Advice Please - Covid-19, Trying To Conceive And Workrelapse pregnancy conception hyperthyroidism covid-19 coronavirus work
Posted 29 April 2020 - 08:37 AM
My name is Meg and I would really love to hear your advice on my situation, I'm feeling very upset and stuck.
Some background: I was diagnosed with Graves' disease in November 2017, aged 25 - I lost over 10kg, my hair was falling out, I was shaking and couldn't sleep.
My initial bloods were TSH <0, FT3 30, FT4 110 - so very severe, and I felt it too! I had a really horrible cough for weeks that I just couldn't shake off, as well as a lot of stressful life circumstances, and my doctor agreed that all these were likely to be contributing factors to it developing.
I have always wanted kids and my numbers gradually improved steadily since diagnosis, I finally got the all clear in December 2019 that I am in remission and it is safe to get pregnant!!! I cannot put into words here how happy I was. Active illness was absolutely hellish for me but I won't go into all that here.
I'm currently living in Berlin (and now aged 27, almost 28) with my wonderful partner and we are trying to get pregnant. I work at a Kindergarten which has been closed but is reopening for 8 kids out of 70, and will have 3 out of 10 staff in at a time to care for them. I told my work I have a pre-existing condition and don't really feel safe coming back when the pandemic is still going on but they consulted with a nuclear physician (!) who told them that Graves' disease is not considered an 'at risk' group for Covid-19.
I feel so so scared that if I get corona virus it will trigger a relapse, just when after two years I'm finally healthy again.
I have always said I want 3 kids and I really worry about how achievable this will be if I relapse now. Not to mention how horrible active illness was and how much I want to avoid it.
My boyfriend has a stable, well-paying job and has said that if I want to quit, he will support me 100%.
Am I overreacting? I know that there are cases of flu and respiratory infections triggering GD but is this common enough that I should be this worried?I really don't want to go through all that again.
Thank you for reading and I would very much appreciate any advice that anyone can give me, I don't think most people can really understand a lot of these things without having been through it themselves.
Stay safe, everyone.
Posted 29 April 2020 - 01:14 PM
Hi MegsieB and welcome:
Can you post the lab numbers with the lab reference ranges? Different lab companies often have their own set of lab reference ranges.
You have raised valid concerns about the COVID-19 as many of us do with having autoimmune disorders and how it would affect them. I can say this, to be safe with having an autoimmune disorder, is try to be as balanced as possible with it for the lab blood work with having the Free T3 and the Free T4 in the 'right' places (such as for the FT3 to be in the mid range and the FT4 near or at the upper third range) and lowered thyroid antibodies numbers.
It has been said that taking vitamin D (such as D3) along with vitamin C (preferrably not the ascorbic acid kind) and Zinc are helpful for viruses. That if the Coronavirus happens, the symptoms are likely to be mild.
Were any antibodies tests done such as the TSI and the TRAb to determine remission? Numbers for these will need to be kept down as low as possible for a pregnancy. This way antibodies are not crossed over the placenta to the fetus.
Posted 29 April 2020 - 02:09 PM
Thank you so much for the quick reply! Sending big hugs right back to you too!
I've really improved my diet - completely cut out sugar, cut gluten right down, and now doing intermittent fasting (which is not for everyone but I feel heaps better with it and it is tied to reducing inflammation) and have been taking vitamin D and C but not zinc, I will definitely look into getting that too! Thank you for the advice.
The table I mentioned above doesn't have units but it does say underneath 'Antibodies: TPO 108/IU/ml TRAB >40u/l' if that gives any indication of what the lab was using for the stuff above?
My most recent one from this December (from a different lab since I moved to Berlin recently) said
TSH mlE/ml Norm: 0.3 - 4.2 [date of test]: 0.63
FT3 pmol/l Norm: 3.38 - 7.51 [date of test]: 5.53
FT4 pmol/l Norm: 7 - 21.1 [date of test]: 12.8
TRAK IU/l Norm: 0 - 0.99 [date of test]: 0.15+
TAK IU/ml Norm: 0- 3.9 [date of test]: 2.0
I've not really looked at much about Graves' disease and pregnancy, obviously having been warned against it when I was diagnosed and now it's such a crazy time.
My work has said that they don't consider me to be in an 'at risk' group, but that seems to mean I'm not especially at risk from corona itself. I think something that causes serious respiratory problems for so many people must pose a risk in terms of respiratory antibodies when I've only just got into remission after two years.
I am going to phone my family doctor in the morning and see what she advises me to do. I will post updates here in case she has insights that might help anyone else.
Posted 29 April 2020 - 02:40 PM
Hi Meg, and welcome
I think it's incredibly difficult to figure out if Grave's patients are more at risk of bad outcomes than other people. On the one hand some of us find that our hyperactive immune systems seem to easily fend off run-of-the mill colds - perhaps you experience this too? I.e. when everyone else is coughing, sneezing and feeling crappy and we just feel the same as usual. I guess the danger here is that our already overactive immune systems may be slightly more prone to go haywire - whether or not this puts us at higher risk of developing the fatal cytokine storm if we are infected with coronavirus is not known.
