question-icon

Suggest treatment for hypothyroidism

default
Posted on Thu, 31 Jul 2014
Question: Hi,
I have hypothyroidism for 3 years and been on levothyroxine all the time. my TSH was 2.5 back in early may. However TSH jumped up to 14.34 when i found out i am 4 weeks pregant in end of XXXXXXX . (FT4 is 20.46 poml/L), my endo has increased my dosage to 100mcg from 75mcg and ask me to recheck in 2 weeks. Will this already affect the baby? (my progesterone level doesn't look optimistic either, only 11.40 for 4 weeks pregnancy.)
doctor
Answered by Dr. Shehzad Topiwala (41 minutes later)
Brief Answer:
Thyroid

Detailed Answer:
Sorry to learn about your hypothyroidism.

Your endo has done the right thing by appropriately increasing the levothyroxine dose, and planning ti check in couple weeks is a fair idea too.

There are several published studies in medical literature demonstrating unfavorable outcomes in the mother and baby with inadequately treated hypothyroidism. That being said, there is no way to predict whether they will occur and in whom, amongst those with such a thyroid profile.

Therefore, the best approach adopted by endocrinologists and conveyed even to their patients is that the moment the lady realizes she is pregnant, an increase in dose is warranted. This should be followed by blood testing soon after change in dose and quickly reaching the optimal dose.
This is exactly what your endo is also doing. This is the best practice worldwide and represents the highest standard of care. It has the best chance of preventing problems because the dose is being raised at the earliest possible opportunity

The goal for the first trimester is to keep the TSH under 2.5, and for the second trimester it is under 3 and for the third it is less than 3.5. In each of these instances, it is desirable to aim for free T4 levels towards the higher end of normal range

Regarding progesterone, check with the obstetrician or reproductive endocrinologist as to the adequacy of the levels
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Shehzad Topiwala (2 hours later)
Thanks. I guess I'll just have to wait my blood test on next Monday.

However, is it possible to know how many chances are there for the baby to get affected in my case? How serious exactly with TSH at 14.34 for 4 weeks? As you can see my FREE T4 level was still in the higher end of normal range although my TSH was high.
On the other hand, since I'm always on pills, does it help for the baby to get what it needs before me?

Moreover, if it does affect the baby, what impacts i'm facing? I have read about cretinism and lower IQ, but how much lower we are talking about? and other problems?

Sorry to have so many questions, it just some gynecologists here recommend to terminate the pregnancy because of my high TSH. Although the idea annoys me, I have to know thoroughly before i make decision.

so again, huge thanks for your help.
Answered by
Dr.
Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

premium_optimized

The User accepted the expert's answer

Share on
Suggest treatment for hypothyroidism

Brief Answer: Thyroid Detailed Answer: Sorry to learn about your hypothyroidism. Your endo has done the right thing by appropriately increasing the levothyroxine dose, and planning ti check in couple weeks is a fair idea too. There are several published studies in medical literature demonstrating unfavorable outcomes in the mother and baby with inadequately treated hypothyroidism. That being said, there is no way to predict whether they will occur and in whom, amongst those with such a thyroid profile. Therefore, the best approach adopted by endocrinologists and conveyed even to their patients is that the moment the lady realizes she is pregnant, an increase in dose is warranted. This should be followed by blood testing soon after change in dose and quickly reaching the optimal dose. This is exactly what your endo is also doing. This is the best practice worldwide and represents the highest standard of care. It has the best chance of preventing problems because the dose is being raised at the earliest possible opportunity The goal for the first trimester is to keep the TSH under 2.5, and for the second trimester it is under 3 and for the third it is less than 3.5. In each of these instances, it is desirable to aim for free T4 levels towards the higher end of normal range Regarding progesterone, check with the obstetrician or reproductive endocrinologist as to the adequacy of the levels