Newly Diagnosed Hyperthyroid Pregnant - Graves' Disease and Thyroid Discussion - Living with Graves Disease

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Newly Diagnosed Hyperthyroid Pregnant

pregnancy methimazole hyperthyroid

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#1 ebonimclendon

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Posted 27 March 2018 - 08:21 PM

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to start off, I'm 25 and ever since I was a teenager at my physicals my thyroid has been flagged several times but with further exemption and ultrasound they have always concluded that treatment was not necessary. 

 

At 14 weeks pregnant, my high risk doctor diagnosed me with hyperthyroidism, negative for graves disease and was put on 10mg twice a day (a total of 20mg) at the time my TSH was 0.01 and my free t4 was 2.1 ( the range is .08 to 1.8 ) my regular OB didn't seemed that concerned because it was only slightly elevated and said to make a point to bring it up at my high risk appointment so they can treat it if found necessary, which they did. My regular OB also sent me back for more lab work on 2/14/18 which I will insert, it may be helpful but all the feed back I've gotten so far suggest that its not.

 

On 3/20/18, I am now 18 weeks pregnant expecting a baby girl, I had more blood work done having been on this medication for 4 weeks and the results are as follows: 

TSH .02

Free t4 - 1.1

 

She has never tested my free t3 to my knowledge and from what I've read those levels are important?

 

I am writing this post because I am concerned about the dosage they have me on. This dr has always been very vague with me and when she went over these results yesterday with me she said that they improved but that my medication will not be lowered and will most likely not be lowered in another 4 weeks. She's waiting for TSH to raise. I expressed my concerns about being medicated into hypo and she sort of responded with "Oh my gosh *shakes head*, its much easier to treat you hypo than hyper"

 

I need some advice, do you think I should get a second opinion? Are my levels 20mg a day worthy? 

I have never seen an actual endo, is it a good idea getting a appointment with one?

 

my concerns go out to my baby and the thyroid/goiter issues I read about online :(




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#2 mmztcass

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Posted 27 March 2018 - 08:40 PM

Hi and welcome:

 

Congrats on your pregnancy.

 

Could you please post the lab reference ranges for the Free T4?  Different lab companies use their own lab reference range.

 

Yes, definitely a Free T3 test is important.

 

Also could you post any thyroid antibodies tests that were done along with the reference ranges for them?  The reason why I ask is that generally when the TSH levels are low like this, it can mean there are positive thyroid antibodies activity going on somewhere.

 

{{{hugs}}} 



#3 ebonimclendon

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Posted 27 March 2018 - 09:06 PM

Thanks! And thank you for responding.

 

The Free T4 range is .08 to 1.8

 

When I was retested by my regular OB on 2/13 prior to being put on medication this is the lab work I received back:

 

t3 uptake - 25 (range 22- 35 )

t4 (thyroxine) total 19.8 (range 4.5-12.0 )

Free t4 INDEX - 5.0 (range 1.4- 3.8 )

TSH - 0.01 

Thyroid peroxidase antibodies <1 (range <9 )

 

Now this new lab work of 3/20 all she relayed to me is that its improved 

TSH 0.02

Free t4- 1.1

Is it possible being on 20mg could make my free t4 even lower in 4 weeks time and if so is that worrisome?



#4 mmztcass

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Posted 27 March 2018 - 09:17 PM

Hi:

 

Yes, at the Free T4 lab reference ranges is now too low (hypO or over medicated).  The need is to take less ATD (antithyroid drug) of by at least half - 10 mg per day.  A healthy, successful pregnancy needs to have both FT3 and FT4 at closer to the upper third range.

 

Thank you for posting a thyroid antibody test.  The TPOab is typically for showing the inflammatory of the thyroid such as more so if one is hypOthyroid and not hypERthyroid.  I would suggest getting the TSI and the TRAb tests which is done for checking for Graves' Disease and see if positive.  I am sure with the TSH being low like this that the TSI is positive.

 

If the TSI is positive, this will need to be kept as low as possible as not to cross over the placenta and affect the baby.  This means taking just the right amount of ATD to keep the FT4 near the upper third range.

