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Old 12-05-2007, 10:37 PM   #1
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Pregnancy and TSH

Hi!
I'm 12 weeks pregnant. I did my TSH test it came as 0.14. The Dr advised that I should do it again also FT3 and FT4.
I did the test after one week of the previous TSH results. This time my TSH was 0.058 and my FT3 and FT4 are both normal.
Does this pose a risk to my pregnancy. There has never been a history of thyroid in my family. I'm really worried for my baby.
Thanks...

 
Old 12-06-2007, 06:20 AM   #2
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Re: Pregnancy and TSH

You are showing signs of hyperthyroidism.. you need to be tested for Graves disease. Bing hyper is more taxing on you than the child.. but if it is Graves the hyperT AI you need to be under the care of an MFM and watched carefully.

What are the most common causes of hyperthyroidism during pregnancy? Overall, the most common cause (80-85&#37 of maternal hyperthyroidism during pregnancy is Graves’ disease (1 in 1500 pregnant patients). In addition to other usual causes of hyperthyroidism, very high levels of hCG, seen in severe forms of morning sickness (hyperemesis gravidarum), may cause transient hyperthyroidism. The diagnosis of hyperthyroidism can be somewhat difficult during pregnancy, radioactive thyroid scanning is contraindicated during pregnancy. SO blood work and surgery tend to be the main viable options with surgery being for extreme cases only.

From my Aunt D's American thyroid Association pamphlet information.. she had four children and has Graves:
What are the risks of Graves’ Disease/hyperthyroidism to the mother? Graves’ disease may present initially during the first trimester or may be exacerbated during this time in a woman known to have the disorder. In addition to the classic symptoms associated with hyperthyroidism, inadequately treated maternal hyperthyroidism can result in early labor and a serious complication known as pre-eclampsia. Additionally, women with active Graves’ disease during pregnancy are at higher risk of developing very severe hyperthyroidism known as thyroid storm. Graves’ disease often improves during the third trimester of pregnancy and may worsen during the post partum period.

What are the risks of Graves’ Disease/hyperthyroidism to the baby?
There are three main risks to the baby from Graves’ disease:
1) Uncontrolled maternal hyperthyroidism has been associated with fetal tachycardia (fast heart rate), small for gestational age babies, prematurity, stillbirths and possibly congenital malformations. This is another reason why it is important to treat hyperthyroidism in the mother.

2) Extremely high levels of thyroid stimulating immunogloblulins (TSI): Graves’ disease is an autoimmune disorder caused by the production of antibodies that stimulate thyroid gland referred to as thyroid stimulating immunoglobulins (TSI). These antibodies do cross the placenta and can interact with the baby’s thyroid. Although uncommon (2-5% of cases of Graves’ disease in pregnancy), high levels of maternal TSI’s, have been known to cause fetal or neonatal hyperthyroidism. Fortunately, this typically only occurs when the mother’s TSI levels are very high (many times above normal). Measuring TSI in the mother with Graves’ disease is often done in the third trimester.

In the mother with Graves’ disease requiring ant******** drug therapy, fetal hyperthyroidism due to the mother’s TSI is rare, since the ant******** drugs also cross the placenta. Of potentially more concern to the baby is the mother with prior treatment for Graves’ disease (for example radioactive iodine or surgery) who no longer requires ant******** drugs. It is very important to tell you doctor if you have been treated for Graves’ Disease in the past so proper monitoring can be done to ensure the baby remains healthy during the pregnancy.

3) Anti-thyroid drug therapy (ATD). Methimazole (Tapazole) or propylthiouracil (PTU) are the ATDs available in the United States for the treatment of hyperthyroidism. Both of these drugs cross the placenta and can potentially impair the baby’s thyroid function and cause fetal goiter. Historically, PTU, has been the drug of choice for treatment of maternal hyperthyroidism, possibly because transplacental passage may be less than with Tapazole. However, recent studies suggest that both drugs are safe to use during pregnancy. It is recommended that the lowest possible dose of ATD be used to control maternal hyperthyroidism to minimize the development of hypothyroidism in the baby or neonate. Neither drug appears to increase the general risk of birth defects. Overall, the benefits to the baby of treating a mother with hyperthyroidism during pregnancy outweigh the risks if therapy is carefully monitored.

I do not have Graves but have looked into both Graves and Hashi's because I suspected both do to my mother having both and a hyper to severe hypo first pregnancy. So I had my preliminary research finding for you. My Endo did state that medication can need to be altered and can be altered every two weeks during pregnancy and every 2-4 weeks FT4 and Ft3 blood work should be checked. I would definitely request the antibody tests to be checked just in case you need to medicate to minimize transfer of an AI to your child.

Good luck. Check out the A T A and A C E E references on hyperthyroidism and pregnancy care. They have many pamphlets for review and evaluation.
Sincerely,
MG
__________________
If we learn by our mistakes, I am working on one hell of an education.

Last edited by mkgbrook; 12-06-2007 at 06:21 AM.

 
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