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Pregnancy and TSH


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Old 03-31-2005, 01:26 PM   #1
ASDGRMama
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Pregnancy and TSH

I am in my first trimester of pregnancy and had my TSH checked. The level is 3.73 (in the first trimester normal levels are a point or so lower than non-pregnant). My concern is that with the new criteria set in 2003 by the AACE I am considered hypothyroid and now that I'm pregnant my levels I'm assuming should not be higher than a 2.0.

Of course my lab is saying the level is "in range" as they have not caught up with the new criteria yet. Does anyone have any opinions as to what I should do? I have mentioned this to my rheumatologist, neurologist, obstetrician and regular doctor but they shrug it off.

My entire maternal side is hypothyroid (my mom's sister had a goiter in her 20's removed and my mom has thyroid nodules; my grandmother and my mom's brothers are on medication). I have had 4 miscarriages (two between this preg and last) as well as a number of other indications of hypo.

I really am not sure what to do. Does an endocrinologist deal with these things? I also feel I have low adrenal function but am not sure if I can get accurate test results during pregnancy.

If anyone has any info or recommendations please let me know.

Love and Prayers, Kelly

 
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Old 03-31-2005, 02:58 PM   #2
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Re: Pregnancy and TSH

An endo might be of more help, but not necessarily. If you can find one who specializes in reproductive endocrinology, that might be best. Or a fertility specialist, perhaps.
I'm not a doctor of any speciality, but even I know that you will have a very hard time achieving and sustaining a pregnancy with TSH that high. It's a crying shame those supposed "professionals" don't know it.

Obtain a copy of Mary Shomon's book, Living Well With Hypothyroidism. She has information in it about becoming pregnant while hypo.
Wishing you success with this pregnancy...

 
Old 03-31-2005, 07:07 PM   #3
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Re: Pregnancy and TSH

I am in a similar situation as you! I am not pregnant yet but plan to be and I am worried about my high TSh that is considered normal by my gynecologist. I always worried that my thryoid was not functioning right, but have recently learned about the effects it could have on trying to become pregnant and on pregnancy and the baby. I tried calling an endocrinologist myself but they wouldn't even talk to me unless I had a referral from anotehr doctor! Very frustrating!
I hope everything works out for yoi! I guess I will keep trying.
Do you know where I can find the new levels that they recommend as normal?

 
Old 03-31-2005, 08:16 PM   #4
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Re: Pregnancy and TSH

Check these out for starters, lismark....
http://www.aace.com/pub/tam2003/press.php
http://www.aace.com/pub/tam2003/explanation.php

 
Old 04-01-2005, 06:34 AM   #5
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Re: Pregnancy and TSH

Quote:
Originally Posted by ASDGRMama
I am in my first trimester of pregnancy and had my Of course my lab is saying the level is "in range" as they have not caught up with the new criteria yet. Does anyone have any opinions as to what I should do? I have mentioned this to my rheumatologist, neurologist, obstetrician and regular doctor but they shrug it off.
Kelly, you need to have your FTs checked. It's absolutely vital during pregnancy that FTs be kept in the upper 3rd of the lab range. This is for your health and your baby's. You may need to find a new doctor if this one isn't up to speed on thyroid and pregnancy.

Also, if your past miscariages happened before weeks 10 you need to have your other hormones looked at, in particular progesterone. Your own body has to be able to supply adequate progestereone for the fetus for the first 10 weeks before the pregnancy can take over. If you dont get enough you'll miscarry.

Where about are you located? Which state?
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Old 04-01-2005, 09:22 AM   #6
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Re: Pregnancy and TSH

Thanks for those links! My TSH was definitely above those guidelines! I think I just have to work up the courage to try a reproductive endocrinologist even though I do like my doctor!

 
Old 04-01-2005, 12:15 PM   #7
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Re: Pregnancy and TSH

Hello! I'm in Michigan (northern lower peninsula). Three of my four miscarriages have been prior to 10 weeks and the other was at 17 weeks.

I have used progesterone cream during the second half of my cycles through two cycles. I am using it because I'm certain I have low progesterone levels (as well as low adrenal function) but I haven't had the tests to prove it.

I miscarried in November and again in December. I've bled and cramped from menstruation to ovulation through the last three cycles (this last one of course I became pregnant).

The OB wanted to put me on birth control to "level out" my hormones. I refused as I don't want to deal with the side effects and I've never been tested for a clotting disorder.

I do not have a great deal of preg symptoms currently (I'm only about 5 wks along). I don't know if the progesterone is helping or if it's supporting a "doomed" pregnancy (this is my 10th pregnancy and I typically have more symptoms at this point).

I'm so tired of dealing with doctors (just did the run-around with my toddler who is failure to thrive) so the thought of having even more tests done is unappealing. I know I have to do this though for our tiny baby's sake.

Thank you all for your help and info!!

Love and Prayers, Kelly

 
Old 04-01-2005, 01:23 PM   #8
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Re: Pregnancy and TSH

You have a toddler with failure to thrive? Do you know that condition is often connected to hypothyroidism, either in the child or the mother or both?

