11 weeks pregnant, disagreement with endo

[Hypottc]

Hi everyone, happy new year to you all. I had my first endo appointment today at 11weeks pregnant. My latest bloods were ft4 16.8 (9-19)

Ft3 4.59 (2.89-4.88)

TSH 0.01 (0.4-2.5)

Anyway the endo was really pushing me to lower my dose by 25mcg as he is worried I'm 'subclinically hyper' and that was a risk to me and baby (hypertension, goitre for the baby) etc I politely argued that my ft4 and ft3 are good so that's all that matters but he was determined to tell me TSH was more reliable than ft4/3 even though I've personally read it's the TSH that can fluctuate.

Anyway I agreed to lower my dose by 25mcg but tbh it really doesn't sit well with me. He said 'oh the baby starts to make its own at 12 weeks' but I've read dose needs adjusting even up to 20 weeks. Ofcourse I didn't want to argue too much as I did not have any back up evidence.

NICE guidance (before it was updated this year) said something like ft4 should be in the 'upper reference range' I cannot find this info now as the guidance has become so vague. And how 'upper' does this mean, are my current ft4 too high according to NICE? I have seen the Lothian Guidance on the thyroidUK website but was looking for something more, I don't know, senior?

Just wondering if any of you in similar boat have some evidence I can shove in front of him to say I do not want to lower my dose. I am tempted to lower it only because I have seen some research that suggests high normal ft4 can cause lower IQ in infant but I think they are really recent studies so I am wondering if my ft4 could do with lowering slightly. He wants my TSH at 0.4 but I am worried my thyroid hormones will suffer but I can't seem to get through. He says all the research refers to TSH and not FT4 but I'm pretty certain I've read so being referred to about ft4! It's really annoying i feel I've forgotten all the 'official' evidence I collected yet when I need to be heard I don't have anything to back up what I'm saying! Argh.

Would it harmful to reduce slightly? Argh I'm so confused. My GP was happy with what I was doing and agreed things need to be high normal, he worked with an obstetrician who liked things being top end but not this endo and his registrar -they can't see passed TSH. My GP has been ordering my ft3 and I'm worried these hospital guys won't bother as I can't even get them to look at ft4 nevermind ft3.

Any advice will be gratefully appreciated.

Thanks xx

[Hypottc]

Oh and I feel fine, I told them if anything I still feel really cold but no palpitations. The registrar then got me to hold my hands up and tense them up and they shook ever so slightly and she said 'oh yes slight tremor' and I'm thinking everyone's hands shake a little when u hold them up like that. I showed my husband who is a GP and he said he wouldn't say that's tremor (he has nothing to do with my thyroid care as I'm the one educating him btw)

[Saya85]

You are nowhere near overmedicated and I would certainly not lower my dose in your case

The research that talks about high free t4 with negative effects is usually when over range t4 not within reference range

Your high free t3 is what's keeping your TSH suppressed - but your T3 is not over range and the baby only uses your t4. If you lower your levo you will lower your t4 and the levels of what your baby will use.

Your endo is an ass and I am fed up with these people playing with our lives.

Your GP and the obstetrician are right it should be in upper reference range in first trimester and mid to upper in second trimester at least

If they are happy to keep prescribing and monitoring i would stick with them and ignore the endos.

If you look through one of my posts earlier asking about t4 and pregnancy I believe someone posted reference ranges for TSH and t4 in pregnancy

[MaisieGray]

You are not over-medicated and I'd say that a dose reduction was not required. As Saya85 said, any reference to high (or low) levels, by definition, means above (or below) the reference range; and not high (or low) within the range. Here is a useful paper, see particularly where mention is giving to lower TSH levels in pregnancy and the unsoundness of FT4 testing, and the conclusion that "Serum TSH concentrations should be interpreted in the context of pregnancy physiology". ncbi.nlm.nih.gov/pmc/articl...

[Marz]

Just an additional comment - low B12 in the Mother can affect baby IQ and Low VitD can lower the immune system in baby after birth. Both topics I have read in various places but need to search for links. Am sure you are up to speed on all this. Wishing you well ...

EDIT : journals.plos.org/plosone/a...

Just one of many papers on B12 in the link above. The same for VitD ...

[Chippysue]

As your husband is a go he will know that you increase your thyroid medication as the baby is using it up, especially early on, I cannot tell you what to do but this Endo is the same as most who are obsessed with the tsh which is what your pituitary is doing. The tsh blood test is the cause of many people being very ill, it should never have been used to measure thyroid disease.

I make sure that my free t4 is at the top and free t3

Towards the top of the lab ranges - I would not lower your dose, if anything I would increase it - if I were in your shoes.

[Hypottc]

Thank you everyone for taking the time out to read and reply, really appreciate your words of wisdom -I think I just needed the voices of reason to reassure me. Thank you for the links, they were interesting and reassuring to read. I have also looked up 'subclinical hyperthyroidism' and the studies appear to show no adverse effects in pregnancy, contrary to what the endo told me, he was talking about hyper not somebody in my situation where TSH is suppressed and ft4/3 normal. I feel better now and feel glad for all the advice I've found in this community and beyond. I feel sorry for all the ladies who these endos give bad advice to who are none the wiser. I have had two early miscarriage before this pregnancy and many months of trying, maybe if these professionals went through this themselves they might double check the information they give us and not be so convinced what they say is gospel.

[LKJ987]

Hi hypottc, know this is an old chain but I’m not in the exact same position as you! I wondered what has happened with your levels over the last few months and if you stayed on same dose? Thanks!

[LKJ987]

*now