and hypothyroidism several years ago and in delving into the research it became very interesting how there are such a strong association, at least at that time too, between individuals, women, who are having miscarriages in association with hypothyroidism. And the researchers started delving further and they started realizing that the problem was even bigger than they thought, and they started realizing that we need to even scrutinize thyroid hormones with a much tighter lens, so to speak, in order to facilitate a female having her best chance of having a successful pregnancy. Not only fertility, but a successful pregnancy. And that brings up the concept of what's termed subclinical hypothyroidism, so many of you won't be treated for hypothyroidism until your TSH is really elevating, meaning your thyroid is really low, usually around five to eight, somewhere in there. And then the research said, well, if the TSH is above 3.7, that's really an issue. And the current research on this is saying that if you have a TSH above 2.5, and you're pregnant, that it needs to be treated. That's a really, really important point, because this is an impassioned broadcast, because if we can impart some information for you to talk to your ob-gyn about, we feel really good about that.

If you have had recurrent miscarriages in the past, which usually designates if someone's had two miscarriages before twenty weeks of gestation, then that counts for recurrent miscarriages. If you've had that or even if you have Hashimoto's and you're concerned about this, this is a really important piece of data, because if you're getting your thyroid checked, most likely, your ob-gyn is not aware of this brand new research, because this brand new research you have to be checking for it all the time to see it. And so if your TSH is above 2.5, you need to bring this up to your doctor. And the good thing is that below this broadcast, if you go off of Youtube and you go onto PowerHealthTalk.com and you search Hashimoto's and miscarriages, you'll see this broadcast come up and below this broadcast you'll see all the reference articles, so you can show that to your doctor. So that's important. And then, even a year ago, there was still some debate regarding Hashimoto's by itself being a cause of recurrent miscarriages, and at this point, it is pretty well accepted among most researchers, most clinicians, that Hashimoto's by itself can cause miscarriages. Which is really confusing, because here we take a woman who's getting her thyroid checked, usually when you're having your thyroid checked, they're just checking TSH and T4, and frequently it's not the standard of care to check thyroid antibodies in conjunction with that. But clinicians are kind of in the know and those of us doing the most current research show that you have to get your thyroid antibodies checked and there's a lot of research out there showing that when your thyroid antibodies are high, your chance of miscarriages go up considerably.

The current treatment for this is basically to use thyroid hormones, so this is a outside the box concept for most medical doctors because they're trained, you don't give somebody a thyroid medication like Levothyroxine or Synthroid unless you have hypothyroidism meaning your hormones are low. But the research is showing that if you have Hashimoto's by itself, they're using Levothyroxine or Synthroid in these situations and they're getting improvements in terms of more live births, less miscarriages, so on and so forth. Now the one outlier seems to be the Japanese.

So we always try to give you the most current data. They did a study out of Japan and this data does not seem to apply to those who are of Japanese descent, but otherwise it seems to apply in India and America and for the rest of the population. We also know that extra mechanisms can be a little different with things like soy and populations in that part of the world. So another interesting facet between this whole Hashimoto's concept and miscarriage is why does Hashimoto's cause miscarriages? - That's what I was going toward. I was going to say it might be beneficial to explain the actual mechanism that causes it. Or even the actual mechanism of Hypothyroid and how it slows everything down. You were gonna do that.

- Relative to the Hashimoto's, they're finding that these immune cells, so if you're a mother with Hashimoto's, they're finding that your immune cells to the thyroid can actually go into the fetus, and they're seeing associations between the hypothyroidism, Hashimoto's, and oxidated stress for the fetus. Just know, if you have Hashimoto's, your immune system should never be killing your thyroid, and if your immune system is killing your thyroid and you have Hashimoto's, these immune cells can go into your fetus and affect the fetus in a very negative fashion. They're also seeing now... There's something called antiphospholipid syndrome Which has to be assessed for a pregnant female, because if antiphospholipid syndrome is where the immune system makes antibodies to the blood vessels which can obviously create a negative affect for the placenta and the fetus. They're now seeing that Hashimoto's has a higher association in pregnant female with antiphospholipid syndrome.

So if you're concerned about that, if you want to talk to your doctor about that, if you want to make sure you have anticardiolipin antibodies run, anti beta two glycoprotein antibodies run as well. And the reason why hypothyroidism by itself can possibly be deleterious is that when the thyroid is slow, when the thyroid is low, basically, all of your physiology slows down. But there's even current research coming out now from the in-vitro fertilization community where they're aware of all this because in the IVF community, they're usually getting the females who can't get pregnant.

They're infertile, they can't carry a baby full term, so out of all the groups, they seem to be most on top of this research, so they will, at least in the research they'll commonly use drugs like Levothyroxine for someone with Hashimoto's or they're really scrutinizing sublinical hypothyroidism. They did a recent study where they were doing that and they didn't see a significant benefit. The thought process is that it's the Hashimoto's. So even with taking the Levothyroxine or controlling for subclinical hypothyroidism in IVF clinic, which is different from most of you. They feel it's the Hashimoto's.

Because Hashimoto's, you create the information associated with these other autoimmune conditions. So that's the current data on this and if you look at our articles out of a European journal of endocrinology probably is the best, and I'm sorry that I kind of confused that IVF data with the rest you, I just want to make the distinction that we have those who are pregnant who don't have hypothyroidism, don't have subclinical hypothyroidism, don't have Hashimoto's. Then we have this other group who has recurrent miscarriages and they do have Hashimoto's or they do have sub-clinical hypothyroidism. And in this group, the research is showing that these Hashimoto's patients are showing the benefit from being treated with Levothyroxine even if they don't have a thyroid problem and if they do have sub-clinical hypothyroidism, which is a TSH about 2.5, then the recommendation now is to treat these people and then if you have IVF, you're kind of in a whole 'nother ballpark because you have a more severe clinical situation, but I just try to use that as an illustration. Now, with all of this, we're not telling you to take Levothyroxine, we're not prescribing information, we're just trying to give you the information so you have it, so you can talk to your doctor because this is potentially one of the most significant life events for most of you. And then lastly, I'll close on polycystic ovarian syndrome. So the most cause of infertility is polycystic ovarian syndrome.

