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Old 06-23-2009, 08:49 PM   #1
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Sister is hypo and pregnant, She's worried about brain development. Info needed!

My sister is 5 weeks pregnant. Her endo just left her an emergency meesage telling her that he thyroid is low. Many times when you raise thyroid meds you go from really hypo to hyper, on and off for 2 to 3 months. She is very worried that this could effect the baby's brain devlopement. What weeks are the most important for fetal brain developement? Is it worse to be hypo in the 1st 2nd or 3rd trimester? I know that this is still a slightly grey area in science. But has anybody read about any recent findings? Please help! My sister is going to have a miscariage if she keep up the worrying.

 
Old 06-24-2009, 10:30 AM   #2
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Re: Sister is hypo and pregnant, She's worried about brain development. Info needed!

In early pregnancy it's essential for the development of the fetus that it gets enough T4 from the mom when it's not yet producing thyroid hormones itself. However I've read somewhere that if things aren't that great early on the second trimester can make up for something. The baby develops throughout the pregnancy and is depending on mom's metabolism the whole time. So keep a close eye on things but stressing too much isn't good for either of them. If she's getting a raised dose now that's a good thing. Do you know her thyroid levels and her dose at the moment?

 
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Old 06-24-2009, 05:21 PM   #3
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Re: Sister is hypo and pregnant, She's worried about brain development. Info needed!

Okay I am pregnent and hypoT. My MDs have been all over me. As soon as I got pregnant the growing nugget started skimming 20% of my T4 off the top. FOR A STABLE hypoT pregnant women, normally an increase of 25% in T4 dosage is a good estimate to aime for and cover the fetus's needs. Hashimoto's patients and other endocrine issues can complicate things.

I have Hashimoto's and Graves and was far from stable on my thyroid meds.. but I had hit a balance at 40%. My MDs increased my T4 in 12.5 mcg increments every two weeks because I was at 30% and they wanted to avoid hyperT spikes. I have went from 112 to162 and will probably increase again with Armour added to my synthroid next jump. Getting pregnant this time is suspected to have caused my thyroid to finally collapse. I will see via thyroid US on Monday. Any way.

Your sister:

What was her level? Was she at least at 30% Or was she below range? If she was at least at 30% the fetus will get what it needs, but she will suffer the lash back. She does need to quickly and steadily increase her levels. If she was less than 30% she probably needs a 25 mcgs boost. Blood test in 2 weeks (FTS only) then steady 12.5 - 25 mcgs increase until she hits 50-60% of range.

She needs a US to confirm pregnancy and current growth. The first thing effected by low T43 in the fetus is growth rate. If she is 7 weeks but the US shows a 5 week size then the fetus is suffering. AS LONG AS growth is not suppressed in the first 12 weeks the fetus is doing well between 12-22 weeks the neuro system needs the T4 and demand increases. This give your Sister time to get her levels. 2 weeks miniboosts can do that with out hyperT spikes. I haven't had a single hyperT spike. After the initial US she needs a follow up targeted ultrasound in the 11-13 week range. This will allow for the heart function, spinal developement, and downsyndrome checks. These are strongly recommended for hypoT mommies. DOes she have a good MFM(Maternal Fetal Medicine) MD? I have three OBs checking me. One specilizes in the endocrine mess. The other is following the fetus and conferring with the endocrine MFM specialist... and my regular OB is specialized surgical and keeps up with the general pregnancy complaints. My IM that follows my Endocrine stuff is seeing me every 3-6 weeks as needed as well.

So to help you sister best we will need to know her treatment plan and current thyroid levels. If she can get FT4 levels to 40% and hold the fetus will have what it needs, but there will be an increased chance of miscarriage. The optimal level for a safe and normal pregnancy is to get your FTs in the 60-80% of normal. However if you can keep it at 40% your fetus should be getting what it needs, but the mom will suffer hypoT issues. I am living there at this time. FT testing should be done AT LEAST every 4 weeks. My MDs have been doing it every 2-4 weeks because my levels keep dropping. I swear I have a T4 leak somewhere....

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Last edited by mkgbrook; 06-24-2009 at 05:25 PM.

