Pregnant and tsh 0.08, docs want to decrease dose

[kys1981]

Hi everyone,

Just wanting some advice! I’m 10 weeks pregnant and my midwife wanted to get an opinion from an obstetrician/specialist re. My hashimotos/hypo and pregnancy. She has written a letter back to midwife saying she would advise to decrease my Levo dose 100mcg per day and retest in 6wks, this seems like a huge decrease considering I️ feel well and don’t have hyper symptoms other than losing a bit of weight but I️ have been sick every day during pregnancy too!

I’m just not sure if I️ should decrease a little bit or leave as is?

Latest results - on 250mcg per day

Tsh - 0.08 (0.4-4.0)

FT4 - 23 (10-20)

FT3 - 5.1 (3.0-6.5)

[shaws Administrator]

Don't reduce yet till you get more responses as pregnancy usually needs an increase rather than a decrease and a decrease of 100 is too much at one go. I am also going to read some past posts about pregnancy. It is far too important as mother's need a satisfactory hormone level so she doesn't miscarry.

[shaws Administrator]

Your results look good to me although FT4 is a bit higher in the range. Did you leave a 24 hours gap between last dose and the blood test?

This is an excerpt from a past post and a response from Clutter:

ElizabethM,

TSH 0.8 was good. As your goitre has increased which may indicate your thyroid is trying to produce more thyroid hormone it may be worth asking for TSH to be tested again. Ideally TSH will be between 0.4 - 3.0 during the second and third trimesters.

Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee

The serum TSH reference range in pregnancy is 0·4–2·5 mU/l in the first trimester and 0·4–3·0 mU/l in the second and third trimesters or should be based on the trimester-specific reference range for the population if available. These reference ranges should be achieved where possible with appropriate doses of L-T4 preconception and most importantly in the first trimester (1/++0). L-T4/L-T3 combination therapy is not recommended in pregnancy (1/+00).

onlinelibrary.wiley.com/doi...

healthunlocked.com/thyroidu...

[kys1981 in reply to shaws]

I️ take my levo at night so I took it about 13-14 hours before testing

[shaws Administrator in reply to kys1981]

That's great.

[diogenes Remembering]

On no account should your T4 dose be changed as drastically as suggested. You aren't a car, which can fiercely accelerate and brake at the touch of a pedal. Rather you have a particular bodily way of working using T4 which can only be gradually altered, especially with the big biochemical changes pregnancy brings. For a 10 week pregnancy on T4 I would say it looks OK, but a 25 ug drop in T4 might be thought about - but no more than that, and prompt retesting should be done to ensure things haven't gone downhill too much. In later pregnancy indeed you might consider replacing that 25ug, as later pregnancy has higher demands of your baby for its own thyroid actions.

[Clutter]

Kys1981,

Emphatically NO! 100mcg is far too high a dose reduction. TSH is mildly suppressed and FT4 is mildly over range but FT3 is within range so you are not overmedicated. Dose adjustments are supposed to be gradual and are usually in 25mcg increments at 6-8 week intervals. The obstetrician's recommendation is likely to make you hypothyroid which increases the risk of miscarriage.

Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email [e-mail] if you would like a copy of the Pulse article to show your GP.

[kys1981]

Thanks everyone, I️ thought it was crazy advice, she obviously knows nothing about the thyroid!

I️ have had 3 miscarriages previously and was diagnosed by a fertility specialist after the 2nd, at the time I️ had a tsh of 3.2 and T4 was 13 so I’m very hesitant to change anything at the moment...