T4 treatment in pregnancy

[diogenes]

This downloadable paper examines the FT4/TSH indication limits for T4 treatment in pregnancy. It also alleges that if women below these limits are treated with T4, the gestation outcome is improved. Useful for discussing with doctors if T4 treatment is needed or not in this situation.

Early Levothyroxine Treatment for Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy: The St Carlos Gestational and Thyroid Protocol

October 2021Frontiers in Endocrinology Follow journal

DOI: 10.3389/fendo.2021.743057

Isabelle runkle de la vega, Paz de Miguel Novoa, Ana Barabash, Alfonso L Calle-Pascual

[jimh111]

Thanks for posting, like your use of the word 'alleges'.

As far as I know all of the studies so far have looked at TSH in levothyroxine treated patients, not the healthy community. The claim 'In both groups, early LT significantly reduced the composite variable' is a downright lie, p=0.256 is nowhere near significant. So much for peer review.

The authors have refused to measure fT3, I suspect this is an attempt to reinforce the TSH / levothyroxine mantra.

There is a non-significant tendency to have adverse outcomes with TSH > 2.5. I wonder if this relates to a few women who perhaps also have low fT3 or some other disorder. As they point out 30% of women have TSH > 2.5 and so would be on levothyroxine at least during early pregnancy. Maybe they should put more effort in, measure fT3 and also other markers such as ankle reflex time, a much better marker for hypothyroidism than TSH.

[tattybogle in reply to jimh111]

curious .. do we know what happens to TSH level during and after a healthy (no thyroid problem) pregnancy ?

i've always assumed ,even in perfectly healthy people, it must go up/ down /all round the houses , whilst attempting to adjust thyroid hormone supply to the changing demands / increase in blood volume / increase in thyroid binding goblins etc. etc. etc .

Suppose i could read the paper . then i might find out but i'm being lazy & am a bit drunk . (Rugby and Cider)

[diogenes Remembering in reply to tattybogle]

It's an interesting story. In the first trimester, a hormone called HCG is at a very high level. This weakly affects TSH formation so that the TSH is slightly reduced compared with normal. In the second and third trimesters, the HCG falls so that TSH rises to a level typical of nonpregnant women. However for quite a few women post pregnancy, the thyroid axis can be temporarily disturbed and may take a little time to stabilise. In some, the disturbance can be permanent, with hypothyroiidism following.

[tattybogle in reply to diogenes]

Thankyou, Mine is one of them that 'went disturbed' and 'stayed disturbed' Got away with it with first kid , but not 2nd .

[diogenes Remembering in reply to tattybogle]

My wife ditto exactly.

[tattybogle in reply to diogenes]

Dangerous activity (getting pregnant ), i decided not to do it anymore.

My grannie had a 2nd kid and ended up committed for 5 yrs after, and got Electric shock therapy. No idea if anyone checked thyroid bloods in 1933 ?

Her daughter had 1 kid and immediately afterwards got a goitre hyper / partial thyroidectomy/ levo for life.

I had 2nd kid then went a little bit 'hyper', then hypo / levo for life .

.... my Daughter says if she wants a kid , she'll adopt one !

[diogenes Remembering in reply to tattybogle]

Babies' DNA of course is an amalgam of DNA from the mother and father. I hypothesise that if parts of the genetic fit are somewhat opposed to each other, it would be perfectly possible for the mother to receive, via the foetus, some element that causes her immune system to try to destroy it. If that happens to be thyroid related, then the immune system could easily turn on the mother and cause an autoimmune reaction which attacks her thyroid. It often intrigues me as how frequently thyroid trouble, temporary or permanent arises from not the first pregnancy so much, as subsequent ones.

[tattybogle in reply to diogenes]

Yes , interesting isn't it .... reminiscent of Rhesus Negative mothers and their 2nd pregnancies, although obviously not the same thing.

Curiously... i felt godawful from more or less 'day one' of the 2nd pregnancy, but had been fine in the first one.

My ante-natal card from the 2nd one has "tired, but well" written all over it. Felt permanently nauseous too .

[mountainice in reply to diogenes]

Thinking back, I also think things went wrong in the third pregnancy. I had two children at 23 and 25 and a third at 33. I was 8 stone after the second child (5ft 8", so quite slim) but when it came to the 3rd child I went up to 10stone 6lb and had strange mental manifestations in pregnancy that disappeared after the baby was born. The third child was large, 9lbs 1oz (other babies 7lb 4 and 7lb 11oz), which I read can be a sign of hypothyroidism and gradually, gradually, I put on more weight until I was 11stone 7lbs at about 46 years and had mental problems (screaming and panic attacks) and ended up in a psych ward for 4 months one year and 3 months the next. I think this was all thyroid/B12 related but I was never treated, until I started self-treating two years ago for hypothyroidism with help from this group as endos said nothing wrong with me.

[RedApple in reply to diogenes]

'post pregnancy, the thyroid axis can be temporarily disturbed and may take a little time to stabilise.'

So it's really no surprise that many women experience Postpartum Blues or Baby Blues. If only someone had explained that as a possible cause to me at the time, instead of telling me to 'pull myself together' and 'get on with it'.

postpartumdepression.org/po...

[tattybogle in reply to RedApple]

For the life of me, i cant understand why a thyroid blood test isn't a routine part of post natal care when there are mental / physical symptoms that could suggest a thyroid issue .

I mean , i realise that it might not be wise to immediately start treating everyone who had an 'iffy' TFT shortly after a birth, because a lot of them will be 'off' and then get right again by themselves ... but why the heck isn't the possibility of temporary thyroid imbalance even discussed in the rest of they information the give you in antenatal / post natal care .

It would have helped how i felt about myself if i knew there could be a physical reason for the state i was in.

Nobody thought to do a TFT when i went 'a bit nuts' and a 'lot too thin' after a birth .. ....they arranged an appointment with a counsellor (i didn't go )

[RedApple in reply to tattybogle]

Exactly! But back then, thyroid issues were even less on the medical radar, especially given the gender issues (that we can still be subjected to).

Here we are, in the 21st century, still fighting for correct diagnosis and treatment of thyroid disorders, despite all the power of information dissemination via digital means.