Hashimoto's and High FSH

by Karen
(Colorado)

Hello,
I am desperate for help. I'm only 33 years old. I was pregnant once before but it ended as a partial molar pregnancy. I was put on cancer screening for 6 months and was cleared to "try again" for the child we so deeply want in August. Nothing happened. We went for fertility testing in November and they found I have a TSH of 11.8 and an FSH of 21!

My OB suspected autoimmune. She was right. According to the blood tests, I have autoimmune thyroiditis (even though I have absolutely no symptoms of it.) It seems to do the opposite of the symptoms sometimes. For instance, with hypothyroidism I'm supposed to gain weight easily, however I can eat a healthy diet, high in protein and vegetables, NOT workout at all, and still lose weight! I lost 2.5 lbs since last Tuesday, 5 days ago!).

I am on a high protein and vegetable, gluten free diet now to help the autoimmune disease. I have seen an acupuncturist since September for fertility. I'm drinking Chinese herbal tea 3x a day. I'm also taking wheatgrass pills (can't get fresh wheatgrass shots)- 14 a day in follicular phase and 7 in luteal phase. I use a fertility monitor which has always given me "peak" days and I chart, which always shows a temp rise, although the anxiety and stress of trying to conceive has delayed ovulation a couple times.

And yet, I still can't get pregnant. I don't know what to do! I'm only 33 and I'm being told I'm in premature ovarian failure even though I regularly menstruate (every month) and can show ovulation. Is it true that my eggs are just bad and I should just jump at doing donor eggs now? I don't know what else to do? I've spent so much $ chasing down anyone who can help me. Can you? Please? I'm only 33.

Thank you,
Karen

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You're not in Premature Ovarian Failure
by: Amelia Hirota

Dear Karen,
First, you're not in Premature Ovarian Failure. There is no way to definitively diagnose this from your FSH levels alone. I will outline some other more plausible causes preventing you from conceiving.

Since you don't have any hypothyroid symptoms (except difficulty conceiving), it appears that there might be an issue with your pituitary gland. If your prolactin levels are elevated, you might want to have an MRI for a pituitary growth. A growth on the pituitary gland could cause the elevated TSH and FSH levels.

You didn't mention which thyroid antibodies, you test positive for, so I'm assuming that you're positive for Anti-TPO and Anti-TG. I recommend that you read about low dose natrexone or LDN online, as this is the only treatment for Hashimoto's right now.

It's ridiculous for any doctor to recommend a donor cycle for you at this point. I strongly encourage you to have your hormones (estradiol, progesterone, FSH and LH) checked with a saliva panel throughout your cycle. This will give you a clear picture of what is going on hormonally throughout your cycle. While your BBT chart and your OPK does show you some data, it would be helpful for you to see these hormone values throughout your cycle.

I also encourage you to have your adrenal function tested throughout a day to see the fluctuation of cortisol. It sounds to me that you may have adrenal issues that are showing up in the thyroid lab values. I hope this is helpful and that it leads you to your answers.

Warm regards,
Amelia Hirota

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by: Karen

Hello Amelia,
Thanks for answering my questions and giving me some assurance.

I did have my adrenals tested. I'm low in testosterone but not out of range. My adrenal function was surprisingly good given the amount of stress my body, mind and heart has been under. I am deficient in vitamin D and am on 10000 units a day now.

The TPO was 79 for antibodies. I will look into that treatment you mentioned. None of my doctors have mentioned it yet.

I thought about the pituitary too, but my prolactin, estradiol and LH were all in normal range. They did not test progesterone. Only my TSH and FSH are out of range. Would the other levels show something on days other than the normal Day 3 tests? Would a normal prolactin level still indicate possible pituitary tumor?

What sort of adrenal issues should we be looking for? As I mentioned above, my adrenals look pretty good, except for Vitamin D and testosterone. What can I tell my doctors to look for now. I'm so hopeless and need something to grab onto.

Thanks so much!
Karen

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Adrenal Testing
by: Amelia Hirota

Hi Karen,
If you had a 1 time serum blood test for your adrenals, that is not measuring cortisol output throughout the day and it therefore not thoroughly evaluating adrenal function. The best test of adrenal function is with a salivary panel taken throughout the day.

You're right about probably seeing elevated prolactin levels with a pituitary tumor. If you've taken any pharmaceutical birth control pills, you may have HP (hypothalamic/pituitary) axis disregulation. This is when the HP axis isn't communicating clearly with the ovaries, hence the elevated FSH.

Day 3 serum tests show your hormones on cycle day 3 only. All of the hormones involved in reproduction fluctuate daily and throughout the cycle. It is this very specific dance of hormones that makes ovulation, menstruation, and pregnancy possible. Therefore, tests that allow you to see the dance of hormones throughout the cycle will give you a better representation of what is going on hormonally. Again, I recommend salivary tests for both their accuracy and affordability.

Best of luck to you!
Amelia Hirota

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