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Pregnancy Labs Updated -Should I be concerned?

August 5, 2011 (before conception)
TSH     0.01    range 0.40-4.0
totalT3  223    range 60-181
FreeT4  1.45    range  0.5-1.50

October 15th 2011 (9 weeks pregnant)
TSH <0.01    range 0.40-4.0
FreeT3  3.7   range 2.3-4.2
FreeT4  0.99    range 0.5-1.50

November 19th 2011 (13 weeks pregnant)   same ranges
TSH  0.01    
FreeT3  2.8
FreeT4  1.35
TSI       2.0    (anything under 1.3 is considered abnormal)

So at this point, the endo says that I'm "subclinical" and although my labs aren't great, their ok for not being medicated.  However, she wants to recheck every four weeks and wants to do a 20 week ultra sound to check the babies thyroid.  She also said that the Antibodies can cross the placenta wall so we should check them again in the second trimester.  This woman is EXTREMELY difficult to get on the phone, and has a thick German accent and very hard to understand, so whatever help you can all give me would be SO appreciated!  here are my questions:

1.  If my labs aren't bad enough to medicate, then why are we worried about the size of the babies thyroid gland?  What are the chances of me having a baby who's hyperthyroid?

2. Can I take Selenium during pregnancy to lower antibody levels? (nobody can seem to answer this) And is it true that only the TSI antibody is the one that is of concern, not the others (which are SO much higher)

3. Why would my TSH stay the same, but my T3 and T4 move all over the place?  They seem to go up, down, all around -is this typical?

4.  Do you agree with her assessment, is it better for the baby to stay unmedicated at this point?
Thank you everyone, I really appreciate it!  Nobody else can seem to help me and I feel like time is being wasted!




27 Responses
Avatar universal
oops! On the TSI test, I meant anything OVER 1.3 is considered abnormal.
1756321 tn?1547098925
1) - risk of your baby developing hyperthyroidism is 1%.

"Neonatal hyperthyroidism has mostly been described in the context of maternal Graves' disease. It has been estimated that about 0.2% of pregnant women have Graves' disease; however only 1% of the children born to these women are described as having hyperthyroidism.

In most of the cases, the disease is due to maternal antibodies transferred from the mother into the fetal compartment, which stimulate the fetal thyroid by binding to the thyrotropin (TSH) receptor.  In this form of neonatal hyperthyroidism, thyrotoxicosis disappears with the clearance of the maternal antibodies and usually signs disappear during the first 4 months of life."  

- excerpt from "Hyperthyroidism in early infancy: pathogenesis, clinical features and diagnosis with a focus on neonatal hyperthyroidism". PMID: 9920374

2) Selenium can be taken while pregnant.  There are a number of human clinical trials published in medical journals that shows selenium lowers thyroid peroxidase antibodies (TPOAb).  See your doctor before starting any supplement.

"Selenium supplementation may decrease inflammatory activity in pregnant women with autoimmune hypothyroidism, and may reduce the risk of postpartum thyroiditis in women who are positive for thyroid peroxidase (TPO) antibodies. This was illustrated in a trial of 151 TPO-positive women randomly assigned to receive selenium (200 mcg daily) or placebo (beginning at about the 12th week of gestation). Postpartum thyroiditis occurred in 22 of 77 women (29%) in the selenium group, compared to 36 of 74 (49%) in the placebo group [28]. The routine clinical application of this supplementation requires further study."

- excerpt from Thyroid Problems After Pregnancy A Look at Postpartum Thyroiditis By Mary Shomon
Avatar universal
Interesting. Thank you for that info.  I'm curious about the antibodies, because I test positive for all of them, and there's conflicting information out there.  Some sources say that only TSI cross the placenta wall and put the fetus at risk, and others say the TPO's do.  After doing a little research myself, it seems as though 80% of the prenatal vitamins out there have selenium so that  answers that question.  Thanks again!
1756321 tn?1547098925
TPOAb, TgAb, and TSI thyroid antibodies all cross the placenta.  High levels of TSI antibodies have been known to cause fetal hyperthyroidism. TPOAb and TgAb antibodies are not cytotoxic to the fetal thyroid and their presence and titer are not related to fetal hypothyroidism.  High titers in the first trimester of pregnancy are predictive for the development of postpartum thyroiditis.

Avatar universal
What are titers? And does a low TSH with normal T3 and normal T4 require medication?  thanks
1756321 tn?1547098925
The titer of an antibody is a way of expressing the concentration of the antibody in your blood. Eg: 100 IU/ml or 1:100.

Mild hyperthyroidism often is monitored closely without therapy as long as you and the baby are doing well. The goal of therapy is to keep your free T4 and free T3 levels in the high normal range on the lowest dose of antithyroid medication.
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