Pregnancy and Hypothyroidsim

[Diana31]

I have been hypothyroid for about 2 1/2 years now.  My TSH and Free T4 have been normal, but my T3 is always low.  I am currently taking 50 mcg of compounded T3, and feel pretty good.  However, I just had my quarterly blood work done, and things appear to be out of wack.  My free T3 is at 500, my free T4 at 0.84, and my TSH at 0.2.  Does this mean I am getting too much T3?  Also, I am wanting to get off birth control and start trying to become pregnant, will my dose change after I get off the pill?  How risky is hypothyroidism during pregnancy?  I had a very good pregnancy with my first child, but that was before my diagnosis.

[val1198]

Sounds like you need a combo of T4 and T3 instead of the straight T3.  Your thyroid levels should be carefully monitored during pregnancy.  Low thyroid in the early months can damage the baby.

[Mark Lupo, M.D.]

Tight control of TSH during pregnancy is key -- I have not used many compounded T3 products so would no be able to comment on the dependability in this regard.  If you go off OCP then you may need less thyroid, but when you become pregnant, you will likely need more again.  Work closely with your doctor during this time.

[winspiff]

Sorry, one more thing - because of estrogen's effect on thyroid hormone, you should standardize what part of the cycle you take your TSH in.  If you take one measurement during ovulation, one before, one after, and one during your period, you will not see much similarity.  Your quarterly readings may simply have been mistimed.

[winspiff]

Hypothyroidism is very risky during pregnancy.  A joint statement between the Center for Disease Control and the American Thyroid Association stated that any woman with a TSH above 2.5 should be treated for hypothyroidism.

A hypothyroid state can cause mental defects, miscarriage, low birth weight, fetal death, and many other birth complications.  It is vitally important that you keep your thyroid in check during the pregnancy.  This is true even for very low elevations in TSH.

Another important factor is to look at the big picture.  Are you having symptoms of hyperthyroidism?  TSH can be very variable in people with antibodies; 6 weeks from now your TSH may be back to normal.  If you are not having hyperthyroid symptoms, and your dose was keeping you within normal ranges before, do not panic and suddenly lower your dosage.  

Birth control can change your needs.  If you are taking birth control, you are most likely taking a dose higher than you would need when you stop taking the medication.  This is because estrogen increases proteins in the body that bind to and essentially inactivate thyroid hormone.

Having said that, increases in your natural estrogen during your 2nd semester will cause you to have to raise your dosage again.  Yes, I do realize this is complicated.  This is why you must work with your doctor to constantly keep track of all components of thyroid function, including fT3, fT4, TSH, and your symptoms.