Polycystic ovarian syndrome absolutely can be associated with risk of miscarriage. Polycystic ovarian syndrome is where the body is typically moving into a pattern of insulin resistance, typically for the female there's high testosterone levels, there can be excessive facial hair growth, there can be cysts on the ovaries, there can be abnormal menstrual cycle, too short, too long. Really heavy menstrual periods, meningorrhea. And they're now finding that PCOS has a huge association with Hashimoto's thyroiditis and the thought process possibly is there's a lot of inflammation with PCOS, there's a lot of oxidative stress for the ovaries of PCOS, and it seems that the underlying mechanisms that break down, causing things like insulin resistance and too high testosterone are very similar to the inflammatory mechanisms associated with Hashimoto's thyroiditis.

And when you clump these two together, PCOS if I remember correctly, it accounts for about 50 percent of the infertility issues in our country. Hashimoto's is number two. So if you clump these two together, we have a huge percentage of the infertility issues in our country. And for those of you who want more of a natural focus, you can go back and watch our Hashimoto's broadcast, but the current thought process is in the research as to why someone has Hashimoto's, it appears that there can be gastrointestinal dysfunction with food intolerances, namely gluten and dairy, particularly gluten have been the focal point of the research.

Clinically, we see gluten as the tip of the iceberg. And then there can be Epstein Barr virus infections living in the thyroid gland itself and it's thought that this may be part of the reason why the immune system is viciously attacking the thyroid as well. There's also thoughts that when there's just generalized inflammation in the body, the thyroid can actually attract immune cells to it trying to clean out the inflammation of the thyroid. Needless to say, once these genes are turned on and you have Hashimoto's, it's like the train keeps rolling. And the far reaching affects of Hashimoto's, go watch our other broadcast, but these immune cells of the thyroid can go into the brain and have affects on frontal lobe function, can be associated with depression, I attached an article today talking about Hashimoto's and risk of depression early in pregnancy and postpartum depression. It just goes on and on and on. And the more aware you can be of Hashimoto's as you go into your pregnancy, the research is saying the better off you're gonna be.

- Yeah, and for those of you who think this is a new development, it's just that I think the research is coming out. You know, as we speak. My mother had three miscarriages. I was in between two and three, she had a goiter. Her sister had two kids, three miscarriages, she had a goiter, they both had their thyroids out this was in the fifties.

My grandmother had a goiter. Had four kids and two miscarriages. All of them very sick, all of them ended up being very sick, my mom ended up being very sick, I ended up with Hashimoto's, so as you state, the immune inflammation antibodies can cross the placenta. I think you briefly alluded to that stress hormones can cross the placenta. - Yeah, that was another broadcast, yeah. - Okay, that can..

So it's interesting, because looking back, it creates tremendous emotional trauma and lots of thyroids coming out and this was in the 1950s and so... And there was always that feeling of "There's something wrong with me" and of course you go, you get checked to see if your sperm count's good or if your eggs are good, and that type of stuff. And frankly, most of the time they are.

And then you get those times where they're not and you're probably that candidate maybe for those types of in-vitro things, but it's interesting sitting here listening, just thinking back and how these things have kind of accumulated, maybe before the fifties, who knows? Maybe they've been around forever, I think, Hashimoto's was discovered in what, 1902 or something? - 1904. - 1904. So anyway, so interesting point. I would just say from a practical perspective, the reality is that if you're having trouble conceiving or carrying to term and you have an established Hypothyroid diagnosis, I would push further to see if you have Hashimoto's. Some of the cardinal signs would be that you intermittently get heart palpitations and even this doesn't happen all the time, but intermittent heart palpitations, inward tremors, insomnia, night sweats, when you don't think you should be getting them.

Anxiety. When you don't think you should be getting them. And so you might want to look further if you have an established diagnosis of Hashimoto's already, you might want to talk to your doctors because not everybody is conversant with this at this point in time, as Dr. Gates said, there's references online that you can look to, but knowing that this a significant trauma to the individual, particularly the mom. We hope that you get enough clinical and practical data out of this for it to be useful for you, so.

- The last thing I'll say is that relative to Hashimoto's, the criteria for diagnosing it vary from lab to lab, so like I talked about with sub-clinical hypothyroidism, anything over 2.5 now is a cause defining for a pregnant female. It used to be five, 4.5, 5.6 used to be. - 5.6, yeah. - High. So you have to keep this in mind. For Hashimoto's, the Mayo clinic is saying a thyroid peroxidase antibody count over nine is too high. Our local hospital here in Reno says anything over nine is too high. Many labs in California are using the nine criteria, however lab courses says 34.

So we find a lot of people fall in between that nine and 34 range and they'll say "Aww, I don't have it", but it's all about the criteria that you're using. In France, they're saying anything over five is too high. Now we feel that may be just a little too restrictive, so we go with the Mayo clinic, but that's the data on it. So we hope you really found this helpful. We try to bring you some good information here and if you have any other thoughts on other broadcasts you want us to do, let us know at PowerHealthTalk.com. We get a lot of those, so for those of you who are recurrent watchers, we do have a list that we're trying to work through. So thanks for watching and we'll see you next week.

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