Hypothyroidism in pregnancy- does anybody on MN know about the effect on foetus?

[duchesse]

Does anybody know anything about high TSH/low T4 levels in pregnancy?

I am about 11 weeks pregnant, and due to a history of borderline hypothyroid occasionally tipping over into clinical hypo, requested a thyroid test at my booking in visit two weeks ago. I am not being treated for the low thyroid, as the doctors decided that it was not bad enough to treat.

The results are:
TSH 4.39
T4 14.4

The TSH is high (the endocrinologist I saw suggested that anything over 2 was potentially harmful to the baby's cognotive development) but the T4 is within normal limits.

So here is my question:

Does anybody know if it the higher TSH or the low T4 that can cause the problems with the foetus?

Also, I thought I would mention a very interesting paper I just read about the link between morning sickness and thyroid levels. The suggestion was that the more T4, the higher the likelihood of sickness. Which would explain why I've had hardly any sickness in this pregnancy so far.

I would be very thankful for anybody's experiences of this.

I had the thyroid problem before I even thought about having children. I had to have my meds increased by 25 - 50 mcg each time.

Both losses were at around 9 weeks.

My dd had to have blood tests till she was 2 as her guthrie test came back abnormal but she is fine. Son has had no problems at all but if either of the start showing symptoms of thyroid dysfunction I will get them tested asap.

I am currently on 150mcg/day of thyroxine.

Duchesse, glad you got some answers from Stuck's DH.

Just thinking, could you afford to see a private endocrinologist for the duration of your pregnancy?

They charge about £150 a consultation but you may only need a few to get you through?

Then you could see one straightaway and choose someone you think would be good.

There are recommended ranges for each trimester. The first is particularly important as others have said, because baby has no thyroid function of it's own. I started on 25mcg - quickly titrated up to 75mcg and it's gradually gone up to 125mcg. I remember you from a ttc thread duchesse - your gp has refused to treat you for a long time iirc. There is an evidence base so if you arm yourself with literature, s/he cannot refuse. Don't worry if they think you're being a pain. When is your scan?

29th Jan for my scan. Am really, really worried, as it was at the 12 week scan last time that they found the baby had died.

I've two beautiful DDs & was being treated for hypothyroidism, following RIT, long before I fell pg with either. During both pgs I was tested every four weeks & levels adjusted accordingly. 2nd pg didn't seem to need as much additional thyroxine but dosage level hadn't decreased to pre-pg level after first baby so maybe that's why.

Both girls were tested twice after birth aside from Guthrie test, at 2 days & then at 3 weeks old. Both had levels nearing normal by 3 weeks and the rate of them settling decided paeds not to test further but I was given checklists to see if either developed any symptoms & to contact them directly if this happened.

GP, m/ws and consultant all very keen to keep me on track throughout pg, maybe I was jsut very lucky but it's surely a standard of care you should be able to expect on the NHS anywhere in the country. My maternity care was all in Glasgow hospitals & surrounding areas.

I'd arm yourself with as much info as possible and push for treatment if you're not getting what you need.

Good luck with everything.

Sorry I havent been back on - had a very busy weekend. I havent really had a chance to read other posts so you may have the answer already, but yes defo worth treating. High TSH will always benefit from being treated but unfortunately the evidence suggests that as low as possible as early as poss is best for baby.
It sounds like your GP is pretty poor to be honest, is it worth changing??? I dont know if you can afford it but maybe even try to see someone privately, depending on your area DH may be able to recommend an endo, but to be honest a good obs might be a good investment.
So sorry I havent got back sooner, I will check this thread regularly throughout the week

OK, so I saw my obstetrician today, who is also the endocrinologist honcho in the Obs & Gyn department, and she has put me on 50 micrograms thyroxine daily until I see the "proper" endo at 20 weeks. I had a scan last week during which everything looked fine. Many thanks for all your help.

Glad to hear the scan was fine and that you've seen the Obs

Thats good news duchess. Keep us posted.

So pleased for you duchesse. At last!

Just had meds increased to 175mcg/day and need to have another blood test in 3 weeks time so that will be 3 tests in first 13 weeks of this pregnancy!

Hi all. I live in the US. I think I am about 5 weeks pregnant. I know I am pregnant just not sure when I conceived. I am going crazy. I had Graves Disease and was treated with radioactive iodine two years ago and now I am hypothyroid.

I got my TSH levels measured last week and they were 50, yes 50. That is horrible. My endocrinologist immediately put me on Cytomel 25mg and upped by Synthroid from 150 mcg to 225 mcg. I emailed her because there is a chance I am carrying twins because of my age (36) and because they run in my husband's family. She wants to test my levels again in two weeks. The thing is, I think right now it is important that I (1) find out if I am carrying multiples because this would most likely change my treatment to my thyroid and (2) finding out would allow the docs to continue the correct treatment.

