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TSH 5.5, mild fatigue, 0.02-6 normal range. Medical abortion or continuation with pregnancy ?

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General & Family Physician
Practicing since : 1980
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I need expert opinion on my situation here.
I am 20 weeks along and recent blood tests showed TSH at 5.5. On knowing that it could be a concern I did my research and found out that it could impact the baby's development. I requested my previous reports which state.
Before conception TSH 4.79 (.5-6)
10 weeks TSH 5.05
FT4 12 pmol (10-24)
20 weeks TSH 5.5
FT4 8.5 pmol (7.9-19)

My caregivers never expressed any concern on these numbers, specially because I had no symptoms except from mild fatigue during pregnancy and instead had quite the opposite of other major symptoms e.g, pretty good appetite and very normal stools,high sex drive but now with my numbers I am super worried for my baby. My doctor (on my insistence) ordered mew FT4 to determine the thyroxine dosage at this point. However she feels it not too much to worry about since its within the range. My lab uses .02-6 range.
Any word of advice on how its going to impact my baby's development. My older son already has mild aspergers. I am considering termination in case this ignorance at doctors part has increased my baby's risks for developmental issues.
Posted Fri, 20 Apr 2012 in Thyroid Problem and Hormonal Problems
 
 
Answered by Dr. Rahul Tawde 8 hours later
Hello XXXXXXX

Thanks for your query.

Recommendation during pregnancy is that TSH has to be <2.5.

Your thyroid function tests will be considered normal even though they are not in the recommended range because there is no evidence to say that this degree of hypofunction will have any effect on baby.

So I think you should not consider termination of pregnancy.

Most of the peolple with this thyroid fuction test will deliver normal babies.

I would also recommend you start Thyroxine tablets now and continue them till the end of pregnancy.

I would also like to share my personal experience - more than 100 patients of mine with similar reports have delivered perfectly normal babies ( some without any treatment). So i think you should not worry too much about it.

Hope I have given valuable suggestions and it will help you.

I will be available for your follow up queries if any.

Wishing you good health.

Regards,
Above answer was peer-reviewed by
 
Follow-up: TSH 5.5, mild fatigue, 0.02-6 normal range. Medical abortion or continuation with pregnancy ? 10 hours later

Thanks doctor,
What worries me is the reports all over the internet mentioning lower IQs and other developmental delays of babies born to borderline hypoT mothers. Also I am wondering on what grounds the labs decide the range? Is is just that they are using outdated datas or because its their methodology.
 
 
Answered by Dr. Rahul Tawde 12 hours later
Hello again XXXXXXX

Thanks for your query.

Do not get carried away by what you see on the internet. Each individual Person is different with different metabolism. That is Why Clinical examination of the patient is required.

Do not worry, Continue to see your doctor.

With regards to mild Hypothyroidism causing low IQ, the current evidence is tenuous and conflicting to say the least.

There is no solid evidence to say that it happens. Data were collected with some of the outdated assays and prospective data aren't available. Many experts in Thyroidology strongly feel it does not have much effect.

One more thing I wanted to highlight is that TSH assays are not as reliable as FT4 and T4 assays. TSH reports vary somewhat from lab to lab. So your TSH from another lab may be 2 or 3 or something like that.

TSH assays are also getting refined with every passing year.The so called ''gold standard'' assays are available only in a few research laboratories around the world.( even the gold standard keeps changing every 5-10 yrs).Since your FT4 is in normal range nothing to worry much, but to keep it in upper half of normal you should take thyroxine tablets.

Regarding the assay cutoffs it depends on the methodology. They will establish the cutoffs by taking blood samples from healthy volunteers, so it also depends on that population.

Hope I have answered your query.

Wishing you good health and a happy Pregnancy.

Regards,
Above answer was peer-reviewed by
 
Follow-up: TSH 5.5, mild fatigue, 0.02-6 normal range. Medical abortion or continuation with pregnancy ? 12 hours later
Thx doctor, just the last word on it. My doctor suggested that upper range is usually require during first trimester. Does that mean that my baby didnt have sufficient FT4 during that crucial stage? What number is considered bottom 10 percentile for first trimester?
 
 
Answered by Dr. Rahul Tawde 1 hour later
Hello XXXXXXX

Thanks again,

Possible, but difficult to say whether this had any impact on the baby. Because during 1st trimester only organogenesis occurs, mental development starts later and continues through out pregnancy and beyond.

Regarding bottom 10 percentile of Ft4 depends on the assay used and difficult to provide a number. Whatever it would be specific to that assay only and cannot be generalized.

Hope my answer has been helpful in solving your concerns.

Wish you good health

Regards,
Above answer was peer-reviewed by
 
Follow-up: TSH 5.5, mild fatigue, 0.02-6 normal range. Medical abortion or continuation with pregnancy ? 3 hours later
I am currently on 50 mcg Synthroid and my new results show TSH 2.89 and FT4 9.6.Would you recommend topping the dosage to keep FT4 in upper normal? The borderline first 20 months levels are getting me quite concerned as I guess it might have a relation to my son's aspergers since I have been in simmilar state during that pregnancy as well. However it was never cured till the end. Can you please provide me more info based on your experience of dealing with similar situations?
 
 
Answered by Dr. Rahul Tawde 34 hours later
Hello again XXXXXXX

Yes, may be you can increase the dose to 62.5 microgm/day.

Regarding my experience, I have seen atleast 8 -10 females who had TSH >100 with hypothyroidism detected at different periods during the 3 trimesters and have delivered normal babies to the extent I had followed them.

But it is slightly difficult to predict in an individual case.

So in your case there is only a remote chance that your baby may be affected and many babies are born with MR even without any thyroid problem.

Thanks and Regards,

Above answer was peer-reviewed by
 
Follow-up: TSH 5.5, mild fatigue, 0.02-6 normal range. Medical abortion or continuation with pregnancy ? 6 hours later
One of the studies published on internet interprets that FT4 levels increased by 24 and 32 months gestation reduces the chances of any IQ differentiation, since it can possibly fill up the developmental gaps? Can I be optimistic about getting treated now? I am ruling out termination based on info provided by you, praying for the best for my child. (However I am very dissatisfied by the medical services here in Canada for taking even this remote chance with my baby.Most of the doctors here mentioned that they would not treat a pregnant patient with these numbers until this stage where levels are consistently dropping).
 
 
Answered by Dr. Rahul Tawde 38 hours later
Hello XXXXXXX

Yes, possibly but the full facts about IQ and mental development are not known.

Mental development continues in postnatal period.

You can be optimistic about getting treated now.

I do not disagree with the approach of doctors in Canada, maybe in their experience they would have seen many more similar cases delivering normally.

Hence they are not ready to believe that this thyroid dysfunction will have any impact on baby. Doctors from many other parts of world would not disagree with them.

Hope I have answered your query.

Regards,
Above answer was peer-reviewed by
 
Follow-up: TSH 5.5, mild fatigue, 0.02-6 normal range. Medical abortion or continuation with pregnancy ? 15 hours later
The increased dose is making my stomach upset. Do you think I should still continue or stay at current dosage. Does that mean that my body is rejecting extra thyroxine? Would you consider this failure to achieve the optimum level in my case.
 
 
Answered by Dr. Rahul Tawde 8 hours later
Hello again XXXXXXX

Increased dose per se will not cause gastritis because dose has been increased only slightly.

I mean to say if 62.5 will cause gastritis then 50 will also cause. So do not worry too much, continue the higher dose.

If gastritis persists see a physician for the treatment.

Regards,
Above answer was peer-reviewed by
 
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