Hello! I posted here when I found out I was pregnant and I’m back again. I self treat with Thyroid-S for the past 5 years (will move to a backup of Thiroyd I have in the freezer once I run out) and have always had my own labs done and adjusted the dose accordingly. I’ve been doing well on it this whole time. When I found out I was pregnant I raised my dose 25% (did it with first pregnancy as well with great success). My OB has several doctors on board and I do not get to pick who I see, as a result my thyroid is an issue at every single appointment. I’ve told them my GP is watching my thyroid (a lie) to get them off my back because my TSH is suppressed (free T3 and free T4 are normal, if not a little lower than I’d like the free t4 to be - checked every 4 weeks). They are trying to force me to go on medication for hyperthyroidism even though I have explained over and over and over that it is unnecessary if my T3 and free T4 are normal. Any advice on how to deal with this? My first pregnancy they let it go after the 2nd trimester but I’m 17 weeks now and have been hounded about it every single appointment. I have had my iron (normal), ferritin (slightly over range, normal in pregnancy), and B12 checked (normal) and my T3 has been consistently upper 1/4 of the range and my free T4 mid to slightly below mid range. I have zero plans to change my dose - at least not before 20 weeks when baby’s thyroid is fully functional.
Pregnancy, OB overreacting: Hello! I posted here... - Thyroid UK
Pregnancy, OB overreacting
Problem is like so much about thyroid treatment, what to do before, during & after pregnancy has its own considerable share of controversy!
A run through the literature alongside patient accounts highlights
this and here in the U.K. definitive guidance due to be issued by RCOG has got delayed because of Covid.m
What is generally accepted is that broadly speakin TSH levels need to be kept relatively low with an increase in T4 medication to ensure the foetus receives an adequate supply of Levothyroxine via the placenta. T3 medication & FT3 levels are another matter altogether with a few reports of poor Mums to be even getting their T3 meds withdrawn during pregnancy & T4 meds increased. While only a bloke, what that must have done to the poor mother during labour beggars belief! There is a limited amount of literature pointing at T3 medication not actually being a danger to the foetus as has been thought but am not confident that that is generally accepted.
So in your situation ...
First, your medics are very likely obsessing on your suppressed TSH and assuming they are aware of the component proportions of T4 & T3 may be concerned about the T3 element regarding the foetus as well. (And I assume you do not have any known underlying cardiovascular issues.)
Going by your results your suppressed TSH is almost certainly due to the T3 content and so is unreliable & FT4/FT3 levels are significant ... but this in itself is still an emerging understanding with as of yet very limited traction amongst practising clinicians.
That you’re being asked to effectively reduce your body’s thyroid levels given your are pregnant & what your FT3 & FT4 levels are demonstrates worrying lack of awareness of the needs of both the foetus and the mother.
I’m not familiar with the abbreviation “OB” where do you live?
Anyway, have you considered under pressure both making a slight, temporary adjustment in coming down on the NDT & taking on a concomitant increase in T4 so as to hopefully both increase your TSH level & increase T4 availability for the foetus. You could of course leave things as they are or even add a little T4 instead, but the ensuing further TSH suppression will not go down well at all!
There is useful commentary regarding T4 needs here
cks.nice.org.uk/topics/hypo...
Look in the “Basis for recommendation” box in particular.
While of course that doesn’t square up with the “obsession” with suppressed TSH while on T3 meds. You may be able to better argue that your FT4 level must not be reduced under any circumstances.
So regarding T3, the paper below is quite complex technically and about the development of human preimplantation embryos but to my mind it indicates the importance of the presence of FT3 at the very earliest stages of foetal development. Whether you could draw on that successfully in discussion with Clinicians is debatable but it seems indirectly to support the importance of retaining healthy FT3 levels as well
as FT4 levels!
stemcellsjournals.onlinelib...
Be strong!
Thank you! I’m in the US - I use this board because we don’t have anything nearly as helpful here in the US. You guys are the true experts and US doctors are notorious for misunderstanding how the thyroid works. I guess I will just have to stand my ground with my obstetricians (OBs) - it’s difficult because they think they know best, even more than a GP who usually has more thyroid knowledge than an obstetrician/gynecologist.
