Pregnancy Labs Updated -Should I be concerned?

[caetlin_h]

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!

[caetlin_h]

I haven't spoken with the endo yet, midwives just called with results and faxed to endo.  I was concerned that this was going to happen, but i'm even more concerned about starting new medication for the first time while being in another country -I return on Jan 9th.  At this point, all I care about is the baby.  Do you two think these levels require meds immediately for the babies health, or just my own comfort?  And is my assumption correct that the first month(s) of medication ussually require some tweaking and contact with Dr.?  thanks!

[Barb135]

I totally agree with Sally; your levels are too low in the ranges..

FT3 is the active thyroid hormone and is the major one to watch because it correlates best with symptoms. Yours is really low in its range.

[Super_sally888]

Hi,

I would think that your doctor should start you on thyroid meds with these current levels.  My endo likes to see Ft3 and Ft4 in the upper end of the reference range during pregnancy, irregardless of where the TSH is.

What has your docotr said about this?  She should not wait for you to go below range before she starts treating as thyroid levels in pregnancy are very important.  When you see her please also emphasise you are feeling so tired.  Hopefully that will help encourage her to start treating.

You definitely should keep testing every month.

I am 24 weeks pregnant with hypothyroid.

[caetlin_h]

TSH        0.05   range 0.4-4.0
Free T3    2.7     range 2.3-4.2
Free T4    .67     range  0.5-1.50

So these are the latest labs, taken just two weeks since the last ones.  I had them taken so early because I'm leaving the country for a month and have had symptoms return slightly this week.  The Ft4 is really close to being too low, and seems to yo-yo each month between going up and then down.  Does this mean anything of significance? The TSH has finally risen a little which is good, I guess I'm just confused because I see NO pattern with these labs.

My symptoms have always been hyper and hypo (hand tremors, heart palpitations but accompanied with fatigue and exhaustion)   Anyway, mostly curious about the T4, should I be worried about not testing for a month?

[Barb135]

Just a word of caution - I've been taking selenium for over 3 yrs and it hasn't done much for my antibody count.  From the research I've done, it seems that selenium does more for the conversion of FT4 to FT3..

Just to clarify: FT4 is the main hormone the thyroid produces, but the individual body cells can't use FT4; it  must be converted to FT3, which is the biologically active hormone...

The antibodies, themselves, are not the major concern; what you need to worry about is the hypothyroidism caused by the antibodies, as they "chomp" away at your thyroid, causing it to produce less and less of the necessary hormones....

Make sure your doctor checks both FT3 and FT4 every time you have blood work.

Hang in there, make sure you get tested monthly and do keep us updated on progress........

[caetlin_h]

*sigh* ok well I'll take things one step at a time.  I'm currently taking 200 mg of selenium a day and hoping that will make a difference with the antibodies.  At this point, as long as Ft4 and Ft3 are "normal" and my symptoms aren't too bad (which they aren't right now) then I wont worry about things until they change.  What else can I do anyway?  And thanks, I know nobody on here are Doctor's, but so far you've all sent me in a better direction than any MD I've seen.

[Barb135]

In my opinion, you have both Graves and Hashimoto's.  

It's my understanding that all of the thyroid antibodies can cross the placental wall, but I'm not a doctor and don't work in the medical field; I know only what my research shows.  Here's one site that explains it relatively well.

http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

Pregnancy can make your levels bounce around and I notice that your FT3 went down, while your FT4 went up; that makes me wonder if you might not be converting FT4 to FT4, well right now.  Studies have shown that selenium helps with the conversion process, so if your doctor approves it, you could try adding a selenium supplement.

[caetlin_h]

TSI tested positive with a result of 2 and anything over 1.3 is considered abnormal.  Not nearly as high as the others, but abnormal none the less. So I'm confused.  If high antibodies for all 3, then what does this mean?  A previous poster mentioned that ONLY TSI antibodies can cross placental wall, is this true? Why wouldn't the others?

