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4.5 months pregnant and in remission for Graves.
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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4.5 months pregnant and in remission for Graves.

I was diagnosed with Graves disease back in 2002 and was on methimazole for a year and a half before going into remission. Because of this, I wanted to make sure it did not come back during my pregnancy. I had my doctor test my TSH levels at 15 weeks and they came back at 0.013, very low.  She proceeded to test both free T4 (16 weeks) and total T4 (17 weeks).  Total was around 16, slightly high, but free T4 was perfectly normal. My OB says that because free T4 was normal that I shouldn't worry, but that she will continue to test periodically. I'm concerned that my TSH was so low in the first place, I didn't think that hCG could drop it that low.  Also, my pulse is elevated again, the first symptom I developed back when I was first diagnosed with Graves.  Should I be concerned that the Graves is back and start PTU, or is this a normal thing to happen to one with previous Graves who is pregnant?

Thanks.
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The TSH is low but it's early in pregnancy so there is an HCG effect that can drop it to 0.03 range usually and on top of that you may have an effect of Graves - both of which usually improve as you are further in to the 2nd trimester.  Your OBGYN is right that PTU is usually not needed at this point but close monitoring is important.  Would ask for TSI test (immune system test of Graves, aka TSH-Receptor Ab).
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I too was diagnosed with Graves disease and am pregnant.  I was diagnosed in Feb 2004, 3 months after my son was born.  Now I am 32 weeks pregnant with my 2nd child and am in complete remission.  I was change last Dec from tapazole/methimazole to PTU and it was a small dosage.  In april, he took me completely off of the meds.  My levels come back perfect every time and my goiter has actually decreased in size.  My BP and pulse are always a little elevated, but most people tend to have elevated BP and pulse while at the doctor.  If it is just a minor elevation, I would not worry.  Just continue to have your TSH levels monitored and keep up to date with both the endo and ob/gyn.  My worry is about after delivery what will happen.  I have asked my dr about postpartum with the graves disease and not received much of a response.  So my question to you and anyone who reads this is....What are the chances it will stay in remission and for how long?  Will it be an immediate resurgence of the disease?  Good luck with your pregnancy and the Graves disease!
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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