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TTC after thyroidectomy w/suppressed tsh?
Hello, I'm really hoping you will take the time to read this post because I'm at my wit's end and I'm receiving conflicting opinions from doctors.
History: I had a total thyroidectomy in 11/03 due to papillary cancer. The nodule was very well contained. I had a small dose of RAI treatment post-surgery.
Fast forward to now. My husband (just turned 42) and I (just turned 40) have been trying to conceive (TTC) for three years. We've (both of us) had every test imaginable and all has come back normal. We have had four chemical pregnancies within this time. I'm working with a fabulous ob/gyn as well as a fair RE. I no longer see a regular endo as I cannot find one who is Armour-friendly. I take a combo of Armour (2grains) and Levothyroxine (88mcg). I mostly feel good.
My most recent levels are as follows:
On 8/8/08, my TSH remained suppressed at 0.02 , my Free T4 was .9 (range .7 - 1.9), and
my Free T3 was 3.9 (range 2.8 - 5.3).
Two months prior, on 6/13/08, my tsh was at <0.02, my Free T4 was 1.0 range .7 - 1.9),
and my Free T3 was at 4.5 (range 2.8 - 5.3).
These levels are typical. My levels were very similiar to the above numbers even when I was on straight Levo with Cytomel. As you know, TSH is generally kept suppressed when treating post thyroid cancer.
My question: could my suppressed TSH and subsequent "subclinical hyperthyroidism" be causing a problem with TTC? Have you known of any women who have conceived and carried to full-term with labs like this? Or is it the opposite issue ie. "I actually need my Free T4 and Free T3 to raise into the upper end of the range"?
Any help would be greatly appreciated. Thank you so much.
- Dev
History: I had a total thyroidectomy in 11/03 due to papillary cancer. The nodule was very well contained. I had a small dose of RAI treatment post-surgery.
Fast forward to now. My husband (just turned 42) and I (just turned 40) have been trying to conceive (TTC) for three years. We've (both of us) had every test imaginable and all has come back normal. We have had four chemical pregnancies within this time. I'm working with a fabulous ob/gyn as well as a fair RE. I no longer see a regular endo as I cannot find one who is Armour-friendly. I take a combo of Armour (2grains) and Levothyroxine (88mcg). I mostly feel good.
My most recent levels are as follows:
On 8/8/08, my TSH remained suppressed at 0.02 , my Free T4 was .9 (range .7 - 1.9), and
my Free T3 was 3.9 (range 2.8 - 5.3).
Two months prior, on 6/13/08, my tsh was at <0.02, my Free T4 was 1.0 range .7 - 1.9),
and my Free T3 was at 4.5 (range 2.8 - 5.3).
These levels are typical. My levels were very similiar to the above numbers even when I was on straight Levo with Cytomel. As you know, TSH is generally kept suppressed when treating post thyroid cancer.
My question: could my suppressed TSH and subsequent "subclinical hyperthyroidism" be causing a problem with TTC? Have you known of any women who have conceived and carried to full-term with labs like this? Or is it the opposite issue ie. "I actually need my Free T4 and Free T3 to raise into the upper end of the range"?
Any help would be greatly appreciated. Thank you so much.
- Dev
A related discussion, Difference between FT4 and T4 was started.
Hi Devra,
Dr. Lupo doesn't normally answer a question more than once.
So I'll try to answer here:-
Actually increasing the thyroid meds will suppress the TSH further. That cannot be avoided. The only way to increase the TSH is to reduce the thyroid meds.
The issue is how to get a balance.
My TSH has always been pretty low.... The month I got pregnant my TSH was
0.06 (range 0.47-4.64), FT3 was 2.67 (range 1.45-3.48) and FT4 was 1.17 (range 0.71-1.85).
My doctor also monitors for any hyper symptoms - which I have never had.... if your TSH is very low and you have symptoms of hyperthyroid, this may be a concern to be watched closely.
My understanding is that when trying to get pregnant they would prefer us to be on the side of slightly hyper (if ever), than hypo.
My latest testing about 10 days ago showed TSH was 0.02, with FT4 being only 1.09. My doctor had me increase my T4 dose by 25 mcg (that will be my second increase so far). My Dr. said during pregnancy he is only concerned with the FT4 and doesn't worry even if the TSH looks very suppressed.
