病人 Maggie：
I'm currently taking .25mcg levothyroxine daily. My last TSH reading was right before IVF cycle at 2.94. Today I'm 8dp3dt and
HCG=13
FT4=1.26 lab range .89 - 1.8
TSH=4.08 lab range .24 - 4.2
Do I need to get my levothyroxine dosage increased immediately? Or is it not a big concern?
This is the 1st time after 2 yrs of infertility treatment that we have gotten a positive beta. This is also the 1st cycle I have been on levothyroxine.
Thanks!
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专家 Geoffrey Sher, MD：
About 50% of women who have autoantibodies to their own thyroid tissues (antithyroglobulin and/or antimicrosomal antibodies) regardless of whether or not there are clinical signs or symptoms of reduced thyroid hormone activity (hypothyroidism) have activated Natural Killer cells (NKa+ and/or activated T-cells in their blood. Such women often present with reproductive failure manifesting as infertility, recurrent IUI and IVF failure or repeated pregnancy loss. The antithyroid antibodies (antimicrosomal and/or antithyroglobulin antibodies) do not cause the problem. They act as markers pointing to an underlying immunologic implantation problem that occurs when NKa or T-cell activation is present. . Here, as soon as the embryo starts to burrow into the uterine wall, "toxins" are produced (locally) that impair implantation. In some cases, the pregnancy is lost before a blood test can detect it, while in other cases a miscarriage occurs. [Some pregnancies escape the "toxic gauntlet" and proceed.
One of the most significant hints that a non symptomatic woman might have antithyroid antibodies is a family history of hypothyroidism (under performance of the thyroid gland requiring thyroid hormone therapy).
We were among the first to demonstrate that women who have reproductive failure associated with antithyroid antibodies and NKa+/T-cell activation can have successful IVF outcomes following administration of intravenous gammaglobulin (IVIG) . Women who are antithyroid antibody positive who do NOT have NKa+ and or T-cell activation do not require or benefit from IVIG therapy.
Might I recommend that you call Patricia Barton (Patient Relations) at (800) 780-7437 or 702-699-7437 at SIRM-Mosaic and ask her to arrange for an in-person consultation at my New York or n Las Vegas office . Alternatively, you could ask her to set up a free medical telephone consultation with me.
SIRM offers qualifying couples access to the Outcome Based Plan (OBP). Participants are eligible for a refund of up to 100% of our in-house medical service-related fees, if the egg retrieval and subsequent transfer of all (fresh/frozen) embryos (over a period of months) does not result in the birth of a baby. Patients can re-qualify for the OBP up to 3 times.
You might be interested to know that the 3rd edition of my book "In Vitro Fertilization the A.R.T of Making Babies” was recently released and is available at most bookstores as well as from
www.amazon.com. It is very comprehensive, current and covers the entire spectrum of the ART arena.
Geoff Sher