Oh boy ... obstetricians are suggesting that? 😱😤🤯
Have you read through this ATA paper ...
liebertpub.com/doi/10.1089/...
Am not myself very familiar with the content in detail but you may find info to support you when in discussion with your Obs!
Keep going!
And just to add ... HU is a very special
place for us patients ... do not imagine for a moment that the general state of knowledge amongst our doctors is any better than yours in the USA!
Thank you! I’ll read over it more closely. I did try to explain to one of the obstetricians that pregnancy itself sometimes causes a suppressed TSH (I read up on this, something to do with an increase in T4 and HCG) but they are all just so hyper focused on TSH. Maybe I need to remind them that they work for me, I pay over $100 USD to see them each visit! haha!
Hah ... re TSH @ suppression during pregnancy that gets a mention very early on in that ATA paper ... maybe you have read before!
Anyway goodnight from me in the U.K. ... it’s 1.50 am here & time for bed!
Thanks for your help!!
Ive nothing much more to add other than stick to your guns as its your baby your life!! The ignorance of doctors around the treatment of hypothyroidism is truly staggering & gets worse.......their pledge of "first do no harm" seems to go right out the window with this condition!!
The excellant Endocrinologist I finally saw (to tick a box for my script) said if you keep Ft3 and Ft4 in range you can do no harm. The TSH is irrevelant when on a combination treatment and will always be supressed. He also told me that there has been no body of research out there to prove the TSH is what matters in the treatment of hypothyroidism. Its a hot potato in the endo world. This means they will not be able to produce a body of scientific evidence to show you are wrong. Ha ha!! I found great comfort in that!! Stay strong you did your last baby proud. Hugs xx
Agree! They do work for you and as a Canadian fan of this site, I encourage you to stand your ground on that score. Further, I’d suggest you ask them to note everything they’re suggesting and why in your chart along with your rebuttals that include links to research papers etc. If you like, printing out papers in hard copy that you bring for them to read is something I’ve done in the past. Ask them to note whether or not they actually read them in your chart as well. It makes liability a very real issue once something is in writing. We also have an excellent Canadian thyroid patient page on Facebook with members from US and UK that has tons of information and is extremely well moderated with the page admin being both a scientist and a thyroid patient with years of research and experience under her belt. Congratulations on your pregnancy, wishing you all the best!
I have underactive thyroids , and Iv just found out I’m pregnant I would honestly take the medication they are asking you to take as if not your thyroid can lead to miscarriages and problems in the baby throughout your pregnancy xx
Reread the post please. I am already on medication for hypothyroidism.
Actually the doctors wanted to treat her for HYPERthyroidim which they mistakenly believe is always the diagnosis if TSH is low. The treatment to suppress her thyroid output would make her very ill and might kill her baby.
Stick to your current plan....you’re correct. Ft4 and Ft3 are always the most important results. And you’re correct when taking any NDT or T3 TSH is almost always suppressed
Some links you may find helpful / interesting that I bookmarked on the subject of pregnancy - note that several of the first few links probably refer to the same person who was pregnant - they aren't all related to different pregnancies :
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
pharmacytimes.com/publicati...
Related to iron deficiency while pregnant : cdn.mdedge.com/files/s3fs-p...
patient.info/doctor/thyroid...
liebertpub.com/doi/pdf/10.1...
See last page : gps.northcentrallondonccg.n...
library.wmuh.nhs.uk/wp/libr...
library.wmuh.nhs.uk/wp/libr...
eprints.gla.ac.uk/137067/1/...
Read the text and click on "View e-Poster" for this link : endocrine-abstracts.org/ea/...
ncbi.nlm.nih.gov/pmc/articl...
Good luck.
I’d also recommend reading up on these articles. According to Dr Izabella Wentz, known as The Thyroid Pharmacist, your TSH should be no more than 2.
These two articles by her are about the thyroid and pregnancy and are invaluable on how to manage your pregnancy:
Thank you all! My obstetrician called me today (after I talked to her medical assitant yesterday and told her I would not be taking any medication while my T3 and T4 were normal) to ask if my GP wants to treat my hyperthyroidism. I’m so sick of having this conversation. Hopefully that will be the end of it.
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