 Hi, this is Dr. Ruscio and let's discuss the association between your thyroid and miscarriage and certainly something, miscarriage that is something that we want to avoid and is something that if there are any things that we can do to screen for an increased risk and potentially understand what treatments may help decrease the risk of miscarriage, that's certainly something that we want to do. So the paper I'd like to discuss with you is a systematic review with meta-analysis and I'll put the abstract up here on the screen and as we've discussed before, a systematic review with meta-analysis essentially reviews all of the high quality available data and in this case nine studies, nine high quality studies were reviewed looking at the association between subclinical hypothyroidism and miscarriage and they found that those with subclinical hypothyroidism were at increased risk of miscarriage. They also found that having subclinical hypothyroidism and having thyroid autoimmunity increased your risk even more. Now subclinical hypothyroidism is when your TSH is elevated above 4.5 and your T4 is normal. What's comforting about this study is that women or women, excuse me, who were treated for subclinical hypothyroidism with thyroid hormone had a risk of miscarriage equivalent to that of healthy controls. So certain there's a very viable treatment if you do find this elevated TSH with normal T4, subclinical hypothyroidism. So what to do? If you are trying to get pregnant or pregnant or have had a history of miscarriage, make sure to have a thyroid screening and if you are subclinical hypothyroidism, speak with your doctor about undergoing thyroid hormone replacement treatment because clearly this systematic review with meta-analysis, very high quality level data has shown that being subclinical hypothyroid and especially if you have subclinical hypothyroidism and your thyroid autoimmunity or thyroid autoimmune, you have an increased risk of miscarriage which can be nullified or at least improved to that of the level of healthy controls when taking thyroid hormone. So this is Dr. Ruscio and I hope this information helps you get healthy and get back to your life. Thanks.