Pregnancy & Thyroid

[Shannon30]

I am a 29 year old female, almost 8 weeks pregnant (dating via ultrasound).  Before my pregnancy, I lost 60 pounds, but I am still considered obese.  This pregnancy was a surprise, but nonetheless, a happy one.

I have been on Levoxyl since I was 16 years old. I have Hashimoto's.  My dosage of Levoxyl pre-pregnancy was 150 mcg (down from 175 mcg when I was at my highest weight).  I was stabilized at a TSH of around 2.0 and felt good.  I had enough energy to exercise and work (I stand all day), without too much fatigue.

I just got my first lab results from my doctor and my TSH was 8.42, Free T4 was 1.30.  I am very concerned about the TSH level.  I have read a few studies suggesting higher rates of miscarriage, lower IQs, and poor fetal development when TSH is out of the normal range (specifically, above 6.0).  The thing that bothers me is that the blurb on the lab results from the doctor says, "I am happy to report that the results of your recent tests were normal."

I have also been feeling really weak. I wake up quite tired and dizzy.  I have been monitoring my BP, which has usually been around 100/68 during the day.  My pulse is around 45-50 after I have been sitting a few minutes.  Before the pregnancy, my pulse was generally low, but not usually 45 (I exercised a lot, but now I'm just too tired to do much other than work).  I don't know if these two things are somehow related.

Am I right to be concerned about this?  I have found no where that says a TSH at this level is "normal."  I realize the T4 is normal, but isn't TSH a better indicator when someone is being monitored for the correct Rx dose?

I have a call into my doctor's office, but I would like a second opinion.  Thank you for your help.

Shannon

[skymax2000]

When I was pregnant, I saw my endo for blood test once a month.

[Shannon30]

You are such a doll. Thank you for all your kind responses.

I also don't agree with the whole t4 normal thing.  I have read that TSH is 50 times more sensitive in predicting hypothyrodism than t4.  Although 8.42 isn't horribly high in the grand scheme of things, having a TSH level above 6 is linked with miscarriage in the second trimester.  I have an appt with the OB next Tuesday.  At that time I will be about 9 weeks along.  Until I go, I'm going to continue taking my 175 mcg (I upped it myself).  I don't pretend to be a doctor, but if 150 mcg gives me a TSH of 8.42, it obviously needs to be increased.  So I will have to do it myself until I get to the doctor.

I switched hospital networks, so I can't go to my old endo.  I haven't even met my primary care doctor because I just switched as of Jan 1.  I am thinking about calling her and going in there.  But, of course, she will refer me back to my OB.  At least she could refer me to an endo, though.

[kitty9309]

If that were the case, I would never had been put on Synthroid- which has helped me. My free t4 was never below normal, though clinging to just above.
Some doctors feel this is "compensated" hypothyroidism b/c the t4 stays in range. I don't really believ that and I have read some articles that argue against that.
Some medical professionals are in the dark ages.
Please try to get to an endo and tell them it is urgent due to pregnancy and symptoms.
I would be in tears too.
Who was you previous doctor who treated the Hashi? Can you get ahold of them?

[Shannon30]

I just got off the phone with the nurse and she said that in the OBGYN dept, they don't increase medication if the T4 is normal.  I busted into tears telling her that I feel awful and she said to go to the ER if I feel that badly.  That is what they told me yesterday (before I got the lab results).  I realize there's really nothing they can do if it's something other than my thyroid.  I have never heard that they don't increase medication if the T4 is normal.  Is that a typical practice anywhere?  The nurse said that if the T4 is normal, it means everything is fine.  I don't even know what to do.  I'm sitting here, crying.  My hormones are all whacked out and I feel awful.  I feel like this is poor medicine.  I have had Hashimoto's since I was 16 and this is the first time I have never had a doctor increase my dose if my TSH was elevated.

[kitty9309]

I hope you get more comforting advice with the call back. I haope it was an oversight on her part. The TSH had to be flagged as "HIGH" on the lab report and that is hard to ignore.
Certainly find a new doc if she insists it is still normal.

Good luck!

[Shannon30]

This is my OB who said the results were "normal."  I got the lab work yesterday in the mail.  I wonder if it was an oversight on her part.  That makes me uncomfortable.  I still have my 175 mcg pills, so that is what I took this morning (instead of the 150).  I am waiting on a call from the doctor.

Thank you for your input.  If she still says it's normal, it's time for a new doc, I think.  I just do not feel well.

[kitty9309]

The TSH needs to be lower, especially in pregnancy- below 2.5 is recommended. It sounds like they are not raising the dose.
Your symptoms are those of hypothyroidism.
A normal t4 is a good sign that the baby is getting enough hormone- so not much worry there.
The TSH may continue to climb during pregnancy, however, so you need a dose increase.
Is this the OB or family doctor saying test is normal?
You should see an endo for a second opinion.