I’m currently 5 weeks pregnant. I have hypo and previously hashis though antibodies have remained at 25 for the past year.
Bloods at the 5 week mark should t4 at 20.7 t3 4.1 and tsh 0.22
these are all normal results for me and where I do well.
However my expectation was that I would increase the dose of levo by 25mcg as soon as I got a positive pregnancy test but wouldn’t that send me over the ref range of 22 for t4 and push the tsh lower. So I’m confused at the guidance to up the dose, I appreciate the body needs more and baby uses some where is line?
I can’t seem to find ref ranges for trimester for the lab used just previous notes of non pregnant lab ranges which topped out at 22 for t4.
thanks
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Wee_Bird
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I don’t have the ranges to hand I just know that the top of the range for the t4 was 22. I don’t really look at the ranges for the tsh as it always stays on that low end and seems to be my normal. I’m also happy that my t3 is within range I think from memory it was 5.6 top range.
It wasn’t a morning blood as I could t get an appt. But I had taken my last levo 24 hours before exactly and a split t3 dose 24 and 12 hours prior as always.
I’m on a dose of 125mcg levo and 5mcg lio. Everything has been very stable and well monitored for the past year. My Dec results showed t4 at 17
I have an endo but I won’t see him for a few weeks so it’s what to do in the interim. My gut says leave it as it is as it seems to have risen naturally anyway and re test in 2 weeks before I see the endo with the results.. But as I have always understood that you increase by 25% immediately upon positive test and did this in my last pregnant, I’m just trying to gauge are there circumstances like mine where there isn’t a requirement for this or do the pregnancy ranges differ from normal ranges and therefore generally is it expected that you’ll go over the range when pregnant and increasing by 25%
I’m not really looking specific instruction, if that helps, but just general thinking as to possibility of sometimes not needed to immediately increase but I’m aware of the increased need for thyroid hormone in pregnancy also and trying to understand the nuance.
Congratulations on your pregnancy.As you had your test later in the day that result will be inaccurate unfortunately. TSH is diurnal and at its highest during the night. It starts to drop after 9 and after food. If you had had this test before 9 it would have shown a higher TSH and a lower FT4.
I'd see if you can book another test before 9 and hopefully before you see the Endo. Your dr should also mention that you are pregnant so they use the pregnancy related ranges.
I'd also ask for Ferritin (iron), B12, folate, Vitamin D and full blood count as if they are low they can affect the thyroid hormones.
Here are the NICE Pregnancy Hypothyroidism Guidelines your dr and Midwife should be following:
Well, to begin with, the TSH doesn't matter. It's totally irrelevant. It will drop if you increase your dose, of course it will, but that won't change anything or have an effect on anything. The important number is the FT4 at the moment. And that's fine. You don't need an increase.
Yes, I know the general rule is that you should have an increase of 25 mcg as soon as you know you're pregnant. But even general rules should be adapted to fit the person. Most women would need that increase as most of them wouldn't have an FT4 that high. You have a high FT4 because you're a poor converter. So, what you should do is keep an eye on that level and increase if and when you need to.
By the way, you do still have Hashi's. Antibodies fluctuate but Hashi's doesn't go away. The antibodies are the result of the disease, not the cause.
Thank you very much for your reply grey goose. Your responses are always extremely informative.
Could you give me a little more info on what a poor converter means and if there is anything I can be doing to assist this?
Thankyou also for the info on hashis. My understanding was once those antibodies went down that it was reversed. I have spent years implemented lifestyle and diet changes and a long time on LDN with the sole goal of improving my health and vitality to try and get rid of the hashis element of this thyroid issue. My further hope was that I may be able to improve my thyroid function overall therefore no longer even requiring medication but maybe this isn’t possible as some would suggest?
