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Old 10-07-2008, 07:38 PM   #1
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what does undetectable TSH mean?

My TSH is undetectable and some other thyroid test came back 17.5 with the high end of the normal reference range being 12.5.

My OB repeated the tests because she did not think my thyroid was high enough to justify an undetectable TSH, but the results came back the same.

She referred me to a maternal-fetal specialist who did not order anymore thyroid testing even though the fetal heart rate was 170. He ordered many other blood tests all of which came back normal.

I am very ill, more or less bed-ridden, and since they can find nothing else wrong with me I have no choice but to believe my thyroid is making me sick.

What do my values mean, and what other tests should I demand?

Please, please someone help me,
Beth

 
Old 10-07-2008, 07:48 PM   #2
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Re: what does undetectable TSH mean?

Beth........

Hang in there.....I know you are feeling terrible.....

Are you on any thyroid meds?

Do you know the tests they did other that TSH?

Like T3 or T4 or TPO........if you do list the values and what your results are..we can better help......you know that fetal rate is high, not dangerous but high....usually you see that with Fever, infection or hyperthyroidism.

Make sure to lay on your left side and not on your back since lying on your back will increase the fetal heart rate and left side will help decrease it...also refrain from drinking too much juice or anything with sugar or caffiene until they know what is going on......Sugar and Caffiene will make the baby active.

Are you home or in the hospital?

I am hypothyroid not hyper but I know quite a bit about high risk pregnancy. We have some very knowlegable people here on this board that know about Hyper..........

How many pregnancies is this for you..?

Oleander

 
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Old 10-08-2008, 08:59 AM   #3
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Re: what does undetectable TSH mean?

Thank you, thank you Oleander for responding.
I had posted to other forums but got no responses...
I think maybe the fact that I am pregnant scared them off from giving me any advice, but I am desperate for it.

I am at home.
I have not been prescribed any thyroid medications.

I know only two thyroid tests have been done.
I know for sure one was the TSH, and I feel quite sure the other was a Total Thyroxine (TT4).
I recall the high end of the normal reference range being 12.5 and my value was 17.5.

My doctor said something to the effect that if the TT4 was 60 she'd be worried, but I got the feeling she pulled that number out of the air.

I had hoped the maternal-fetal specialist would investigate the thyroid hormones more but he said since I had the same TSH and TT4 test results two weeks in a row there was no point in repeating them.

After a third visit to a doctor in three weeks for help with this, a nurse friend of mine who brought supper to my family told me she was appalled that the OBs hadn't at least given me some IV fluids.

It was kind of light bulb moment for me- I hadn't been vomiting so dehydration never entered my mind, but it should have- anyone who runs a fever for 5 weeks is bound to be dehydrated. Why didn't I think of this myself?

So I did what I thought might be the next best thing- I started taking Zofran and forcing electrolyte balanced fluids day and night.

Forcing fluids has given me some relief in the mornings-
I can now take a shower, and stand at the sink long enough to brush my teeth without my heart feeling like it is going to give out,
but the afternoon and evening symptoms are the same as before- I am just bed-ridden-
and if I slack off at all on forcing fluids through the night I don't get the symptom alleviation in the morning.

This is my seventh pregnancy in 20 years.
All were near or full term births with entirely uneventful pregnancies. Normal morning sickness with three, mild to no morning sickness with the other three.

Thank you for the information about lying on my left side. I have been avoiding caffeine but I will now avoid juice and ginger ale.

The next time I see a doctor I need to know what to ask for.

I just can't bear to see another doctor who pats me on the head and tells me to come back in a week or two...they just don't understand how sick I am.

Beth

 
Old 10-08-2008, 10:02 AM   #4
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Re: what does undetectable TSH mean?

So you had a fever for several weeks? and have been vomiting? How many weeks are you?....... just so you know dehydration can cause many of your symptoms and can also make you feel like you are contracting. You may want to keep sipping liquids with sugar just on the safe side......... Do they know what your fever was from? Has anyone checked you for a urinary tract infection? Dehydration can cause rapid fetal heart rate........so you need to get hydrated..

