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What Does The Following TSH Result During Pregnancy Indicate?
Question: Hi, My wife 24 years in her first trimester is said to have T3-104ng/dl, T4-8.9 micro gm/dl and TSH level 7 micro IU/ml. Now she is in 10 weeks of pregnancy . She having a problem of hypothyroidism. Endocrinologist refers 75 mg thyroid tablet (1/06/2013, body wt 49.8 kg and height - 152.5, BMI - 21.46). Before pregnsncy thyroid profile is normal and weight was 55kg but now she's weight increase up to 61 and TSH 7.
so please suggest me what can I do...
so please suggest me what can I do...
Brief Answer:
On right path, monitoring needed.
Detailed Answer:
Dear Dr. XXXXXXX
I do appreciate your query.
You have not done your wife's Thyroid function test before pregnancy and hence you are not aware what was her thyroid status. My be she could have been borderline hypothyroidic. Even otherwise also, a euthyoid women landing into Hypothyroidism in first trimester is known.
The reports of your wife clearly indicate that she is having hypothyroidism. TSH 7 microgms is definitely raised, T3 and T4 levels are also supporting this diagnosis. So she will have to be on Levothyroxin. Try to maintain her TSH below 5 micrograms, but not very low. Now on what dose to start is at the discretion of the endocrinologist.
Hypothyroid state during early pregnancy may lead to abortions, or may affect the growth of the foetus. So please have no dilemma in your mind; and make her take levothyroxine tablets.
Later on the dose of levothyroxine may have to be titrated by repeat values of TSH and may be T3, T4. During this dose, please keep a watch on her mood, diet, weight pattern, etc. You are a doctor and you know how to monitor it. If she starts exhibiting irritability, too much of hunger and weight loss, you may have to minimise the done of levothyroxine.
Have you monitored so far the growth and development of the foetus/embryo by ultrasonography? If so, please upload the reports and images for my viewing; and if not please do so.
I think you are on the right path of treatment. However, close monitoring is absolutely necessary.
Based on the information you have provided and your queries, I have tried to guide you to the most. For any further information, I am always there for you Dr, XXXX; just provide me the reports and case details.
On right path, monitoring needed.
Detailed Answer:
Dear Dr. XXXXXXX
I do appreciate your query.
You have not done your wife's Thyroid function test before pregnancy and hence you are not aware what was her thyroid status. My be she could have been borderline hypothyroidic. Even otherwise also, a euthyoid women landing into Hypothyroidism in first trimester is known.
The reports of your wife clearly indicate that she is having hypothyroidism. TSH 7 microgms is definitely raised, T3 and T4 levels are also supporting this diagnosis. So she will have to be on Levothyroxin. Try to maintain her TSH below 5 micrograms, but not very low. Now on what dose to start is at the discretion of the endocrinologist.
Hypothyroid state during early pregnancy may lead to abortions, or may affect the growth of the foetus. So please have no dilemma in your mind; and make her take levothyroxine tablets.
Later on the dose of levothyroxine may have to be titrated by repeat values of TSH and may be T3, T4. During this dose, please keep a watch on her mood, diet, weight pattern, etc. You are a doctor and you know how to monitor it. If she starts exhibiting irritability, too much of hunger and weight loss, you may have to minimise the done of levothyroxine.
Have you monitored so far the growth and development of the foetus/embryo by ultrasonography? If so, please upload the reports and images for my viewing; and if not please do so.
I think you are on the right path of treatment. However, close monitoring is absolutely necessary.
Based on the information you have provided and your queries, I have tried to guide you to the most. For any further information, I am always there for you Dr, XXXX; just provide me the reports and case details.
Above answer was peer-reviewed by :
Dr. Prasad
Thank you Sir giving me information.
I want to share something about my wife.
On the date of 20 march 2013 she did 1st abortion. In that time T3 - 115, T4 - 11.8 and TSH - 0.51
and I did second abortion because of no growth on foetus on dated 4 November 2014. On 9 the week of gestration no heart beat found so I did again on 11th week. In that time also not found any foetal heart that they doctor refer for abortion. Second abortion time also normal T3(94), T4(11.1) AND TSH(1.07) level .
Third pregnsncy start at 17 April 2015. 12 week going on I found she's weight drastically increasing and her extrimites is warm. That why I did thyroid test again and found elevated level of TSH hormone. I show this report to my consulting gynecologist. She suggest to increase dose rate by 25 mg. It means 75 mg shifting to 100mg tablet.
My question are
1) any problem of pregnacy due to increase level of TSH -7
2) any problem on foetal growth
3) 100 mg is correct dose or not. If not give me correct dose.
(Age - 25 yr, Weight -61 kg, height - 152.5)
4) how many days after I do again test.
5) suggestion any special diet.
6) how to control TSH
7) give me level of TSH hormone during 1, 2 and 3 trimister. How I control it. It need to change dose rate of thyroid tablet during pregnancy.
8) need any exercises
9) how to control her weight.
10) which precaution should I take for good health of mother and baby.
I want to share something about my wife.
On the date of 20 march 2013 she did 1st abortion. In that time T3 - 115, T4 - 11.8 and TSH - 0.51
and I did second abortion because of no growth on foetus on dated 4 November 2014. On 9 the week of gestration no heart beat found so I did again on 11th week. In that time also not found any foetal heart that they doctor refer for abortion. Second abortion time also normal T3(94), T4(11.1) AND TSH(1.07) level .