This is my experience. However, you should work closely with your doctor.
Best wishes in having your dreamed of child.
Sally
Dr. Lupo doesn't normally answer a question more than once.
So I'll try to answer here:-
Actually increasing the thyroid meds will suppress the TSH further. That cannot be avoided. The only way to increase the TSH is to reduce the thyroid meds.
The issue is how to get a balance.
My TSH has always been pretty low.... The month I got pregnant my TSH was
0.06 (range 0.47-4.64), FT3 was 2.67 (range 1.45-3.48) and FT4 was 1.17 (range 0.71-1.85).
My doctor also monitors for any hyper symptoms - which I have never had.... if your TSH is very low and you have symptoms of hyperthyroid, this may be a concern to be watched closely.
My understanding is that when trying to get pregnant they would prefer us to be on the side of slightly hyper (if ever), than hypo.
My latest testing about 10 days ago showed TSH was 0.02, with FT4 being only 1.09. My doctor had me increase my T4 dose by 25 mcg (that will be my second increase so far). My Dr. said during pregnancy he is only concerned with the FT4 and doesn't worry even if the TSH looks very suppressed.
This is my experience. However, you should work closely with your doctor.
Best wishes in having your dreamed of child.
Sally
Thank you to both Dr. Lupo and Sally for your responses! I really appreciate it!
Sally, it sounds as it your situation was similar to mine. So, while you were increasing meds to adjust your Free T3 and Free T4 to high normal, did your TSH remain suppressed? If so, how suppressed?
I'm wondering how one adjust meds to make Free T3 and Fee T4 high normal while simultaneously bringing TSH slightly higher so it is not so suppressed? That seems contradictory to me.
I look forward to your response. Thanks so much for your help!
Peace,
Dev
Sally, it sounds as it your situation was similar to mine. So, while you were increasing meds to adjust your Free T3 and Free T4 to high normal, did your TSH remain suppressed? If so, how suppressed?
I'm wondering how one adjust meds to make Free T3 and Fee T4 high normal while simultaneously bringing TSH slightly higher so it is not so suppressed? That seems contradictory to me.
I look forward to your response. Thanks so much for your help!
Peace,
Dev
MEDICAL PROFESSIONAL
Recent data suggests that T4 only is the treatment of choice during pregnancy as the fetus needs T4 for development and less so T3. So the current thought is T4 only in this situation and to keep the TSH in the low range (0.1-0.3 perhaps?) but not over-supressed -- particularly if you are already having problems with TTC/carrying.
This is a tough situation....the T3 part seems more straight-forward perhaps, but the experts debate TSH suppression in thyroid cancer patients becoming pregnant.
This is a tough situation....the T3 part seems more straight-forward perhaps, but the experts debate TSH suppression in thyroid cancer patients becoming pregnant.
Hi,
I cannot comment from the Dr's point of view. He will answer himself.
However, I am being treated for hypothyroid. My TSH numbers are usually very low, while my FT3 and FT4 were low to mid normal.
I also take a combination of dessicated thyroid and T4. Last year I told my endo that I wanted to have a baby. I am 37, nearly 38. We then adjusted my thryoid meds so that my FT4 and FT3 were high normal. I became pregnant with no trouble in May of this year. Since I've become pregnant we continue to monitor FT3 and FT4 and are still trying to keep them high normal (last test was only mid normal so we've increased meds again).
Everyone is different, but would just like to let you know that my situation appears similar and I was able to get pregnant and so far I'm 4 months on and everything is looking good.
Best wishes
Sally
I cannot comment from the Dr's point of view. He will answer himself.
However, I am being treated for hypothyroid. My TSH numbers are usually very low, while my FT3 and FT4 were low to mid normal.
I also take a combination of dessicated thyroid and T4. Last year I told my endo that I wanted to have a baby. I am 37, nearly 38. We then adjusted my thryoid meds so that my FT4 and FT3 were high normal. I became pregnant with no trouble in May of this year. Since I've become pregnant we continue to monitor FT3 and FT4 and are still trying to keep them high normal (last test was only mid normal so we've increased meds again).
Everyone is different, but would just like to let you know that my situation appears similar and I was able to get pregnant and so far I'm 4 months on and everything is looking good.
Best wishes
Sally
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