I agree with your OB nurse friend.....they are the wisest so keep her close.

The important thing is to know what the normal Thyroid lab values are while pregnant. Then you do have some variation of what is actually normal. Have you ever had a thyroid problem in the past?

7th pregnancy so you know what is normal for you and what is not........

I have a 15 year span between my children...

When do you go back to the Doctor? If you get feeling worse call call call them. Do not be afraid to bug them and if you are not happy with them get a second opinion.

You can always take yourself to your OB dept at your local hospital and get monitored.........they will never turn you away........Just so you know that.

Rest, hydrate, call you Doctor if needed.

Oleander

 
Old 10-08-2008, 10:31 AM   #5
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Re: what does undetectable TSH mean?

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:

(Fact 1)
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 &#37; 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: [url]http://www.nih.gov/news/pr/aug99/nichd-18.htm[/url]

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.

(Fact 2)
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.

(Fact 3)
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.

(Fact 4)
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!

(Fact 5)
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.

(Myth 1)
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.

(Myth 2)
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.

(Fact 8)
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.

MG
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Last edited by mkgbrook; 10-08-2008 at 10:35 AM.

 
Old 10-08-2008, 11:59 AM   #6
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Re: answers for Oleander and questions for MG

Thank you Oleander and MG.

No I have not been vomiting. I did have a few loose stools the first week I was sick which was my sixth week of pregnancy,(I am in my twelfth week now) but since then no more. My dehydration is coming from something other than vomiting or diarrhea, but yes my symptoms definitely are exaggerated when I don't force fluids.


I had a low grade fever (100) beginning around 4 pm and it would break in the middle of the night. I thought I had a virus but by the end of the second week I had lost ten pounds, and couldn't do anything except lie in bed or on a couch, so I went to my OB.

I did have what I thought was kidney pain that coincided with my fever so the OB did urine cultures but they were normal. Now that I am forcing fluids the upper back pain is gone so if it was my kidneys I think the pain was coming from dehydration.

MG mentioned miscarriage and hyperthyroidism. After my first visit with my OB when ever my "kidney"pain was especially bad for a couple of days by the third day I would have lower back pain like I was in early labor.

I mentioned this at my second appointment with my OB and my one appointment with my MFM but neither gave me any kind of response.

Now some questions for MG.

What are targeted ultrasounds? How often do I need them?

I have an aunt about 15 years older than myself who was just diagnosed with Graves.

I have had hairloss since May which I mentioned to my OB which prompted her to do those two thyroid tests. She does not normally do them as part of her pregnancy screen.

I was a skinny kid but I have slowly put on 16 lbs over the last 20 years so I never thought I was hyperthyroid or hypothyroid. i just attributed the slow steady gain to getting older.

My eyes did seem more sensitive to light this past summer.
And my libido never recovered after my last baby 4 years ago.

I did have some joint problems about two years ago...jaw kept coming unhinged and had difficulty standing up straight after sitting but these went away after I weaned my daughter.

I never had any sudden weightloss until this illness.

MG, I am unsure of what this means for me...

"(Myth 1)
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."

I have undetectable TSH- where do I want it to be?

What is the 60-80% region of normal Ft4?

Thank you for all the info...I have printed it out so I can write down the tests I need to request.

Another friend who is an internist thinks my OB and MFM are quacks because they didn't order more thyroid tests or even examine my neck.
Can a pregnant woman get help from an endocrinologist? My MFM is the senior partner in the only high risk OB practice in town.

Thanks again, I am still sick but you have given me hope that I can get better,
Beth

 
Old 10-08-2008, 02:43 PM   #7
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Re: what does undetectable TSH mean?

Hi! Mg is a wealth of info isn't she? make sure you get the FREE T3 tested. My total t-4 was in the normal range and they didn't believe Graves either, I had undetectable tsh too!!! It was my FREE T3 that was over the range=T3 toxicosis, tell them that. Hyper is better for the baby than hypo, but like Mg said it's the antibodies too, do as she says.