To prove what I'm saying, here are two studies on the subject:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15687825&itool=iconabs tr
This study by LaFranchi SH, Haddow JE, Hollowell JG states that published data consistently document a relationship between maternal thyroid deficiency, antithyroid antibodies during pregnancy and problems with neuropsychological development of the babies.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15554886&itool=iconabs tr
This study, by Mitchell ML, Klein RZ says that in hypothyroid mothers, the amount of circulating T4 is generally too low to sustain a pregnancy beyond 17 weeks. They say that treatment of the mother should begin as early as possible in preg'cy, and the FT4 should be maintained in the upper half of the range, with the TSH in the lower half.

Your continuing problems with pregnancy are very likely associated with thyroid antibodies and/or your probable low FT4 levels. I really hope you'll reconsider the importance of making an effort to find a knowledgable doctor before even more heartbreak happens to you.

 
Old 04-01-2005, 04:29 PM   #9
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Re: Pregnancy and TSH

I'm sure you have low progesterone, Kelly - you've described some very classic symptoms. Keep up the cream, I've been on it for 3 months now and it's just starting to work. I had a 14 day follicular cycle for the first time in my life.. I was 22 days up until this month.

I agree with midwest that a huge part of your problems with carriyng to term are related to your thyroid. Please, Please, check out your FT levels. If we are right and this is the problem it's only going to get worse as time goes by.

Because you're in the US you can use healthcheckusa and pay the 75$ for the tests, FT4, FT3 (Thyroid Panel II) and TSH. Use promotional code 12345 when you check out and it will be even cheaper.

Nat
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Old 04-02-2005, 06:12 AM   #10
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Re: Pregnancy and TSH

Hello! I just wanted to let you know I took a closer look at my lab sheet and found they DID test my FT4 on Monday (the office had ink stamped something routine over it).

The level is 1.1 with a reference range of .8-1.8. If someone could give me some insight on this it would be helpful. Would it still be beneficial to have my FT3 levels checked?

I have often wondered if my daughter was affected during my pregnancy. It was an odd pregnancy. I gained far far less weight that usual eating a normal diet and I had an insatiable thirst. I also had my appendix out around 81/2 months it was found to be healthy and there was no explanation for my extreme right abdominal pain, chills and fever. I delivered a healthy baby three weeks later. By two months she was developing well but losing weight.

I don't know if they tested her thyroid (he said he would but I don't know if he remembered as he went home ill that day and didn't order her tests until two days later. They were only going to do allergies and lead testing when we got there until I demanded they run the complete blood work-up I had been told she was getting).

Thank you all for your help!!

Love and Prayers, Kelly

 
Old 04-02-2005, 06:51 AM   #11
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Re: Pregnancy and TSH

According to the study I quoted, your FT4 of 1.1 is too low. Center of the range is 1.3.
Your TSH is too high, your FT4 is too low.
Your doctor owes you some answers... ASAP.

 
Old 04-02-2005, 09:58 AM   #12
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Re: Pregnancy and TSH

I agree, your FT4 should be in the upper 3rd of the range, You want it at least 1.5, Kelly. You're way too low and that's why your TSH is above 1.0. You need to find a better doctor - for you own health and for your baby's.

This is from the The National Academy of Clinical Biochemistry, which is part of the Academy of the American Association for Clinical Chemistry (AACC), and it can be found in their Laboratory Medicine Practice Guidelines: Laboratory Support for the Diagnosis and Monitoring of Thyroid Disease:
"Thyroxine requirements increase during pregnancy. Thyroid status should be checked with TSH + FT4 during each trimester of pregnancy. The L-T4 dose should be increased (usually by 50 micrograms/day) to maintain a serum TSH between 0.5 and 2.0 mIU/L and a serum FT4 in the upper third of the normal reference interval."
And from AACE (AMerican Association of Clinical Endos)
Until recently, physicians accepted the normal TSH range of 0.5 to 5.0 mIU/L. Recent data suggest that normal serum TSH levels may have a narrower range. For example, the National Academy of Clinical Biochemistry (NACB) guidelines believes that a sustained TSH level above 2.5 mIU/L might not be normal and that current TSH upper limits of >4 mIU/L are likely skewed by the inclusion of individuals with occult thyroid deficiency. The NACB guidelines were published in their entirety in the January issue of the Thyroid.
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Old 04-02-2005, 10:22 AM   #13
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Re: Pregnancy and TSH

I am so grateful for all the info!! I am making an appt with an endocrinologist on Monday (on her website she has "thyroid problems in pregnancy" as an area of "specialty"). She is also a member of the aace so hopefully she is up on the latest studies. If I explain the urgency of the situation maybe they'll be able to get me in this week.

I printed out the AACE's new guideline recommendations for hypoT and also the Pubmed article about untreated maternal hypothyroidism (the one that lists ideal FT4 range). Hopefully she'll be willing to consider all that I have to present to her.

With my family history, symptoms and test levels I can't imagine she'll brush me off.

Thanks again!!

Love and Prayers, Kelly

 
Old 04-03-2005, 06:58 AM   #14
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Re: Pregnancy and TSH

Good luck, Kelly - let us know how it goes OK?

Nat
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