I am so afraid I am going to miscarry. I am afraid to move. Thank God I am not working right now but I do have two other children to take care of but they are older (15 and 8).

Thanks for your advice. Oh and my OB doctor doesn't see the urgency in doing an ultrasound and is afraid they won't see anything at this point anyway.

due- as I understand it is critical to get your thyroid levels right early on in the pregnancy, as that is when the risk is the greatest to the foetus. Beyond 13 weeks their own thryoid is up and running, but before that they rely on yours. a TSH of 50 is extremely high, and I'm astonished they're not taking it seriously. I would have thought they would be far more likely to treat very proactively in the US since most US endocrinologists seem to think that anything over 2 is too high. Your TSH on medication should ideally not be over 1.5. Are they offering you regular testing?

I can see why they're not bothering with an ultrasound at this early stage. The risk of seeing nothing this early is quite high even if you are pregnant, and they wouldn't want to alarm you unneccessarily.

The best thing you can do if keep checking that yoru TSH and T4 levels are appropriate and stable. Do you feel better on this dosage?

There is an added level of complication of course if you have Grave's disease- I assume they are also supplementing your adrenal function? The thyroid and adrenal systems are fairly interdependent, and you doubtless already know that your pregnancy will be high risk anyway if you have Grave's.

Good luck with getting the answers you need. Focus on the hormone levels, and try not to worry too much- I;m sure they will do an ultrasound as soon as it's practicable.

Duchesse - I see you're becoming an expert now Hell, with us self-taught women, who needs doctors

Due - my TSH in this pg was 2.9 (though my T4 was fine at 19)and the endo upped the dose of Thyroxine to 175mcg. It has been increased from 100mcg pre-conception (25mcg at a time). Yours is 50 which is shockingly high. They should be more assertive in treating/monitoring you imho.

I know it's been a while since this thread was last commented on, but I just wanted to say thanks for all the info you girls have put out! I've had 2 miscarriages in the last 5 months, and I think it might be because of undiagnosed hypothyroidism, even tho my doc said my levels were normal. Your thread and some other sites have def diven me the info I need when I go back to see him next week about getting on some meds

Hi I have a question to ask those in the know, I have had my tfts done by g.p before pregnancy and during (am 19 weeks now) the first pre preg showed tsh of 1.99 and free t4 of 9.6 which is below normal but because my tsh is fine docs weren't worred, 2nd tft at 11/40 tsh was 1.19 and free t4 of 12.4 low end of normal, as of 17 weeks my tsh was 1.09 and free t4- 9.6 again below normal.

I have read that during pregnancy free t4 should be in the upper end of range, does anyone know about free t4 and if anything could or should be done? they won't even refer me to endo.

TSH does not change during pregnancy, but T4 decreases. I had hypothyroidism before pregnancy for a few years and learned quite a lot about treating. You need to put on a thyroxine medication (fairly harmless) until your TSH levels are brought to the normal range. Your endocrinilogist should have prescribed it asap...

Thanks sunny, I'm really worried about the baby not getting enoough thyroxine I have seen all the gp's in the practice and not one of them will refer me to an endocrinologist They keep saying 'your tsh is fine, but obviosuly your t4 is abnormal'

I did read that low t4 and normal tsh can be secondary hypothyroidism caused by pituity dysfunction and should be looked have told gps this but they don't listen.

me23, you should see an encrinologist privately. i would not delay the doctor's visit as taking thyroxine is critical for your baby's proper development. I was on L-Thyroxine medication for a couple of years and luckly the problem corrected itself before pregnancy (I also had normal TSH and abnormal T4). I have been taking iodine (in natural form aka Kelp)as profilacts and continue to take fairly high dosages during pregnancy now as this has been recommended by my endocrinologist, depite normal thyroid tests results... I wish the best of luck and best possible pregnancy!

thankyou both for taking this seriously why can't the doctors? they honestly do not have a clue about thyroid, although I have thought I did need a referral I trusted them because they're the ones with a medical degree

we cannot really afford to go private but I am going to make one last effort for a referral and if they refuse I will have to put it on credit card. Does anyone have any idea how long a nhs referral would take? or how soon I could get a private appt?
I am having my tfts done again tomorrow, and I have the results of my last 2 as print outs so If I did have a private consultation then I shouldn't need bloods done.

Good that I can ask him to ask gp to refer me on NHS.

I do worry that it is too late? as I will be 20 weeks on weds. I thought the critical period for baby was first trimester.

If you have any relatives or friends travelling to other european counties, you can buy L-thyroxine over the counter there (I believe it is sold in Germany, Greece, Spain and Russia over the counter). You will need at least 25mg per day (I took 50mg per day, which is 2 pills, but that was prepregnancy)... The medicine has a detailed leaflet you can check, though. This might be a good way to bipass beauracracy and get the treatment you need quickly...

PS I meant one can buy L-thyroxine without prescription in some european countries