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  • pregnant (hypo) and worried

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    Old 09-18-2009, 06:09 AM   #1
    alma29
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    pregnant (hypo) and worried

    Hello everyone!

    I'm currently 18 weeks pregnant and very worried.

    Before pregnancy I had my thyroid checked and got the following labs:
    TSH 2.38 (.34 - 5.60)
    FT3 3.13 (1.71 - 3.71)
    FT4 .70 (0.61 - 1.12)

    My endo said everything was fine, I wasn't hypo, even though I told her I was planning to get pregnant and felt that my TSH was too high for pregnancy. The only symptom I had were irregular periods and she put me on Duphaston in order to regulate this.

    But decided to ask for a second opinion. The new endo understood my concerns and agreed to put me on a small dose of levothyroxin (Euthyrox 25) and so one month after starting treatment I got pregnant..

    I decided to get tested every 4 weeks during pregnancy and so far I got labs as follows:

    At 4 weeks of pregnancy:
    TSH 1.22 (.34 - 5.60)
    FT3 2.52 (1.71 - 3.71)
    FT4 .88 (0.61 - 1.12)
    Endo felt they were ok.

    At 8 weeks of pregnancy:
    TSH .86 (.34 - 5.60)
    FT3 2.33 (1.71 - 3.71)
    FT4 .73 (0.61 - 1.12)
    Endo a little concerned with my FT4 levels, but still confident everything was fine; No dose increase..

    At 12 weeks of pregnancy:
    TSH .85 (.34 - 5.60)
    FT3 2.55 (1.71 - 3.71)
    FT4 .76 (0.61 - 1.12)
    Couldn't reach endo, no change in dosage

    At 17 weeks of pregnancy:
    TSH 1.44 (.34 - 5.60)
    FT3 2.48 (1.71 - 3.71)
    FT4 .60 (0.61 - 1.12) !!!!
    This time around I got worried! Endo increased dosage by 50 Euthyrox , but said not to worry, baby is fine, even with these low end numbers , since my TSH was still so good and the FTs (almost) in range! She even implied that maybe the lab had made an error and suggested that next time around I should get tested at another lab.

    But I'm still worried sick, especially after reading your posts and learning that a normal TSH is not relevant, but good FT4 levels are crucial.. And mine are so low!

    What do you all think? Could it be a lab error, considering the fact that my FT4 has always been at the lower end, with or without meds? I know I will eventually find the answer to this question, but until then I can't stop obsessing over this issue..
    Do you think it is possible that may baby was damaged by these low end FT values during the first trimester? I want to add that I'm totally asymptomatic, I feel perfectly fine and the baby is developing fine, according to my gyn?

    Sorry for the extra long post, but I'm so worried..
    Thanks for answering!

     
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    Old 09-18-2009, 07:54 AM   #2
    midwest1
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    Re: pregnant (hypo) and worried

    First of all, the baby probably is fine. Those little people have a way of getting what they need despite everything.

    I suspect what happened is that the non-dose of 25 mcgs was just enough to dial down your TSH, which then causes FT4 to drop; but it isn't enough to replace both the drop in FT4 plus the original shortage. That's how you end up even lower than before meds. Of course, it could be a lab error, but... I wouldn't bet the farm on that.

    It's good he raised you to 50, which is the lowest genuine therapeutic dose. If it doesn't raise your FT4 this time around, though, push for a trial of 75 mcgs next time.

    Try not to worry unduly. As you probably know, stress isn't healthy for either of you. Good luck with the pregnancy!

     
    Old 09-18-2009, 08:42 AM   #3
    dea4
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    Re: pregnant (hypo) and worried

    Midwest is right, the baby takes what it needs and leaves you lacking. You are doing well keeping a close eye on your levels. Don't stress over it, you are doing the right thing by checking your levels often. Good luck!

     
    Old 09-18-2009, 10:42 AM   #4
    dream77
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    Re: pregnant (hypo) and worried

    Just something I am going through personally.
    Am 13 weeks pregnant and hypo..
    as soon as I got hypo I sung into mildly hyperT. MKG confirmed this is typical with hashi behavior..
    Just wanted to highlight that to be careful and watchful of either swings..

     
    Old 09-18-2009, 11:40 AM   #5
    dea4
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    Re: pregnant (hypo) and worried

    your right dream, you can swing hypo/hyper more when pregnant with hashi's so it it wise to keep a close watch on those levels.

     
    Old 09-20-2009, 12:52 AM   #6
    alma29
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    Re: pregnant (hypo) and worried

    Thanks for your answers! I'm feeling so much better now. Good luck to you all!

     
    Old 09-21-2009, 07:02 AM   #7
    mkgb
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    Re: pregnant (hypo) and worried

    Alma,

    Are you seeing a MFM? Maternal Fetal Medicine specialist? You are classified as a high risk pregnancy as a result of your hypoT status. As a result your OB should have you seeing a HIGH RISK OB = MFM. The MFM if upto date on the latest thyroid care for pregnant women will tell you that you need an FT4 level ABOVE 1. TSH is IRRELEVENT! The stop testing it and ONLY go by your FT4 and FT3 levels. Pregnancy hormones and changes in estrogen/progestorone levels effect the reliability of TSH in PREGNANT women. Endos are not as well versed at dealing with pregnant hypoTs.. so yours saying your TSH is fine shows IGNORANCE in this matter.

    So I recommend that you get in to see a MFM/High Risk OB ASAP. Let them CO-manage your thyroid status. It is true that the baby will skim what it needs off the top, BUT if your levels fall below 30-40% some of the MFMs/OBs believe there is not enough thyroid hormone for both mother and child.

    1) Rule of thumb is OPTIMAL FT4 levels are 60-80% of normal range for a pregnant woman.
    2) Next rule: 40-60% is safe, but the mother will suffer hypoT effects.
    3) Below 40% and there is increased risk for the fetus.

    4) Thyroid maintenance and management rule of thumb for a MFM:
    A) As soon as pregnancy is detected thyroid homone dosage should be increased 25%.
    B) Then the FT levels should be monitored every 4-6 weeks until optimal levels are reached.
    C) If hypoT prior to pregnancy detection the monitoring and dose adjustments are done EVERY two weeks by FT4 and FT3 level monitoring.

    Your Endo did not do this. But in the Endos defense they may not know how pregnancy effects the TSH versus FTs and thus are clinging to their TSH watcher status. However your OB should and an MFM should know this WITH OUT fail.

    Now don't be scared. The main thing that low thyroid hormone in a developing fetus causes is delayed to slow development rate. At your last US were you at least at 50% on the growth scale? If your US matched the chronological age of the fetus, it is getting what it needs now. At 22 weeks the fetus's thyroid will come on line. This will allow for it to handle shifts in your actual T4 levels, BUT it still needs T4 from you. In the final trimester the brain is developing and this si where increased cognitive deficiency will have a greater chance of arising if your are STILL too low in your T4 levels. SO you still have time to get your house in order. Be forceful and aggressive about your thyroid management and care. You are caring for TWO. MAKE your ENDO look only at the FTs. Force them to be aggressive about increases. Get in to see an MFM. If you have Hashi's pregnancy can have two effects. It can cause increased hyperT/hypoT swings... OR it can kill your thyroid all together. My first pregnancy I was on the Graves/Hashimoto's roller coaster. This one... well I went from almost being optimal at 112 mcgs of T4 to needing 175 mcgs of T4 WITH 1.5 grains of Armour daily. This is most likely going to increase again. Pregnancy 2 has also kicked in a thyroid hormone resistance issue.

    Good luck and congratulations on your developing bundle of joy.

    MG
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