 
Old 10-08-2008, 03:36 PM   #8
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Re: what does undetectable TSH mean?

Thanks GravesGirl...I will do as MG said.
Beth

 
Old 10-08-2008, 05:57 PM   #9
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Re: answers for Oleander and questions for MG

Beth,

Staying hydrated is important. Lots of fruit and veggies will help with htis as well as drinking water. Food has water too.

I had a low grade fever (100) beginning around 4 pm and it would break in the middle of the night. I thought I had a virus but by the end of the second week I had lost ten pounds, and couldn't do anything except lie in bed or on a couch, so I went to my OB.

This fever may be due to the hyperthyroidism. WHen you are hyperT your body temp elevates. It is one avenue your system has to use up excess hormones.

I did have what I thought was kidney pain that coincided with my fever so the OB did urine cultures but they were normal. Now that I am forcing fluids the upper back pain is gone so if it was my kidneys I think the pain was coming from dehydration.
My liver and kidneys were taxed to the extreme during pregnancy. I was bordeline liver and kidney failure when my son decided to come early at 35 weeks. He was a healthy big premie.

MG mentioned miscarriage and hyperthyroidism. After my first visit with my OB when ever my "kidney"pain was especially bad for a couple of days by the third day I would have lower back pain like I was in early labor.
Many cases are attributed to antibody attack of the thyroid and disrupted development and growth of the fetus as a result. Too much thyroid hormone can over stress a developing fetal heart. It is best to control your levels if at all possible.

I mentioned this at my second appointment with my OB and my one appointment with my MFM but neither gave me any kind of response.
If they didn't respond you need to look for a Internal Medicine MD or an Endo that will treat you seriously. These MDs are too hands off. They are giving me chills.. or my thyroid hormones are running low.

Now some questions for MG. Shoot I ready!
What are targeted ultrasounds? How often do I need them? Targeted ultrasounds are more detailed and intense US scans of the fetus. This allows the OB to see inside the fetus as clearly as they can see inside you. It doesn't hurt you or the child. It is just a more recent development of the technology that allows for the childs thyroid, heart, and internal organ developement to be CLOSELY monitored. Your MFM and local hosipital should have access to one.

I have an aunt about 15 years older than myself who was just diagnosed with Graves.
Here is your family history. You are predisposed to it. INSIST on the antibody tests. They will not hurt you and can only help in your treatment.

I have had hairloss since May which I mentioned to my OB which prompted her to do those two thyroid tests. She does not normally do them as part of her pregnancy screen. A TSH is recommended to be checked in all first trimester patients. My SIL is an OB. Top of the line. OBs that do not check a patients TSH and FT4 every early visit are not up to snuff in thyroid care and management of pregnant women.

I was a skinny kid but I have slowly put on 16 lbs over the last 20 years so I never thought I was hyperthyroid or hypothyroid. i just attributed the slow steady gain to getting older. It could be a slowing metabolism and age. It can also be a sign that your thyroid is slowing giving you issues, like Hashimoto's.

My eyes did seem more sensitive to light this past summer. And my libido never recovered after my last baby 4 years ago.

This can be a sign of migraines. It can be a sign of low magnesium and B12. Hair loss can be the result of low ferritin. These are all important to look into.

Libido can be thyroid or adrenal dysfunction. You need an ENDO. A good Endo.

I did have some joint problems about two years ago...jaw kept coming unhinged and had difficulty standing up straight after sitting but these went away after I weaned my daughter.
These tend to be symptoms of malabsorption of key minerals.. or thyroid dysfunction. Too much T4 really makes me ache.

I never had any sudden weightloss until this illness.
You do not always loos weight when hyperthyroid. It is just a POSSIBLE symptom.

MG, I am unsure of what this means for me...
"(Myth 1)
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." I have undetectable TSH- where do I want it to be?

It is just one of an established list that I cut and pasted here. It applies to you because you have more than the 80% upper limit. You clearly meet the under 2.5 TSH.. but being hyperT is not better than being optimal in range. OPtimal TSH is 0.89-1.1.. somewhere about 1 for 95% of the populaton.


