Postpartum thyroiditis - Next steps?

[Lola33]

Hi there,

At six months postpartum I discovered I had an under active thyroid. This was definitely a postpartum thing as I had been tested prior to getting pregnant and during pregnancy. From previous testing, I also know I have thyroid antibodies. Doc put me on 50mg of levothroxine which then increased to 75mg.

About a month ago (ten months post partum), I had follow up tests and my results came back in range (see below) which I was really happy about.

TSH - 2.05

Free T4 - 17.0

I thought doc would reduce my meds or taper off but he has kept me on 75mg and said to retest in another six to eight weeks.

Would you agree with this approach?

I’ve been feeling really anxious the last two days which of course could be anything, but I’m worried my under active thyroid could be swinging the other way if I am over medicated!?

Any thoughts would be most welcome.

Thank you!

[PurpleNails Administrator]

Please can you add ranges. Ideally FT3 needs to be tested to check you are converting adequately.

Did you test as recommended? Fast overnight, Early draw, delaying dose u til after & stop any supplements containing biotin.

Most feel best with TSH under 2. FT4 top 3rd of range & FT3 over 50%.

Regular checking levels (6 weekly ) & adjusting dose by 25mcg is standard approach.

[SlowDragon Administrator]

also test vitamin D, folate, ferritin and B12

What vitamin supplements are you taking

[humanbean]

Would you agree with this approach?

Yes!

There are women who develop hypothyroidism during or after pregnancy whose doctors are really keen to get them off their thyroid hormones. It is fairly common for the patients to then become very hypothyroid, and to have poor health for months or even years before a doctor finally agrees to reinstate the thyroid hormones.

Although my hypothyroidism has nothing to do with pregnancy or childbirth, in the early days of my treatment I tried coming off my thyroid hormones for three or four months and regretted it enormously. It took at least a year for me to recover back to how I was before I stopped, once I restarted taking the hormones.

A TSH of 2.05 might be well in range and isn't particularly bad but it is possibly too high when compared to that of people who've never been short of thyroid hormones. High TSH indicates hypothyroidism. Hyperthyroidism would show with a very, very low TSH, e.g. 0.005 or less.

See this graph for TSH levels in people with healthy thyroid glands :

web.archive.org/web/2004060...

You haven't given us the reference ranges for your results but if the ranges are the standard ones then your Free T4 is right in the middle of the reference range. For most hypothyroid people this level would be too low. Most of us feel best with a level of roughly 60% - 80% through the range. If you were hyperthyroid and on treatment for hypothyroidism your Free T4 would be sky-high.

Someone who is hypothyroid cannot become hyperthyroid, although they can be over-medicated. There is no evidence that you are over-medicated.

But one very important point is that your results don't include a result for Free T3, which is the active thyroid hormone. If your Free T3 is low it can cause all sorts of symptoms, including anxiety. In fact, the symptoms of both hypothyroidism and hyperthyroidism are usually caused by their Free T3 level being too low (hypothyroidism) or too high (hyperthyroidism).