133. Thyroid Antibodies & Fertility: The Missing Link Even with “Normal” TSH

What if your TSH is “normal,” but your thyroid is still part of the fertility story? In this episode of Cycle Wisdom, Dr. Monica Minjeur breaks down how thyroid antibodies—specifically thyroid peroxidase (TPO) and thyroglobulin antibodies—can impact ovulation, luteal phase health, and early pregnancy, even when standard thyroid screening looks reassuring.

Through Isla’s story of recurrent miscarriage and persistent thyroid symptoms despite a normal TSH, we explore why antibodies often appear years before overt thyroid disease, how they subtly disrupt hormone signaling, and why they matter so much in restorative reproductive care. You’ll learn which labs are frequently missed, how inflammation and autoimmunity affect implantation, and what cycle-timed, nutrition-based, and medical strategies can help stabilize thyroid function long-term.

If you’ve been told “your labs are normal” but your symptoms and cycles say otherwise, this episode will help you move from uncertainty to a clear, personalized plan.
 Learn more or book a free discovery call at radiantclinic.com.

Transcript

Speaker 0:02

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. What if your TSH is normal, but your thyroid is still a part of the story? Today we're going to unpack how thyroid antibodies like thyroid peroxidase or thyroglobulin can impact your cycles, your luteal phase length, and early pregnancy even when your standard screening test looks fine. We will also discuss practical cycle time steps to move from confusion to a clear plan if you are found to have elevated thyroid antibodies and what to do about them in the long run. So let's get started as always, with a story about ILA. Now, ILA came to us after trying to conceive for the past year and she had had two early miscarriages during that time. She feels as though she had many thyroid symptoms like fatigue and hair loss and energy troubles, but her doctor told her, your TSH is normal. Keep on trying. After every negative test, she felt like something was still missing. A friend had mentioned to her that thyroid antibodies can matter even more than just being told that your TSH or thyroid stimulating hormone is okay. So Isla booked an evaluation with us asking if we could please look deeper. So as always, we started off with taking a look at her charting patterns, which were fairly regular. She had a good mucus pattern, a little bit short on the luteal phase. Had some PMS symptoms and one day of brown bleeding prior to her cycle beginning. Her prior testing at her last doctor's office showed that her TSH or thyroid stimulating hormone ranged between 2.3 to 2.6 on two separate occasions, and she was told that everything was normal. Her free T four level was checked, but no other thyroid levels and no antibodies were evaluated. As a part of our standard evaluation for anybody that has fertility issues, miscarriages, and even for our medical clients, we always evaluate thyroid antibodies. And so when we did ILAs lab work, we did a full thyroid panel, which included the TSH, free T four, as well as checking T three total free and reverse, because all of these can play an impact as to how the thyroid hormone is able to actually bind to your cells. We also checked thyroid peroxidase antibodies as well as thyroid globulin antibodies. And for ila, even though her TSH was fairly normal, her thyroid peroxidase antibodies were markedly elevated. She also notably had a low vitamin D and a low normal ferritin store. Her luteal phase, progesterone levels seven days after ovulation was also a bit low. When we met for our visit after her labs were completed, we instituted a few interventions right away. I started her off on low dose naltrexone, which can help with autoimmune disease. I talk more about this particular prescription strength medication in episode number 88. We also looked through what she had for dietary intake and in her multivitamin specifically for selenium, zinc, and iodine, as these are very important for regulation of thyroid health. We also worked on repleting, her vitamin D stores. Talked about anti-inflammatory food updates and also worked towards maintaining a regular phase. During her luteal phase, we set a threshold to consider when we might need to start other prescription strength medications for her thyroid, but focused first on seeing if we could help restore her symptoms. Over the course of the next three cycles, her luteal phase stabilized. Her thyroid symptoms had decreased significantly, and she was able to conceive again after about four months on these targeted treatments with a full term healthy pregnancy. Isla described to us that she was so glad to feel seen and informed instead of feeling like her body was telling her one thing while the labs were telling her something different. So how do thyroid antibodies impact overall reproductive health? In many cases, we find that the development of thyroid antibodies actually come well before any actual overt thyroid dysfunction or symptoms. In some cases, antibodies can be present for years before you develop anything that would relate to thyroid related symptoms. Even with a normal TSH, which is the most commonly checked, thyroid lab antibodies can be associated with suboptimal ovarian and uterine signal. It can also impact your luteal phase and lead to a higher risk of early miscarriage. So this is why it is so important to understand if you have antibodies that are present, and to be able to then treat them appropriately by decreasing inflammation and helping to understand if thyroid symptoms develop in order to be able to understand when prescription strength medication might be important. Thyroid hormones are especially important because they impact all of the other hormones in our body. Specifically