Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
hypothyroidism and pregnancy
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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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hypothyroidism and pregnancy

I am 30yo and was dx'd with hyperthyroidism in 10/06 following the birth of my first in 3/06.  Unclear if post-partum vs. graves b/c I couldn't undergo testing as I was still nursing.  Thyroid globulin and thyroid peroxidase ab's were high.  Was started on PTU.  Became pregnant again in 1/07.  Was able to stop PTU at about 7-8 weeks in feb.2007 secondary to levels normalizing.  Free T3 and T4 have continued to trend down.  I am currently ~25 weeks and my last levels were as follows:
4/16/07 free t4 1.08 (ref 0.89-1.8);  free t3 3.3 (ref 2.3-4.2)
5/15/07 free T4 0.84;  free T3 2.6
6/11/07 free T4 0.84;  free T3 2.4;  TSH 0.086 (ref 0.35-5.5)
My OB wants to start synthroid, but endo doesn't.  I don't understand the low tsh in relation thyroid level as I wouldn't expect to be pregnant and have pituitary issues.
Of note I had to start on insulin at 9 weeks with this pregnancy (pre-pregnancy weight 100lbs and 5'2''), so not typical time frame or body type for gestational, although I also had to be treated with insulin with ny first.(A1C non-pregnant 5.0 & GAD ab's neg)
Also my mom had Addison's and hypothyroid (presumed polyglandular autoimmune syndrome)dx'd in her 20's.
Sx's (fatigue & weight gain) are present, but hard to sort out while pregnant
?'s:
1.  Do you think you would start synthroid
2.  Any other ideas re: funky thyroid studies
Thank you for your time and input.  I really like my specialist, but am just interested in hearing another opinion.
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Would not start synthroid.  The OB is concerned about the low normal T3 and T4 levels - but these levels are sometimes difficult to interpret during pregnancy and checking total T4 may be more revealing as estrogen increases thyroid-binding-globulin.  The low TSH suggests subclinical hyperthyroidism which does not need treatment in pregnancy according to recent research.

the autoimmune family history is important to keep in mind, glad the GAD ab was neg.
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i was diagnosed with sub clinical hyperthyroidism w/multiple nodule goiter just last week.  i am acutually have an uptake and scan done later this afternoon.  i am TTC and my endo thinks the best route would be to do RAI.  i am torn as she also said that another choice would be to start on meds but this would increase my chance of miscarriage.  can you help me out here on which option would be better.

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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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