 
Old 06-24-2009, 09:50 PM   #4
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Re: Sister is hypo and pregnant, She's worried about brain development. Info needed!

The endo only told my sister that her tsh was 7, didn't even mention T4 or T3%. Her meds were at 100mcg and they raised it to 137mcg. Too late for the gradual increase because she started 137 2 days ago. She is 5 weeks pregnant. Hopefully she will level out soon enough? She is so worried.

 
Old 06-26-2009, 06:15 PM   #5
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Re: Sister is hypo and pregnant, She's worried about brain development. Info needed!

Have her go to her OB. Get the OB to run FTs if the Endo did not run them. The first 22 weeks the fetus does not have a thyroid and is dependent on the mother for all its T4 needs. It needs T4 first for muscle and organ development and then for brain and higher function. After 22 weeks the fetus demand of T4 lessens. However being pregnant in its own right later on results in a greater T4 demand. It is essential that the Endo and MDs follow the FTs. NOT TSH. My MDs are not even running TSH on me because estrogen levels and pregnancy hormones interfere with that reading.

The Endo bumped your sister 37%. This is giving 25% for the pregnancy factor and a bit more for prior hypoT. It will probably take her 4 weeks to level. After 4 weeks on this dose she needs her FTs run. Tell her to go through her OB, they shouldn't quibble over it.

Have your sister call and make sure that the Endo had run FTs in addition to the TSH. IF NOT she should go in fasting and get a level now for comparison in 4 weeks.

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Old 06-27-2009, 08:04 PM   #6
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Re: Sister is hypo and pregnant, She's worried about brain development. Info needed!

Ok I'm afraid that this endo doesn't know anything about prenancy and thyroid changes. Here is my sister's labwork

T4 11.3 normal 5.0 - 11.6
fT4 9.6 normal 6 - 10.5
TSH 6.9 normal 0.3 - 3.8

The endo was worried because her TSH was high but I'm reading that TSH always rises during early pregnancy.


 
Old 06-28-2009, 11:58 AM   #7
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Re: Sister is hypo and pregnant, She's worried about brain development. Info needed!

I've have 2 very healthy and smart babies while on Synthroid. My first we had to change the dose in the middle, but the 2nd one I stayed the same dose throughout.

 
Old 06-28-2009, 07:37 PM   #8
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Re: Sister is hypo and pregnant, She's worried about brain development. Info needed!

I am hypo caused by hashis and it is very important for the levels to be good through the whole pregnancy. Thyroid levels of the mother matter at all stages. I had a very big, healthy baby boy, and my synthroid started at 100, then 112, 137, 150. Right after I had DS I went to 125, then back to 112, and now I am at 175. My levels have not been able to be "fixed" since I had DS. However, as long as your sister regularly see her endo, and her endo and OB are in contact, the pregnancy should be fine. She is early enough, that they found there was a small issue and are now fixing it.
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Old 06-29-2009, 11:09 AM   #9
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Re: Sister is hypo and pregnant, She's worried about brain development. Info needed!

Quote:
Originally Posted by TV in RV View Post
The endo was worried because her TSH was high but I'm reading that TSH always rises during early pregnancy.
Actually with healthy people TSH drops during early pregnancy since thyroid speeds up it's function to make enough hormones for both. Her FT4 seems high enough but those labs seem a bit confusing together - with a TSH that high you wouldn't expect to see a FT4 that high - a lab error perhaps?? Is she having any symptoms?

Last edited by FinnMaid; 06-30-2009 at 07:33 AM.

 
Old 07-01-2009, 12:41 PM   #10
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Re: Sister is hypo and pregnant, She's worried about brain development. Info needed!

That can occur in some. But the key is the FT readings. Her TSH increase may be the result of a pregnancy induced RT3 conversion loop error. Her FT4 levels are FINE. Adding more T4 may throw her hyperT in T4 and do nothing to fix the source of the TSH increase. My RT3 production sky rocketed and I am having to start adding Armour to my T4. This may be what your sister needs. But she has plenty of T4 in her system not to worry about the baby. Now she needs FT3 and RT3 testing to determine the state of her T4 to T3 conversion system.

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Last edited by mkgbrook; 07-01-2009 at 12:42 PM.

 
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