Third pregnsncy start at 17 April 2015. 12 week going on I found she's weight drastically increasing and her extrimites is warm. That why I did thyroid test again and found elevated level of TSH hormone. I show this report to my consulting gynecologist. She suggest to increase dose rate by 25 mg. It means 75 mg shifting to 100mg tablet.
My question are
1) any problem of pregnacy due to increase level of TSH -7
2) any problem on foetal growth
3) 100 mg is correct dose or not. If not give me correct dose.
(Age - 25 yr, Weight -61 kg, height - 152.5)
4) how many days after I do again test.
5) suggestion any special diet.
6) how to control TSH
7) give me level of TSH hormone during 1, 2 and 3 trimister. How I control it. It need to change dose rate of thyroid tablet during pregnancy.
8) need any exercises
9) how to control her weight.
10) which precaution should I take for good health of mother and baby.
Brief Answer:
Levothyroxin dose has to be titrated as per the TSH levels
Detailed Answer:
Dear Dr. XXXXXXX
I can understand your confusion and dilemma.
I am also surprised to note that at the time of first two abortions she was not having hypothyroidism. Otherwise considering her todays levels of T3, T4 and TSH I would have labelled her bad obstetrics history with repeated abortions, blighted ovum, etc. due to hypothyroid state during early pregnancy.
Any way, today she is definitely in hypothyroidia. In spite of levothyroxine, her TSH levels have gone up to 7 μIU. So the doctor has increased the dose up to 100 μgms daily. Now by repeated testing the blood for TSH, the dose will have to be adjusted to bring the TSH below or around 4μIU. The dose will entirely depend up on het TSH level control. As I have suggested you in my previous communication, Levothyroxin tablets are to be taken on empty stomach lest the ineffect of the medicine due to hampered absorption. Certain vegetables like Broccoli, cauliflower, spinach, soya, cabbage affect the iodine absorption adversely and hence should be avoided. Thyroid tablets should not be taken with Calcium tablets. Apart from Medicinal Thyroxin, please see that she consumes iodized salt. Let her consume plenty of fruits also.
Since the TSH levels are not under control as yet, you will have to get her Thyroid (TSH) test done more frequently. Once the dose is stabilized, then you may get these tests done once a month or as suggested by your obstetrician.
Throughout the pregnancy, you will have to maintain the TSH levels below 4 μIU.
Hypothyroidism is known to increase the weight in spite of low appetite. Her weight will be controlled only after the thyroid function becomes euthyroidic. This condition in early pregnancy can affect the foetus and may lead to missed abortion or abortion.
Routine exercises as suggested by your Obstetrician during pregnancy.
In short, for the good health of the mother and baby, apart from the routine antenatal care, she has to concentrate on her Thyroid function.
I hope I have answered all your queries which will guide you through towards her good health. Please do not loose faith in your Obstetrician and Endocrinologist. Any further reports, please go on uploading for my review.
Even if you close this communication string, please keep me updated about her progress and reports - not only T3, T4, TSH but all.
If you feel any other information is needed, I am always available for you Dr. XXXXXXX
Levothyroxin dose has to be titrated as per the TSH levels
Detailed Answer:
Dear Dr. XXXXXXX
I can understand your confusion and dilemma.
I am also surprised to note that at the time of first two abortions she was not having hypothyroidism. Otherwise considering her todays levels of T3, T4 and TSH I would have labelled her bad obstetrics history with repeated abortions, blighted ovum, etc. due to hypothyroid state during early pregnancy.
Any way, today she is definitely in hypothyroidia. In spite of levothyroxine, her TSH levels have gone up to 7 μIU. So the doctor has increased the dose up to 100 μgms daily. Now by repeated testing the blood for TSH, the dose will have to be adjusted to bring the TSH below or around 4μIU. The dose will entirely depend up on het TSH level control. As I have suggested you in my previous communication, Levothyroxin tablets are to be taken on empty stomach lest the ineffect of the medicine due to hampered absorption. Certain vegetables like Broccoli, cauliflower, spinach, soya, cabbage affect the iodine absorption adversely and hence should be avoided. Thyroid tablets should not be taken with Calcium tablets. Apart from Medicinal Thyroxin, please see that she consumes iodized salt. Let her consume plenty of fruits also.
Since the TSH levels are not under control as yet, you will have to get her Thyroid (TSH) test done more frequently. Once the dose is stabilized, then you may get these tests done once a month or as suggested by your obstetrician.
Throughout the pregnancy, you will have to maintain the TSH levels below 4 μIU.
Hypothyroidism is known to increase the weight in spite of low appetite. Her weight will be controlled only after the thyroid function becomes euthyroidic. This condition in early pregnancy can affect the foetus and may lead to missed abortion or abortion.
Routine exercises as suggested by your Obstetrician during pregnancy.
In short, for the good health of the mother and baby, apart from the routine antenatal care, she has to concentrate on her Thyroid function.
I hope I have answered all your queries which will guide you through towards her good health. Please do not loose faith in your Obstetrician and Endocrinologist. Any further reports, please go on uploading for my review.
Even if you close this communication string, please keep me updated about her progress and reports - not only T3, T4, TSH but all.
If you feel any other information is needed, I am always available for you Dr. XXXXXXX
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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