 

{{{hugs}}}



#5 Allies

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Posted 28 March 2018 - 12:40 AM

 
I am writing this post because I am concerned about the dosage they have me on. This dr has always been very vague with me and when she went over these results yesterday with me she said that they improved but that my medication will not be lowered and will most likely not be lowered in another 4 weeks. She's waiting for TSH to raise. I expressed my concerns about being medicated into hypo and she sort of responded with "Oh my gosh *shakes head*, its much easier to treat you hypo than hyper"
 
I need some advice, do you think I should get a second opinion?

Hi Eboni

 

I think your instinct about getting a second opinion is sound. The doctor's job is to help you get well and to consider the health of your baby. It shouldn't be about being easier for her. I'm actually horrified that she said this!

 

It's not clear from your post whether the 'high risk' doctor is an endocrinologist? Although she may well be high risk! If she was an endo she would probably have tested you for Grave's antibodies (TRab and/or TSI) before ruling out Grave's disease. TPOabs can be present in Grave's and their presence can indicate autoimmunity, but their presence, or lack thereof is not diagnostic of Grave's disease.

 

Cheers
Allies
:D



#6 ebonimclendon

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Posted 28 March 2018 - 08:31 AM

Hi. 

No she's a nurse practitioner. I haven't been able to see the actual doctor who is not an endocrinologist either since the day he prescribed me methimazole in 45 seconds and sent me on my way. Im pretty sure he said I was negative for graves disease but as of now I have no actual proof of that other then what I think he said to me. I will be trying to be getting all my medical records and recent labs and making a new patient appointment with an endo and cutting my pills in half in the meantime. I really appreciate the input of both of you, truly. I will post again when I get my next labs / see a new dr!



#7 ebonimclendon

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Posted 10 April 2018 - 10:28 AM

[color=rgb(69,69,69);font-family:Helvetica;font-size:12px;]**Update**[/color]

 

I did go get that second opinion with an actual endo. He ran my free t4, free t3 and tsh which are as follows:

 

Tsh .079 - range .4 to 4.50

Free t4 - 1.1 - range 0.08 to 1.8

Free t3 1.9 - range 2.3 to 4.2

 

He has lowered my dosage to 10 mg a day. That cuts in half what I was taking but I was still hoping for something lower then 10 mg 

 

Should I be concerned about my low free t3?? 

 

TSI was also tested and are pending



#8 ebonimclendon

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Posted 10 April 2018 - 10:46 AM

TSI is negative!



#9 Allies

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Posted 11 April 2018 - 12:00 AM

Hi Eboni

 

Do you have a copy of the TSI results along with the reference ranges?

 

Your FT4 seems a little on the low side to me but at least it hasn't gone down any further :), were you still taking 20mg prior to these latest results, or had you already halved the dose? ...and how long was it between the two tests? Your FT3 is definitely looking too low, how do you actually feel? FT3 is considered to be the 'active' hormone, so can have a more immediate effect on how we are feeling and functioning

 

Are you being tested again soon?

 

Sorry, lots of questions.

 

I think the FT3 is worth worrying about if it stays low. As a general rule it moves up and down faster than our FT4 does, so it may be higher now than it was a few days ago, or a week ago (it could also be lower), so i think regular testing is a must when you are expecting. Especially when taking antithyroid drugs

 

Cheers
Allies
:D



#10 mmztcass

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Posted 11 April 2018 - 12:18 PM

Hi:

 

Yes, please include the TSI labs.  If TSI is negative, it means that the levels is under the range for any GD activity.  However I do see from a previous lab prior to your latest that the TSH was .02 which indicates the TSI was likely high enough to cause problems.

 

Normal people do not have any TSI, it would be zero for them.  I have had my TSI as low as 24 and still had positive GD going on.  I once knew a gal from here with a TSI of 2 and a full blown GD.

 

The TSI, if any, can be kept as low as possible with keeping the Free T4 at the upper third range and the Free T3 at mid range.  This will help the pregnancy a lot.  

 

{{{hugs}}}







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