[Barb135]

Yay -- it worked.........

Yes, this is a large jump, and warrants very close observation.

[Barb135]

Per verification via PM, I'm going to try to get your antibody results in here, but can't guarantee they will post any better for me than they did for you.......

2009   TPOab = 120 (range < 61)
           TGab  = 185 (range < 22)

Current  TPOab = 1300 (range < 61)
             TGab   = 844   (range < 22)

[Barb135]

I just sent you a PM, with my interpretation of your results.  If I'm right, let me know and I'll try to help get it in here.

Bottom line is: it looks like you've had Hashimoto's for at least a couple of years.  

You mentioned that you tested positive for ALL the thyroid antibodies, but I don't see a TSI result - that would be Thyroid Stimulating Immunoglobulin, which is the definitive test for Graves Disease.... please post that, with reference range, if you have it.  

[caetlin_h]

nope, not working. TGab range is <22. jumped from 185-844  TPOab range is <61 and jumped from 120 to greater than 1300

[caetlin_h]

once again these aren't posting correctly. grrrr. I'll try once more
2009 TPOab was 120 with range of <61 and TGab was 185 with range of 1300 and TGab is 844 with same ranges.

[caetlin_h]

Sorry, those didn't post right for some reason.
in 2009 TPOab was 120 with range of <61
and TGab was 185 with range of 1300  and TGab is 844 with the same ranges

[Barb135]

I don't understand this: "TPOab  was 120 with range of 1300 with range <61"

Please clarify...

Let's back up for a bit and go one step at a time -- If your levels were high in 2009, what are they now?

[caetlin_h]

Nobody in the medical field has mentioned that I could have both, but all of you on here have certainly mentioned it.  I'm curious how having both will effect being medicated in the future if/when needed?

In May 2009
TPOab  was 120 with range of 1300 with range <61
TGab      was     844    with range  <22

So obviously they've jumped tremendously in the last two yrs.  What does this mean to you?

[Barb135]

Have you had TPOab and TGab tests done?  What are the results?  

Has anyone suggested that you may have both Graves Disease and Hashimoto's Thyroiditis?  Have you had a thyroid ultra sound to check for nodules/inflammation on your thyroid?

Some people with Hashimoto's have swinging FT3 and FT4 levels.

[Red_Star]

Well i have read a comment that their endocrinologist would only test the FT3 when they didn't feel well.  In my opinion, i think medical school push the importance of TSH and T4 above all other thyroid tests.

[caetlin_h]

Another question for you, which doesn't necessarily pertain to pregnancy, just in general.  I went to get my monthly blood draw today, and they said that the endo just ordered TSH and FreeT4.  I said this couldn't be, that she'd ordered the freeT3 the previous month, it must be a mistake.  I finally insisted that they do all of the tests, but I'm wondering now if it was a typo or if she really only wanted TSH and T4.  Would that make sense? What would be the point of that?

[Red_Star]

You have subclinical Graves disease - low TSH, normal free T3 and free T4 and elevated TSI.  Graves disease symptoms typically worsens in the postpartum period, usually in the first 3 months after delivery. This sounds like what happened last time. You may need medication during this time to help with symptoms.  It states on various websites that close monitoring during this time is necessary but i've yet to find how frequently testing should be. Every week or every few weeks perhaps.  Check with your doctor on this.

[caetlin_h]

Great, thank you.  The only other thing I'm wondering is how soon after birth to get my levels checked?  Looking back I think I had a thyroid storm or something close to it directly following the birth of my daughter -just over a yr ago.  I didn't have a diagnoses then, so we didn't know to look for that, but I'm worried that levels are going to go crazy again this time.  Should I get them tested every day after birth for the first week, or once a week or what?

[Red_Star]

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.

[caetlin_h]

What are titers? And does a low TSH with normal T3 and normal T4 require medication?  thanks

[Red_Star]

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.