How do you know if you are hyperthyroid?

The signs can be subtle, so nearly all fertility programmes now do blood tests on all new patients for thyroid disorders at the first visit, regardless of symptoms.

If we suspect hyperthyroidism from the initial test results, we will often order a complete screen.

This means repeating the first test for thyroid-stimulating hormone (TSH) which is what controls how hard your thyroid works. Sometimes, TSH levels can fluctuate dramatically. It’s a good idea to double-check.

We will also test your blood for T4. This hormone is produced by your thyroid and controls your metabolism.

T3 is a second hormone your thyroid produces. It determines how your body uses the energy it produces.

The last of the blood tests we screen for is TRAb (thyroid receptor antibodies). The most common reason for hyperthyroidism in reproductive aged women is elevated levels of thyroid receptor antibodies.  This condition is known as Graves disease.

We will likewise do a thyroid ultrasound and a physical exam.

Though it is important (and relatively straightforward) to ensure good thyroid control, it is rare that the thyroid is the only impediment to fertility.

Miscarriage, preterm delivery rates, and pre eclampsia are higher in uncontrolled Graves disease.

Since Graves has been identified before pregnancy, one common treatment option is radioactive iodine.  Iodine is picked up by the thyroid, so radioactive iodine will preferentially affect the thyroid…effectively ablating (shrinking) it. As long as we have good control of the thyroid before pregnancy, we do not usually see difficulties for mum or baby.

This may not be “the” answer to your concerns.  A Reproductive Endocrinologist is generally not the best person to manage Graves disease.  Your RE (or, if pregnant, your Ob/Gyn) will refer you to an Endocrinologist with experience in treating thyroid disorders.

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IVF with Intracytoplasmic sperm injection (ICSI) should provide a success rate that is at least 3-4x better. Recent improvements in lab techniques have been shown to lower DNA fragmentation rates to ensure higher fertilization rates in eggs.

But you’re doing the right thing: getting yourself organized before taking this next, important step.

Thyroid control should happen quickly. But the effects of varicocele repair can take 3-9 months….and still not make a difference.

If you really aren’t certain what to do, get a second opinion if you can.

You’re about to embark on a new approach (surgery? IVF? both?). Before doing so, you want to be certain that you’re getting the best advice possible.

The post My husband has thyroid problems and a varicocele. We’ve tried IUI 6 times. What now? appeared first on Fertility.ca.