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Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)

by Dr. Geoffrey Sher on November 9, 2015

Between 2% and 5% of women of the childbearing age have reduced thyroid hormone activity (hypothyroidism). Women with hypothyroidism often manifest with reproductive failure i.e. infertility, unexplained (often repeated) IVF failure, or recurrent pregnancy loss (RPL). The condition is 5-10 times more common in women than in men. In most cases hypothyroidism is caused by damage to the thyroid gland resulting from of thyroid autoimmunity (Hashimoto’s disease) caused by damage done to the thyroid gland by antithyroglobulin and antimicrosomal auto-antibodies. 

The increased prevalence of hypothyroidism and thyroid autoimmunity (TAI) in women is likely the result of a combination of genetic factors, estrogen-related effects and chromosome X abnormalities.  This having been said, there is significantly increased incidence of thyroid antibodies in non-pregnant women with a history of infertility and recurrent pregnancy loss and thyroid antibodies can be present asymptomatically in women without them manifesting with overt clinical or endocrinologic evidence of thyroid disease. In addition, these antibodies may persist in women who have suffered from hyper- or hypothyroidism even after normalization of their thyroid function by appropriate pharmacological treatment. The manifestations of reproductive dysfunction thus seem to be linked more to the presence of thyroid autoimmunity (TAI) than to clinical existence of hypothyroidism and treatment of the latter does not routinely result in a subsequent improvement in reproductive performance.

It follows, that if antithyroid autoantibodies are associated with reproductive dysfunction they may serve as useful markers for predicting poor outcome in patients undergoing assisted reproductive technologies.

Some years back, I reported on the fact that 47% of women who harbor thyroid autoantibodies, regardless of the absence or presence of clinical hypothyroidism, have activated uterine natural killer cells (NKa) cells and cytotoxic lymphocytes (CTL) and  that such women often present with reproductive dysfunction. We demonstrated that appropriate immunotherapy with IVIG or intralipid (IL) and steroids, subsequently often results in a significant improvement in reproductive performance in such cases.

The fact that almost 50% of women who harbor antithyroid antibodies do not have activated CTL/NK cells suggests that it is NOT the antithyroid antibodies themselves that cause reproductive dysfunction. The activation of CTL and NK cells that occurs in half of the cases with TAI is probably an epiphenomenon with the associated reproductive dysfunction being due to CTL/NK cell activation that damages the early “root system” (trophoblast) of the implanting embryo. We have shown that treatment of those women who have thyroid antibodies + NKa/CTL using IL/steroids, improves subsequent reproductive performance while women with thyroid antibodies who do not harbor NKa/CTL do not require or benefit from such treatment.

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  • Jennifer Lee - October 18, 2018 reply

    Hello-
    I’ve got CTL/NK issues and hypothyroidism and will be being prescribed prednisone and intralipid donor FET, what does the research show for dosage of prednisone and frequency on intralipid? My clinic is supportive of trying but unfamiliar with immunocompromised issues. I’ve had 4 mc with donor eggs all between 5-6 weeks which indicates to me a very strong likelihood of interference with the trophoblast. Can you direct me to sources to share with my provider? Thanks so much! I’ve learned to be a better advocate with your blogs!

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 18, 2018 reply

    I give dexamethasone 0,75mg orally from the start of the cycle until the 8th week of pregnancy and then tailed off over 2 weeks. IL 20% solution (100cc dissolved in 500cc of saline and infused ovwr 3 hours-4 hours, 10-14 days prior to transfer and repeated once with a +ve pregnancy test.

    Good luck!

    Geoff Sher

  • Rose - January 19, 2018 reply

    Hi Dr Sher,
    I tested positive for anti thyroglobulin antibodies and finally acheived a positive pregnancy test with steroid and intralipid treatment. I am now 12 weeks and am being weaned off steroids gradually. I just wanted to ask whether thyroid antibodies are a concern later in pregnancy too? Should they still be regularly monitored in addition to thyroid funtion? Or is it safe to come off the steroids and are antibodies no longer a concern once pregnancy is established?
    Many thanks in advance.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - January 19, 2018 reply

    In my opinion, no concern at all!

    Geoff Sher

    Rose - January 20, 2018 reply

    Thank you Dr Sher! That’s reassuring.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - January 20, 2018 reply

    Copy and G-d bless!

    Geoff Sher

  • Michelle - April 19, 2017 reply

    Hey.
    I have hadhimotos disease. And am experiencing infertility. My husband also has low sperm count. One failed iui attempt so far. And doing a second iui this week. How does a person find out if they have those CTL/NK cells that can be causing infertility?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - April 20, 2017 reply

    Your blood needs to be tested for natural killer cell activation using the K-562 target cell test. Call Julie Dahan at 800-780-7437 and she will direct you on how to get this done.

    Between 2% and 5% of women of the childbearing age have reduced thyroid hormone activity (hypothyroidism). Women with hypothyroidism often manifest with reproductive failure i.e. infertility, unexplained (often repeated) IVF failure, or recurrent pregnancy loss (RPL). The condition is 5-10 times more common in women than in men. In most cases hypothyroidism is caused by damage to the thyroid gland resulting from of thyroid autoimmunity (Hashimoto’s disease) caused by damage done to the thyroid gland by antithyroglobulin and antimicrosomal auto-antibodies.
    The increased prevalence of hypothyroidism and thyroid autoimmunity (TAI) in women is likely the result of a combination of genetic factors, estrogen-related effects and chromosome X abnormalities. This having been said, there is significantly increased incidence of thyroid antibodies in non-pregnant women with a history of infertility and recurrent pregnancy loss and thyroid antibodies can be present asymptomatically in women without them manifesting with overt clinical or endocrinologic evidence of thyroid disease. In addition, these antibodies may persist in women who have suffered from hyper- or hypothyroidism even after normalization of their thyroid function by appropriate pharmacological treatment. The manifestations of reproductive dysfunction thus seem to be linked more to the presence of thyroid autoimmunity (TAI) than to clinical existence of hypothyroidism and treatment of the latter does not routinely result in a subsequent improvement in reproductive performance.
    It follows, that if antithyroid autoantibodies are associated with reproductive dysfunction they may serve as useful markers for predicting poor outcome in patients undergoing assisted reproductive technologies.
    Some years back, I reported on the fact that 47% of women who harbor thyroid autoantibodies, regardless of the absence or presence of clinical hypothyroidism, have activated uterine natural killer cells (NKa) cells and cytotoxic lymphocytes (CTL) and that such women often present with reproductive dysfunction. We demonstrated that appropriate immunotherapy with IVIG or intralipid (IL) and steroids, subsequently often results in a significant improvement in reproductive performance in such cases.
    The fact that almost 50% of women who harbor antithyroid antibodies do not have activated CTL/NK cells suggests that it is NOT the antithyroid antibodies themselves that cause reproductive dysfunction. The activation of CTL and NK cells that occurs in half of the cases with TAI is probably an epiphenomenon with the associated reproductive dysfunction being due to CTL/NK cell activation that damages the early “root system” (trophoblast) of the implanting embryo. We have shown that treatment of those women who have thyroid antibodies + NKa/CTL using IL/steroids, improves subsequent reproductive performance while women with thyroid antibodies who do not harbor NKa/CTL do not require or benefit from such treatment.

    Geoff Sher

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