What is the 60-80% region of normal Ft4?
If you have an FT4 range of 0.8 - 1.8 then an FT4 of 1.4 would be 60% of normal and 1.6 is 80% so anything given that range between 1.4-1.6 is optimal.

Thank you for all the info...I have printed it out so I can write down the tests I need to request. You are welcome.

Another friend who is an internist thinks my OB and MFM are quacks because they didn't order more thyroid tests or even examine my neck. Can a pregnant woman get help from an endocrinologist? My MFM is the senior partner in the only high risk OB practice in town.

Get your internist frind to order the tests and push a rush referral into an ENdo. Yes an Endo can help. They tend to be more active in your care when you are pregnant.

Thanks again, I am still sick but you have given me hope that I can get better,

You are not alone. We will all help out the best we can. We can share knowledge and experience, but you have to get the MDs to work with you. Do not let up. Camp out on their door step if you have too.

MG
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Old 10-10-2008, 08:33 AM   #10
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Re: treatment in an ER

I called a number of endocrinologists but the earliest appointment I could get was one month from now.

One woman making the appointments was very helpful and said if my OB made the call they would see me immediately-they always see hyperthyroid patients immediately.

So I called my OBs office and told them that and when the endo's office called me back the appointment was still a month away. How can MY OB do this to me! How can she not understand how sick I am!

I called another OB and pleaded my case with the appointment secretary who got me an appointment for Monday morning at 9. I hope I can make it without going to an ER over the weekend.

The Zofran has made me so constipated I can't take it anymore...either that or maybe I'm hypo now? My fever is back, so of course I am so emotional to be taking a step backward...

Have any of you ladies sought treatment in an ER? How did that work out?
Gravesgirl did your Graves come on during pregnancy?
What treatments made you feel better when you had T3 toxicosis?
Thanks so much, Beth

 
Old 10-11-2008, 07:55 PM   #11
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Re: what does undetectable TSH mean?

Beth,
No hon, my hyperthyroid came on with menopause,it seems many in my age group have this happen and also in the mid thirties age group. I was treated with Methimazole and am still on them 2 years later. I don't know if they give beta blockers in pregnancy,I didn't take them cause they said my bp was too low,but they have helped others greatly,but maybe can't take them while pregnant.Hope you make out okay at the doctor's,sometimes this goes into remission after the first or second trimester, then can come back after the birth.

 
Old 10-13-2008, 04:49 AM   #12
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Re: what does undetectable TSH mean?

Thanks Gravelsgirl.
Going to a new OB this morning.
Hoping for some relief,
Beth

 
Old 10-13-2008, 11:22 AM   #13
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Re: what does undetectable TSH mean?

Thanks for all your help MG and Gravesgirl.
The OB I saw today got me into see and Endocrinologist tomorrow.
I will ask for all the right tests and ongoing treatments that MG suggested if the Endo doesn't offer them.
In the meantime I am getting IV fluids and a transdermal pump thing for meds.
What a difference a seeing the right doctor can make.
Beth

 
Old 10-13-2008, 02:31 PM   #14
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Re: what does undetectable TSH mean?

Hmm, the issues with pregnancy and hyperthyroidism are very interesting.

I was just diagnosed this past June, but I had a *very* difficult time carrying a pregnancy to term 10 years ago. I had several miscarriages, and after lots of tears, drugs, and procedures, I too gave birth to a 34 week big premie.

I wonder how many years this had been flaring and I didn't know? I'd been taking HZTC (sp?) for several years before TTC.

Hugs,
Charisse

 
Old 10-13-2008, 03:43 PM   #15
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Re: what does undetectable TSH mean?

Yes hyper or Graves is linked to preemie births,pre eclampsia and miscarraiges.I never had these issues when I was young though and I have Graves now in my fifties.Giving birth sometimes triggers hyper too but it can be post partum thyroiditis and goes away after awhile.

 
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