the release of different hormones like luteinizing hormone and gonadotropin releasing hormone, which are responsible for helping to time ovulation appropriately. Thyroid also helps with the timing and signaling of other hormones like estrogen and progesterone. That significantly impact the development of follicles, ovulation, timing, and that luteal phase. The low grade autoimmune cells and inflammatory signaling can subtly impair implantation and early development of the placenta, which is why it is. So important to understand if they are present. Now, I talked all about the thyroid in episode 28, and we covered it so early because a normal TSH oftentimes misses the mark. Thyroid stimulating hormone is a lab test that we check. It is a signal that comes from your pituitary gland in your brain, but having a normal TSH doesn't automatically rule out autoimmune disease or gaps in nutrition. Or a borderline thyroid reserve. All of these things will struggle under increased stress or pregnancy demands. And so it is so important to understand all the pieces that go into thyroid evaluation, including the evaluation of your pituitary gland, the thyroid gland itself, and then very importantly, what happens with that thyroid hormone when it tries to bind to yourself. If your symptoms align with thyroid dysfunction and you have only had a TSH done, that was normal. Please don't let that be the end of your story. Thyroid symptoms that show underactive thyroid typically will present as fatigue. Energy loss, cold intolerance, depression or decreased mood, hair thinning, constipation, heavy or very light. Menstrual flow, ovulation dysfunction, shortened luteal phase. Any of these things can be seen if your thyroid is underactive. Now if your thyroid is overactive, this is typically going to be picked up more easily with an abnormal TSH. But sometimes we'll also start to manifest when you have thyroid antibodies that are elevated. One of the most challenging things to understand with thyroid antibodies is that you can have either an overactive or an underactive thyroid with these thyroid antibodies. Now overactive thyroid hormone typically is going to result in symptoms that are seeming to be hyperactive. So think about things like heart palpitations or anxiety or sweating, or significant weight loss, unintentionally diarrhea, anxiety, things that seem to ramp up your system quite a bit more. So what do we want to look for when we are doing a complete thyroid evaluation? Again, we wanna map out all of your symptoms, but making sure we are checking all of the components of your thyroid. So again, TSH, thyroid stimulating hormone free T four, free T three total. T three, reverse T three. And then thyroid peroxidase. And thyroid globulin antibodies. Those are the seven fairly standard labs that we are checking on all of our patients, whether they are seeing us for medical concerns or for fertility concerns because it is so important to understand not only the current situation going on with your thyroid, but also the long-term trajectory and is. Especially if we find there are antibodies present, it leads us to focus on correcting those antibodies over time, but also paying closer attention to make sure that thyroid doesn't tend to go off the rails and need treatment sooner than later. We also are always going to check all of the other hormones because again, as I mentioned earlier, thyroid can tend to overtake and sidetrack all of the other hormones. So we are going to be checking those luteal phase, progesterone and estrogen levels, looking for other vitamin deficiencies like ferritin, vitamin D, vitamin B12, looking for things or reasons why you might not be absorbing those nutrients. Or in cases where you would not be getting enough selenium, iodine, or zinc in your diet, because again, those three in particular are very, very important when it comes to good thyroid hormone production. We do sometimes consider thyroid ultrasound, but typically this is only if you have an enlarged thyroid or nodules present, or if you have really high antibodies and you have neck symptoms. So sometimes I have a patient comes in that says they have a hard time swallowing or feel like their throat swells sometimes for no good reason. Those are all good signs or reasons to get a thyroid ultrasound. So how do we treat this? First and foremost, we want to focus on things that you can do in your lifestyle to decrease inflammation. So we always are going to talk about getting a good dietary intake, ideally trying to limit or decrease the amount of glu. Sugar and dairy that we have focusing on colorful plants, fruits and vegetables, foods that are high in omega threes and protein, and minimizing ultra processed foods, especially oils and sweeteners, wherever possible. We also focus on getting enough. Selenium in your diet. Now, ideally, if you don't have an allergy to nuts, one Brazil nut a day is pretty great for getting adequate selenium. That's all you need, just one. So many of my patients will add in just one Brazil nut a day to their regular diet in order to get enough selenium that they need for good thyroid support. Iodine and zinc are also really important for that good thyroid production. But if you are trying to get iodine, it can be a little more tricky. Now you can get iodine through iodized table salt, but you have to have one full teaspoon a day, which is a fair amount of salt unless you like salty things. Now you cannot get iodine through pink salt or Himalayan salt. It is only going to be in the iodized or iodine, added table salt. You can also get iodine through dairy, seafood, and other fortified food products. Zinc typically is a little bit easier to get. It is in many fruits and vegetables as well as meat. Um, but also important to make sure that we're getting enough of all of those. For my patients