The currently acknowledged risk factors for bad outcomes with this virus are advanced age, heart disease, diabetes, and people undergoing immune suppressive therapies (like cancer treatment, steroid treatment or some drugs used to suppress immune system response with other immune diseases). All of these conditions are pretty obvious and would show up readily in the sorts of blood tests that are monitored, or are already diagnosed in a patient. ...But it can take years for a person to be diagnosed with an autoimmune disorder, so I'm not 100% convinced that autoimmunity can be categorically ruled out as a risk factor (personal opinion), nor is it clear whether autoimmunity has actually been considered or tested for amongst people badly effected by covid-19. In fairness, in places badly effected there is probably not the time or money to undertake exhaustive testing.
My fear is that this virus has only been known to be around for a few months so we can't really know everything we need to about it. Not knowing is particularly stressful for those of us with 'underlying conditions', and stress is a pretty widely acknowledged trigger for autoimmune relapse; so this may be more of an issue than whether or not coronavirus is likely to produce bad outcomes for us. If the thought of going back to work is causing undue stress, then that could put you at risk of a hyper relapse, with all that entails. If you are feeling really stressed by all this, is it possible to take some extended sick leave? Your doctor sounds like he/she understands the immune system/stress relationship and might be able to help you organise sick leave?
Posted 01 May 2020 - 06:54 AM
I am very new to the Graves Disease Journey i was diagnosed in mid February and along way off from remission. A month after my diagnosis Corona began to ramp up in Australia. Going to work was stressful for me.
I work with vulnerable people. My work place did not close and i began to become highly anxious at work, I developed a hyper vigilance with what my co workers touched and what i touched. I have never experienced this before. I was germ phobic in an unsustainable way. I wanted to be one of the work places that had shut due to being non essential and looked with envy at those who were being laid off work or could work from home. I began to call in sick, which i never do and eventually addressed my stress. I went to my GP and as Allies suggested in the previous post i asked for extended sick leave.
I then asked for personal leave for the duration of the Pandemic and as i had to give a reason for this my boss was very understanding and offered me reduced hours and less front line work. Although i am less stressed now i am constantly gauging how i feel about working. Especially now as they are beginning to slowly lift restrictions in Australia. This is a work in progress and evolves according to how comfortable i am with the changes that are implemented in my work place.
My GP told me that Graves was not a high risk category however a colleague left work as her husband who has an auto immune disease received a letter from their doctor informing the whole family to self isolate. I wanted one of those!
Your work place sounds like it has a good ratio in place for children and workers and Germany (from what i reports i have read) appears to have good strategies (as much as you can have under these circumstances. However you need to feel comfortable and if you are in a financial position not to work or have leave you can take or sick leave then this could be a good choice if going back to work is causing you stress. Is reducing your hours an option? This really helped for me.
Posted 03 May 2020 - 05:21 PM
Hi Allies and Mich,
Thank you for your replies!
Allies, I totally agree with everything you said. I think not knowing very much about the current situation and how it could affect us is especially nerve-wracking. I've normally caught all the bugs going around but found out a few months ago that I also had anaemia (I assumed I felt tired for months because I was adjusting to lower levels of thyroid hormones), and I've not been sick since I started taking supplements which is great!
Mich, sorry to hear of your recent diagnosis. Glad your employer has taken some steps to improve the situation for you but still sounds like it's less than ideal? I had a big germphobia phase not long after I was diagnosed, and there weren't even any big illnesses going around. My class used to joke about how I'd pop out of nowhere and tell them to cover their mouths when they sneezed! It's a shame your GP said you weren't classed as high risk - I find it strange because we seem to know so little about it at the moment.
I talked to the doctor and she was great - basically said that my worries were valid, and given how anxious I was she signed me off for a few weeks, which is a big relief. She also said if I hadn't resolved things with my work by the end of the sick leave, to go back and talk to her and she could discuss it with me from a medical perspective (I guess to either try and calm me down or to help figure out what I should do next).
Posted 04 May 2020 - 02:45 PM
What a huge relief I'm glad your doctor has approved some time off for you, hopefully that will help to ease the anxiety.
When we are in an active phase of hyperthyroid graves our metabolisms can speed up to an alarming degree - this seems to be why we feel exhausted - we might feel as though physically we are not doing very much, but our internal systems are in hyper-drive and in this state they burn through vitamins and minerals very fast. This can result in vitamin and mineral deficiencies which may take a while to correct even once the hyper phase has passed. The anaemia may have been a result of your recent hyperthyroid state.
Of course nothing is ever simple when it comes to health and how our individual bodies function, and it's within the realms of possibility that vitamin and mineral deficiencies might increase the chances of a genetically susceptible person developing Grave's disease in the first place. Iodine is a rather controversial case in point - national iodine fortification programs are usually followed by an increase in diagnosed cases of autoimmune thyroid disorders; this tends to level off after around 10 years as the population as a whole become more iodine sufficient. It seems that our bodies may adapt somewhat to the deficiency, but then don't cope so well with a sudden increase of this particular mineral Vitamin D also seems important - epidemiologically, low/insufficient vitamin D has been linked to autoimmune disorders and there are current studies exploring whether a deficiency in vitamin D might play a part in covid-19 outcomes.
It's probably wise for us to try and ensure we are replete in the various vitamins and minerals - especially at this time
Posted 04 May 2020 - 03:57 PM
Yay, good for your doctor!
I remember before each of my planned pregnancy that I would take a good multivitamin such as a prenatal multi for several months prior to get my body ready. Back then I didn't have Graves' Disease though I was mildly hypOthyroid. I did take the Iodine that was part of the prenatal vitamins.