Alright ladies, reposting my MFMs recopmmendation for thyroid treatment. My Maternal Fetal Medicine MD and I discussed thyroid issues in depth with regards to my risks for being a secondary hypothyroid, Hashimoto's thyroiditis patient. These also apply for someone that is HYPERTHYROID. My MFM was a trooper and held up admirably to all my questions and demands for facts and statistics. He addressed all my fears and laid things out for me in a logical thorough manner. I hope sharing this information will help you all as well.
First thing I requested was to discuss the myths and facts on hypothyroidism/Hashimoto's fetal development.. what does the fetus need from us with regards to thyroid hormones:
Now there has been one large study that states untreated hypoT mothers can result in a mild increase in IQ suppression and cognitive function of their unborn child. Basically normal functioning thyroid patients or optimally treated thyroid dysfunctional patients show no significant difference in IQ percentages <85. Untreated hypoT mothers or mothers detected late and then treated after the initial 12 week pregnancy period were 19 – 15 % more likely to give birth to a child with an IQ <85. Fifteen separate cognitive tests were given. In this study the case children of all untreated hypoT mother's or late detection treated pregnant hypoT mother's scored poorer in all 15 cognitive test categories. A summary of this study is available at the Governmental website: http://www.nih.gov/news/pr/aug99/nichd-18.htm
Being hyperthyroid you have other issues to look into. Mainly stemming from driving the fetus hyperthyroid and inducing a goiter. Targeted ultrasounds are recommended and should be scheduled routinely.
It is essential that you have FT4 levels in the 60-80% region of normal before, during, and after pregnancy. The fetus requires ~40% of your T4 during its first 12 weeks of development. This is the period that the fetus is developing its brain, essential organs, and thyroid. If you have less than 50% T4 the fetus and you are subject to hypothyroid effects.
This is more for hypoT patients. You have plenty for your child... too much actually.
Hypothyroidism, Hashimoto's thyroiditis, Hyperthyroidism, and Graves disease all make you a high risk pregnancy candidate. As such you require special testing and close monitoring. The fetus should have direct targeted thyroid scans between 12 and 32 weeks in utero to monitor its thyroid health and state. In the rare case a groiter or thyroid function is effected an ENT should be brought in for consult and available at the time of delivery.
This applies to ALL of us. Note and be sure to drive this one home with your MDs.
Antibody attack does occur with autoimmune thyroid disease. Speculation points to the antibodies attacking after the fetus's thyroid becomes active and begins to produce thyroid hormone. High levels of antibodies (>1000) result in a 15-20% increased chance of miscarriage. Optimal FT4 levels help mitigate some of this risk.
You need your antibody tests run.
TSI and TRAb for Graves and TPOAb and TGAb for Hashimoto's.. do not accept substiturtes.
You also need FREE T4 and FREE T3 testing. TT tests are moot for pregnant women because of the levels of estrogen and pregnancy hormones in the system. They interfere and make all total T3 and T4 results GARBAGE! Your OB should know this. Anything less than testing your Ft3 and Ft4 levelsis irresponsible on your MDs part IMO! They should also have jumped to test you for antibodies!
Family history tells. In the case of one parent having an AIT, there is a 60% chance that a female fetus and 10-15% chance that a male fetus will develop an AIT in the future. In the case where both parents have family histories of thyroid disease and AITs, there is an 80% chance that a female fetus will be a carrier and a 20-40% (depending on study) that a male fetus will be a carrier of AIT/thyroid dysfunction. So look to your families and don't just take there word on it.. evaluate their physique/health/symptoms. My husband's family is thyroid dysfunction free.. mine.. well AIT grand central station.
Keeping a TSH less that 2.5 is sufficient management.
(Fact 6) You need to monitor the FT4 concentration and keep it high normal! This means 50-80% in range! TSH is insufficient measurement when thyroid is dysfunctional.
Hypothyroidism and AITs put the fetus at increased risk for birth defects such as Down syndrome.. etc.
(Fact 7) Only confirmed impairment is cognitive in nature. The studies showing increased cases didn't not exclude woman over the age of 35 thus.. the increased percentage can not be clearly attributed to thyroid function versus maternal age.
Hyperthyroidism has its own risks and should be managed with PTUs. Having this condition while you are pregnant may put you at risk for any of the following:
* Abortion (miscarriage).
* Babies with low birth weight.
* Heart failure (you not the child due to too much thyroid hormone and added physical streses).
* Pre-eclampsia, which is a condition having hypertension (increased blood pressure), low platelet count, protein in the urine, and problems thinking.
* Preterm labor or having the baby delivered before the proper time.
Hyperthyroidism in many cases is harder on the mom than the child. It still should be treated responsibly. How should hyperthyroidism be treated?
Medicines or surgery as a last result:
Antithyroid medicines: These medicines act on the thyroid and stop it from making too much thyroid hormone. They may also decrease and prevent the signs and symptoms of hyperthyroidism. These may be used safely during your pregnancy.
Others: Beta-blockers to treat very fast heartbeats, nervousness, too much sweating, and trembling may also be given.
So.. with all this said. You can get pregnant and have as healthy a baby as a normal functioning thyroid patient. You just must watch your ACTUAL T4 levels before and during stringently. If you get your Ft4 level into the 60-80% region of normal and keep it there you have the same 2.5% chance of an abnormal fetus that “normal” thyroid function patients have.
SO my MFM has given me these walking orders and they apply to any woman of child bearing age:
1) Wait until after my levels are 60-80% on the FT4 range. You are hyper.. not an issue.
2) When pregnant come back and we will test blood every 2- 4 weeks to maintain my Ft4 levels in the 60-80% range of normal. You need to get yours down, but not too low.
3) Get your blood chem levels balanced and take folic acid and all the B's I can get a hold of...
4) Keep a routine eye on your antibody levels. Both TSI and TPOAb/TGAB. I have both Graves and Hashimoto's. You need to determine if you have them as well.
Hope that this helps you.
I also now have a great MFM I can recommend that is up to date on all the current thyroid lore and treatment for anyone in need in my area.