that have nut allergies or if it's challenging to get enough in their diet, or especially for those who are trying to conceive that are taking prenatal vitamins already. There are definitely prenatal vitamins available out there that have adequate amounts of selenium, iodine, and zinc in order to support good thyroid health. We also talk about making sure that you are managing your stress and your level of sleep. Again, focusing on adequate sleep. Again, ideally close to that eight hours per night, cutting out excess caffeine in your afternoons and trying to decrease stress levels just prior to going to bed. All of these things can help with decreasing stress and inflammation. Now, as I mentioned, as with Islas case, I oftentimes will also add in low dose Naltrexone to help with treating thyroid antibody disease, even if my patient doesn't need to go on a thyroid prescription replacement medication. Low-dose Naltrexone seems to have fantastic assistance with helping to decrease antibody production. Now, it doesn't always take those thyroid antibodies down to zero, and in some cases it doesn't decrease them overall, but it does tend to provide stability as far as decreasing inflammation and decreasing the body's ability to continue to produce more antibodies. So low-dose naltrexone is a very common treatment that we utilize within our practice. Anytime we find any sort of antibodies, and again, episode number 88 goes into deep dive. When it comes to low-dose naltrexone, there are certain cases where we will recommend prescription strength thyroid medications like Li Thine or Levothyroxine. Now these are. T three and T four medication replacements. We would individualize treatment to your lab results and especially consider treating if that thyroid stimulating hormone or TSH is above 2.5. There are good guidelines that show your risk of a miscarriage increases if that TSH is above 2.5. So we want to very intentionally make sure that that TSH is at an. Adequately low level if you're on thyroid medications currently, the ideal target range for that TSH is definitely less than 2.0, and some experts actually recommend getting that TSH less than 1.0. We also want to make sure that we're correcting any other underlying dysfunction that may be present, whether that's vitamin or nutrient deficiencies, and supporting any hormones that may be going off track because of the thyroid dysfunction. So let's follow this up with a few questions here. What if my TSH is normal? It's 1.8. Why would I test antibodies? It's a great question, and the reason for this is that antibodies can signal active autoimmune disease that can still impact your reproductive system and pregnancy risk. Even with a normal TSH. It helps us to guide how frequently we need to monitor your levels and support care. During stressful times, whether that's emotionally stressful or physically stressful, an illness or a pregnancy, thyroid can be one of the things that is most quickly impacted by that stress. And if we know that you are somebody who already is dealing with thyroid antibodies, then we want to make sure that we are checking those levels much sooner during any illness or pregnancy. Another question we get asked, well, I have these antibodies. Does that mean I have to take thyroid medications? And the answer is no, not automatically. In fact, in many cases, we try to avoid medications where possible and try instead to minimize the inflammatory response or the autoimmune response that could be adding to those antibodies. Over time. We do tend to monitor things more closely as far as your lab levels, but also paying attention to your symptoms, pregnancy status, and your risk profile. Many of our patients benefit from watchful, waiting, helping to support the luteal phase, the rest of the hormones, your nutrition before we start on medications. Another question we get asked is, can I still get pregnant even if my antibodies are elevated? And the answer here is yes. The goal here is to improve your thyroid symptoms and to monitor for any overt signs of thyroid dysfunction. Our goal is not necessarily to treat just to lower the antibody levels, and although trending the antibodies going down is a good sign, it doesn't always dictate your ability to ovulate. Or to conceive. In fact, many of the changes we see when we start to institute treatment for thyroid antibodies can take quite some time before we notice a difference. So things like nutrient deficiencies or your sleep or energy levels can shift within the first four to eight weeks, but antibody levels or the titers can move much more slowly if you end up starting on any prescription strength thyroid medications. We would always want to reassess those labs sometime within the next four to six weeks to make sure that treatment is adequate and that we are not over-treating or under-treating thyroid dysfunction. Imagine if your plan for thyroid finally matched what you were feeling. Your antibodies were identified and acknowledged nutrients were replenished. You had support during your luteal phase, and your thyroid levels remained steady. Over the course of a few months, your cycles can be more predictable. Early pregnancy would be better supported, and your peace of mind could return to help improve your health and promote fertility.

Speaker 2 18:03

If you're ready to work with our elite team of healthcare professionals, go to our website, radiant clinic.com to schedule a free discovery call and learn more about our package based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa Clinic, or can arrange for a telehealth visit if you live in many different states across the us. Check out our website for current states that we can serve medical clients and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach. Please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.