Hyper last month now Hypo this month and pregnant - super confused

[Princessyaz26]

Last month got diagnosed with hyperthyroidism, but it started improving by itself and FT3 and FT4 were in normal range, TSH was improving slightly, I found out that I am 6 weeks pregnant (naturally) and got my thyroid results today, image results below, I’m confused and don’t understand that firstly I got hyper after a round of IVF in December, got told to pause the next round and wait to fix thyroid problem, it already starter getting better by itself and I got pregnant naturally and checked it again and now Hypo? The only medication I have been taking is progesterone 200mg and folic acid, the specialist has recommended to to start immediately with Eltroxin 0.1mg without waiting for possible normalization. I’m just confused because before the IVF all my levels were fine. I did ask if it was linked but my house doctor and Gynocologist don’t understand it either. Trying to find answers. Not sure what the immunology results are either. I will research myself online but if anyone can help that may understand I would be very grateful.

Wishing you all a nice evening and thank you in advance! Xx

[Jazzw]

Have your thyroid antibodies been tested? It’s sounding like you may have autoimmune thyroiditis - or Hashimoto’s as we commonly call it. That can have the effect of you alternating between hyper and hypo. It shouldn’t be surprising your doctors as it’s very common, but we often hear here that they’ve got confused. It clearly isn’t taught very well at medical school these days...

Press to have another thyroid blood test as soon as possible - and to have them every few weeks for a while to work out what dose you should be taking, as reallyfedup123 is right - it’s very important for you to be optimally treated while pregnant.

[SlowDragon Administrator]

Clutter has some links about levels needed for pregnancy

TSH should be around 2.5 or less

[molliemdz in reply to SlowDragon]

My endo told me 2.0 or less for TSH for pregnancy.

But I think the autoimmune question is probably the bigger hurdle for sustaining a pregnancy.

It’s a big, long story and a lot to take in at once. In the short term, if it were me, I would get off gluten and dairy as a pre-emptive (like how OB-GYNs sometimes prescribe progesterone “just-in-case”) and stay off at least 3 months, and take stress reduction seriously (whatever helps you relax mind and body — prayer, meditation, yoga, deep breathing...).

Many best wishes for you and your baby.

[Clutter]

Princessyaz26,

Congratulations!

Ask for thyroid levels to be retested 4 weeks after starting 100mcg Eltroxin as dose may need increasing to ensure TSH during the first trimester is in the low-normal range 0.4 - 2.5.

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

13. 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...

According the ATA First Trimester TSH levels between 2.5 and 5.0 are associated with increased pregnancy loss.

thyroid.org/patient-thyroid...

[molliemdz in reply to Clutter]

Yes, that’s true. Those are the official guidelines. The endo I went to while experiencing pregnancy and thyroid issues said the official line was 2.5 but that most found TSH under 2.0 to be optimal for getting pregnant/ early pregnancy.

[Angel_of_the_North]

You probably have Hashis and were never truly hyper, but had recently had a Hashi flare where the dying throid dumps extra hormone into the blood stream before you go back to being hypo again. Everything needs to be right for a successful pregnancy.