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Pregnant. Diagnosed with PCOD, thyroid disease. Is it safe to undergo ultrasound during pregnancy, to take thyroid medication?

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Practicing since : 1999
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Dear Doctor,

We are expecting our first baby. I have few questions.

The doctor whom we are consulting has advised her to go through an ultrasound. Is the ultrasound safe right now? Since this is our first baby, I do not want to take chances by going through an ultrasound in the first month itself.

I would also like to tell you that two years ago my wife missed her periods by 1 month therefore a gynae advised us to go for an ultrasound and she was diagnosed with Cysts in Ovaries. Do you think this is a cause for concern for her pregnancy?

She was also diagnosed with Thyroid two years for which she took medication. However her Thyroid subsided an year ago and her TSH results very pretty normal for past one year. However, when the doctor checked her TSH last week, it was 5.2 but within the upper limit range of 5.5. But the doctor advised her to restart her Thyroid medication (50 mg). Should she continue having her thyroid medication as her TSH are still normal.

I am sending the Gynae's prescription in a separate email.
Posted Wed, 1 May 2013 in Women's Health
Answered by Dr. Timothy Raichle 29 hours later
Hello, I would be happy to help you with your question.

To summarize your questions:
1. You have concerns about ultrasound in pregnancy
2. She has concerns about polycystic ovaries and implications for pregnancy
3. You have questions about management of thyroid disease in pregnancy

First I have a few questions:
1. What was the first day of her last period?
2. How many weeks pregnant do you think she is?

Thank you - please answer and I will get right back with you.
Above answer was peer-reviewed by
Follow-up: Pregnant. Diagnosed with PCOD, thyroid disease. Is it safe to undergo ultrasound during pregnancy, to take thyroid medication? 11 minutes later
Thanks for the response doctor. We got the TVU ultrasound done today. I have attached the report (Sudha USG.jpeg) along with this link. I also checked with the radiologist if my wife has cysts in her ovary. The radiologist told me that she could not find any cysts in my wife's ovary. The radiologist also answered the query of the age of pregnancy. Its 7 weeks and 1 day.

I am now updating my question -

1. I am still concerned about the management of thyroid disease in pregnancy
2. My wife was complaining of mild pain (and for a few seconds - severe as well) 3-4 hours after the TVU procedure. She is not having any spotting or blood loss. Is this normal muscular pain after any TVU? Should we take any medication in case this pain does not subside?


Answered by Dr. Timothy Raichle 1 hour later
Thank you for the clarification. Here is my response:

1. I reviewed the ultrasound report. It is completely normal. In addition, the fetal heart rate of 130 is normal for this gestational age. You are right, there is no mention of an ovarian cyst.
2. Ultrasound is a very safe test during pregnancy. The amount of energy used to produce the image is quite low and considered safe.
3. A prior scan might have suggested a condition called "polycystic ovarian syndrome". This is a problem that is usually associated with irregular cycles. Patients are also at risk for diabetes who have this problem. For this reason, and in terms of implications for the current pregnancy, patients with a history of PCOS are usually screened earlier for gestational DM, usually around 20 weeks. If the 20 week scan is normal, then they are re-checked at 28 weeks.
4. If the pain was specifically associated with the ultrasound (which I will assume was a transvaginal scan) then I would attribute this to cramping of the pelvic floor musculature. It should get better over time. As long as there is no bleeding, the level of concern is very low. It is safe to take Tylenol for pain during pregnancy.

I hope that this helps. If I have missed any details, please let me know!
4. Thyroid disease is more common in women, and it is a common problem encountered in pregnancy. It is important to manage because hypothyroidism that is not treated will affect the pregnancy. So the goal is to keep the tests of thyroid levels within the normal range. TSH is not a great way to follow levels in pregnancy. It is not as reliable as checking the FREE T4 levels. This is the circulating level of active thyroid hormone. I would agree that based on her history of thyroid disease, and a TSH that is a little high, that starting her off on 50mcg per day (which is a small dose) seems appropriate. The level of TSH and Free T4 should be checked every 6 weeks, with adjustments made based on the level of free thyroid hormone.

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