As I'm sure you know, T4 (levo) is basically a storage hormone that doesn't do very much Until it is converted into T3, the active hormone. Conversion is the removal of one atom of iodine - T4 has four atoms for every molecule and T3 has three - by a protein that is called a deiodinase. In a healthy body, this happens automatically but hypos can't always do it very well. There are many possible causes of poor conversion but the odds of you ever finding out wy you're a poor converter are pretty slim. You can try optimising your nutrients, but there's no guarantee that that will help conversion. So, no, there's not much you can do about it.
I cannot imagine where you got the idea that reducing antibodies got rid of Hashi's. As I said, antibodies are the result of the disease, not the cause. Some people believe that it's the TPO/Tg antibodies that attack the thyroid. They don't. What they do is come along during/after an autoimmune attack on the thyroid to clean up the blood because during the attack traces of TPO and Tg can leak into the blood where they shouldn't be. The antibodies make sure it is removed. So, the fact that your antibodies are now very low could mean that the bulk of your thyroid has now been destroyed and there's nothing much left to attack. So, they don't have a job to do anymore. But you'd have to have an ultrasound to find out.
But you will always have Hashi's. That just doesn't go away and could flare up again at any time. It's good that you've made improvements to your life-style and diet, but Hashi's was never about either of those. And I've heard a lot of good talked about LDN - although never been able to try it - but even that cannot - doesn't not - get rid of the autoimmune element of your disease.
As for improving your thyroid function enough to stop your levo, that's not going to happen, either. Even if, by some fluke, you were able to halt the disease, your thyroid was already so badly damaged - witnessed by the need to take thyroid hormone replacement - that you're always going to need exogenous hormone of some kind because thyroids cannot regenerate.
The internet is full of stories of people claiming to have cured their Hashi's and come off their thyroid hormone, but you'll notice that you never get up-dates five/ten years later. Sometimes, on forums, you do get people who have made these claims come back for new advice on thyroid hormone replacement, but normal it's just silence.
The thing is with Hashi's, after a 'hyper' swing, when levels are coming down again, the disease can go into a sort of remission, and your levels can stick at euthyroid for quite a while - years even, from what I've read on forums - and people that stopped their levo when the 'went hyper' don't feel the need to restart it for quite a while. But, sooner or later, the levels will drop to hypo and they do need to go back on their thyroid hormone replacement. That's just the way it is, I'm afraid.
Wow this is fascinating. Thank you for taking the time to put together all of this info. It’s really very appreciated. As you say, you hear different stories and posts and it pulls you away from the reality of it.
I have an appt with endo in a few weeks and will be pushing for a scan on the thyroid now. Thank you very much.
20 years after my diagnosis, my antibodies dropped very low and a doctor said I no longer had Hashimoto’s. An ultrasound then showed an atrophied gland. My antibodies (very high at the time of diagnosis) have remained in range for the past five years so I guess their ’job’ is done and there is no thyroid tissue left to destroy. And I remain very much hypothyroid. As greygoose says, unfortunately that is how this disease works. And, even if your gland does not atrophy (not all do), there will be loss of thyroid tissue.
it is usual/ common for levels of TPOab to reduce over many years in autoimmune hypo patients, some ups and downs in levels are to be expected too , but with a general downwards trend . mine were >3000 [0-50)at diagnosis 22yrs ago , 17yrs later they were 195 , last year they were 101
i made no alterations to diet/ lifestyle to try and get my TPOab levels lower , the reduction has just happened over time , as it does in many long term patients.
In theory , i think this is likely due to ongoing destruction of my thyroid gland by the autoimmune process , meaning there is now less thyroid tissue, so less thyroid peroxidase is spilled when it is attacked , and therefore less thyroid peroxidase antibodies appear to clear it up.
i haven't had an ultrasound, so no idea what has happened to my thyroid gland in reality.... but i do not take my lower TPOab levels as a sign that the autoimmune disease has gone away , just that it now hasn't got as much thyroid left to have a go at.
thank you so everyone for your responses. They have all been extremely helpful and enlightening. It’s what makes this forum so good, the info is just of such reputable quality and cuts through all the noise out there.
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