jimh1114 years ago

These are good results, especially the fT3 which is high normal. The elevated antibodies mean she is at higher risk of becoming hypothyroid sometime in the future, IF the antibodies stay high.

maro in reply to jimh1114 years ago

Thank you that’s a relief , yes she will need to keep an eye on it. Thanks again

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SeasideSusieAdministrator4 years ago

Maro

For a successful pregnancy and a healthy baby, TSH should be below 2.5

I think she should take these results to her GP and ask him to take advice from an endo experienced in pregnancy/hypothyroidism, especially as she has raised TPO antibodies confirming autoimmune thyroid disease aka Hashimoto's.

What time of day was this test done? We always say early morning blood draw, no later than 9am, as TSH is highest then. Also eating lowers TSH according to member Diogenes (advisor to ThyroidUK and scientist) so delaying breakfast and tea, coffee, etc, until after the blood draw is advised. If she can get TSH over range, this is Subclinical Hypothyroidism, and with raised antibodies Levo should be started. But the most important thing now is that she needs TSH to be below 2.5.

maro in reply to SeasideSusie4 years ago

Thanks susie, yes I was concerned re TSH. I don’t think she done the test early as I forgot to advise her so it was prob done in the afternoon after work. I will ask her to make appointment to see g.p, if they are not willing to treat maybe I should advise her to start ndt .

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SeasideSusieAdministrator in reply to maro4 years ago

She should insist they test but make sure it's one no later than 9am and fast overnight, water only. I would get this one urgently.

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maro in reply to SeasideSusie4 years ago

Ok thanks susie, now I’m anxious as she prob can’t get appointment till next week

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SeasideSusieAdministrator in reply to maro4 years ago

At my surgery we can ring up at 8am for an on the day appointment. I would do that and stress that as she is pregnant and has a high TSH you consider this an emergency.

I don't want to scaremonger, but as the grandmother of 4 babies who didn't take breath due to my daughter-in-law's undiagnosed hypothyroidism then this is a subject very close to my heart and it upsets me greatly when I read posts like yours about your daughter. My d-i-l's TSH wasn't high enough for diagnosis despite symptoms, she had to get diagnosed/treated by a private doctor and only after a successful birth and healthy baby did her hospital notes say, after blood tests, "TSH satisfactory for someone on thyroid hormone replacement". Only then did her GP accept the diagnosis and agree to prescribed Levo on the NHS. She went on to have 3 healthy pregnancies and successful births although one of the children is autistic and I believe this might be linked but haven't done any research as he was only diagnosed when he reached 18, the school was very good at evading his issues.

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maro in reply to SeasideSusie4 years ago

Thank you susie I’ll make sure it’s done ASAP. As usual thank you for your excellent advice

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SeasideSusieAdministrator in reply to maro4 years ago

Maro - please let us know how it goes.

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maro in reply to SeasideSusie4 years ago

Will do susie xx

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jimh1114 years ago

Mary, I need to correct my comments as I thought your daughter had her blood test before pregnancy. First, the guidance varies between bodies and countries, you daughter's case is marginal.

Her elevated antibodies gives her a higher risk of becoming hypothyroid sometime in the future. She also has a risk of developing Hashimoto's thyroiditis. Having antibodies does not equal Hashimoto's thyroiditis, it's only Hashimoto's thyroiditis if the thyroid is harmed ('itis' means inflamed). Lots of people have elevated antibodies, only a minority go onto Hashimoto's.

All guidance says to treat pregnant women who are hypothyroid. This is defined as an elevated TSH and low fT4. Some guidance says to treat pregnant women who have 'subclinical hypothyroidism' (I hate this term). Subclinical hypothyroidism is defined as an elevated TSH and normal fT4. This gets messy. In some countries an elevated TSH is defined as a TSH above the upper limit of its reference interval, for example above 5.0. In other countries they refer to trimester specific TSH 'ranges' and in this case it might mean a TSH above 2.5 in the first trimester or above 3.0 in the second and third trimesters.

Some guidance specifies that pregnant women with elevated TPO antibodies should be treated as if they are hypothyroid. i.e. keep TSH below 2.5, 3.0, 3.0 for the three trimesters.

I believe (my knowledge is rusty on this) that it can be difficult to measure fT3 and fT4 during pregnancy, it depends on the assay used. I also believe the total T4 assay is usually OK. Note the lack of certainty in my comments. So, it looks like her T4 levels are fine, based on her total T4 result which I think we can trust.

It's not routine to measure (screen) antibodies in pregnant women who are not hypothyroid, a decision based on risk / cost / benefit. I'm not sure about not screening antibodies, I'm just pointing out that it's not thought to be a big issue.

My inexpert opinion is that your daughter is borderline. Depending on which country she is in, which guidance and which endocrinologist she might get differing advice. If it were me (it couldn't be) I would ask for a little levothyroxine to bring my TSH below 2.5 initially and keep it below 3.0 after the first three months. I'd then ditch the levothyroxine after delivery (unless I became hypo). I don't think it's a good idea to take thyroid tablets if you don't need them, they're never as good as your own thyroid.

Sorry, for the earlier confusion. As you can see it's a complicated situation, perhaps because her thyroid status is marginal.

maro in reply to jimh1114 years ago

Thank you that makes sense. We're in th UK so not sure nhs test for antibodies but if tsh higher than 2.5 then they should prescribe levo hopefully. Thanks again for replying you and susie have been most helpful.

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jimh111 in reply to maro4 years ago

I think it is the presence of antibodies which tips the balance in favour of keeping TSH below 2.5. The other factor is this blood test was run when she is pregnant and for complex reasons I've never got into TSH is lower in the first trimester, so the usual reference interval (e.g. 0.5 - 5.0) doesn't apply.

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HughH4 years ago

TSH is not a thyroid hormone. It is produced by the pituitary gland and travels in the blood to the thyroid gland where it signals to the thyroid gland to produce more thyroid hormones. High TSH is used by doctors to indicate hypothyroidism but does not in itself cause symptoms.

Thyroxine (T4) is a thyroid hormone but is not an active hormone, it needs to be converted to T3 to become active.

T3 is the active thyroid hormone which controls the metabolism and therefore the symptoms. It is therefore the best way to diagnose hypothyroidism. Your daughter's Free T3 is near the top part of the normal range, which is good, so she should not have hypothyroid symptoms.

maro in reply to HughH4 years ago

Hi hugh yes she seems well in herself we are concerned that due to tsh being higher than recommended for pregnancy that she would need treatment but then that may elevate her t4 and t3 too much?

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HughH in reply to maro4 years ago

TSH is not a thyroid hormone so will not have any impact on your daughter or her baby - it just tells the thyroid to make more hormones.

Your daughter has good free T3 and as she is well she should not need any thyroid treatment.

Some doctors, through lack of understanding, will prescribe based on TSH, because they do not normally do a free T3 test. However when a free T3 result is available this should be the main guidance in terms of treatment.

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maro in reply to HughH4 years ago

Thank you hugh that has eased my anxiety

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