Thyroid: continued

It has been a long and mentally exhausting week.

Ever since I got my TSH results back, I've been researching and discussing. I sent emails back and forth to my endocrinologist. I asked to speak to her over the phone but she prefers email or face to face, so I scheduled an appointment at her first available which is next Thursday. I asked to be on the cancellation list as well if anything sooner opens up. I also looped in my RE. His response was that it's not an issue. That didn't sit right with me. Why. Why is it not an issue. I sent him links to the articles keeping me up at night and asked him to call me. What was I expecting him to say? I don't know. I think he knows me enough to know he couldn't convince me with anything he said, so he sent me a study to read. I went over it with a fine tooth comb absorbing all the statistics and information it had to offer.

As I understand the study it basically says there's not enough evidence to really say one way or another about the 2.5 - 4.0 range. There is fair evidence that SCH, defined as a TSH level >4 mIU/L during pregnancy, is associated with miscarriage, but insufficient evidence that TSH levels between 2.5 and 4 mIU/L are associated with miscarriage. So if several studies have found that elevated TSH levels in pregnancy are associated with an increased risk of miscarriage in patients without a diagnosis of hypothyroidism (>4), and studies show improved pregnancy rates in cases of what's considered the ideal range (<2.5) then, all else being equal, wouldn't it provide a better chance at success if my TSH was closer to the 2.5 level instead of the current 3.54? I understand TSH numbers can vary greatly and it's an inexact science but I've been getting these 3ish readings consistently since the summer and even after starting medication (albeit very low starter dosage) it's still stubbornly at that range.

The other thing that caught my attention was that the studies in the article were done later in gestation and there's limited information about early miscarriages, or even TSH rates and implantation. My chemical pregnancies didn't make it past six weeks gestation and while it's impossible to know why, I can't help but wonder if TSH was a factor. If the Endocrine Society recommends 2.5 as the upper limit of normal in the first trimester, and it's known that TSH tends to go up during pregnancy, I'm not understanding why a level at 3.54 is not an issue.

When I asked if 3.54 is as good as having a number in an ideal range or if there's a benefit to waiting to get my TSH number closer to "ideal" of under 2.5, this was his response:  "We in the practice have gone both ways in the past. I cannot argue with your goal. Different societies can read things differently."  Basically, he has no answer but also has no objection to trying to bring TSH lower to under 2.5. He doesn't believe that it will make a difference, but if it makes me feel better he's not opposed. There's certainly no harm to it.

So RE says it's not a problem. Endocrinologist says it's not a problem. My mind is stuck wanting to give the transfer the best chance but I'm willing to accept that it's my own hangup and can be convinced to move past it.

Enter new factor for consideration: I forgot about the endo scratch. The hysteroscopy was done on 1/26 and counts as having similar benefits of an endo scratch as long as a transfer is done within 60 days of the procedure. If I wait to lower my TSH to "ideal" then I lose the benefits, if any, of whatever the endo scratch did. There's no way I'm interested in doing a hysteroscopy voluntarily again, so if we want the benefits of it then transfer can't be delayed.

I reached out to the doctor we saw in the summer for our second opinion back in the summer. I really liked her and thought she had some good ideas. I decided to see if she has time to chat with me and get her take on it. If she also says that it's not an issue then I can comfortably proceed with peace of mind. She heard me out, got all the dates and numbers and basically said that if my thyroid anti-bodies are normal (negative) then she would recommend to proceed. In her opinion, getting the benefits of the hysteroscopy endo scratch were better than trying to get the TSH down to ideal, especially considering I'm already on meds and have already increased the dosage.

So there we have it. It's one thing to get the opinion of a doctor and disagree with it, but here there are three. Three medical professionals, trained endocrinologists, are all saying it's a go. I can't argue with that. Whatever will be will be, and hopefully this is the time it's supposed to stick.

I feel completely drained from all the anxiety and worry and questioning everything about this issue. But at the same time I feel satisfied that I left no rock unturned and no question unanswered. At the end of the day, my husband and I need to live with this decision and I needed to make sure I'm at peace with what we chose.

Shabbat Shalom!