# Thyroid level and pregnancy



## christina20003 (Sep 27, 2011)

Hi all,

I have been seeing an endo for my Grave's disease and have been in the normal ranges for a while now, but recently my free T4 is low. This was before my last appointment but my endo did not adjust my meds. I've been taking methimazole as my treatment since we're trying to get pregnant and with my fertility issues could not delay 6 months to a year for RAI.

Here are my most recent results:

TSH 0.2 (range: 0.3 - 4.2) LOW
Total T3 1.48 (range: 0.76-1.81) 
Free T4 0.48 (range: 0.7-1.4) LOW

My endo knows that we are actively trying to conceive through IVF and we have a cycle planned with embryo transfer in late August/early Sept. I'm concerned about potential for miscarriage if we do finally get pregnant this time (using donor eggs so it is a good possibility). What I've found online says that free T4 should be in upper 3rd of normal range and mine is no where near that. I'm having more labs in a week or 2. I'm just wondering if I should let him know my concerns or if I should discuss with my reproductive endocrinologist(infertility doc) who knows more about pregnancy and then go to him with what the fertility docs has to say. There is time to get my free T4 back into the normal range if we change doses soon.


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## Octavia (Aug 1, 2011)

Um...I should preface by saying that I have NO personal experience with this. But my gut tells me, given the cost of IVF, that you may want to wait until your levels are more in range and stable.

Given that you are eager to conceive, and you want a healthy baby, have you discussed the option of surgical removal of your thyroid instead of RAI?


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## webster2 (May 19, 2011)

I agree with Octavia on this one. What is your fertility specialist's opinion?


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## Lovlkn (Dec 20, 2009)

> Given that you are eager to conceive, and you want a healthy baby, have you discussed the option of surgical removal of your thyroid instead of RAI?


I think this is a better option than being on anti thyroid medications during pregnancy and the fact that your labs really are not currently in a good place.

Have you had antibody testing and can you share that with ranges?


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## blueyes (Feb 15, 2013)

I would agree with everyone else about your levels, but I obviously don't know your personal situation. Both my endo and my GP are on the same page as far as not wanting to do RAI or a thyroidectomy on a woman if she still plans to have children (as long as she's responding well to thyroid meds).

Are your doctors planning on switching you to PTU when it gets closer to the IVF procedure? If not, I would also throw that question in with your other concerns. My endo made a huge deal about making sure I don't get pregnant while on methimazole (can cause birth defects, thyroid problems with baby) and actually made me shake on it with him.

With that, I wish you the best and hope everything works out


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## christina20003 (Sep 27, 2011)

Thanks for the feedback. Unfortunately my current endo doesn't really consider removal as a treatment option which bothers me somewhat. When I first started seeing him last year, we discussed the options and he said it was safe to take methimazole while TTC and while pregnant. I also had a consult with a maternal fetal medicine specialist before beginning IVF who also agreed with this. Now at my most recent appointment, my endo said he would switch me to PTU if I get pregnant. Of course I want to do what will be safest for the baby, but it concerns me that he has previously told me several times that the meth. was safe during pregnancy and that I could stay on it. Now he's acting like he never said that at all.

I just had more labs drawn last Friday so we'll so how those come back. I plan to discuss with my fertility dr since we are getting close to starting a new cycle.

Off topic, how do I get notification when people reply to my post? I know the board has changed since I first started using it and I used to get notifications automatically when people replied. This time I had to come back and look to see.


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## Prudence (Oct 30, 2012)

PTU seems to be the safer drug to take while pregnant, I've always heard that methimazole is a big no-no to take for Graves' treatment if pregnant. I don't understand why your endo suddenly changed their mind, I was even told by my group if I planned on having more kids when I was on methimazole, they'd have to switch me if I became pregnant.

Your labs are strange to me-your TSH is high, yet your T4 is low, as seen in hypo ranges. TSH isn't always the best indicator, since it can be repressed... Do you have any symptoms of Graves' still? Or hypo symptoms?


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## christina20003 (Sep 27, 2011)

Thanks. I had heard that about the meth too, just don't like that he seems to be changing his tune at such a critical time for me. My TSH isn't high. It's always been low/supressed since I've been on the meds. My free t4 and total T3 were on the hyper side for the longest time and now the free T4 is on the hypo side. I actually am mostly symptom free right now. The biggest thing I'm struggling with is weight gain. I assume that's because I'm a little hypo right now. I used to have a lot of eye symptoms and those have mostly subsided.

I plan to talk to my endo this week about my newest labs which I don't have the results for yet. I want my dose lowered so I can be in the higher range. Is it better to be a little hyper than hypo in the first trimester.


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## StormFinch (Nov 16, 2012)

Out of curiosity, how long have you been on the MMI and how much are you taking?

Even 4 months after having my thyroid removed and while taking T4 only my Frees were at the low end of the range or below and my TSH was still well below range, so I know where you're coming from lab wise. It's my understanding that labs look that way because there are still stimulating antibodies at work, yet the anti-thyroid, or in my case lack of thyroid, is lowering the production of T4 and T3.

If you don't want to delay this IVF cycle then you are correct in asking for a lowering of your dosage to get your Free T4 back in range. Your current TSH means very little in these circumstances. It could eventually follow your Free T4, or it may continue to stay low so the Frees become the important indicators.

I'm guessing that your endo finally cracked a PDR and figured out that MMI is contraindicated for the first trimester. I have to say, it's amazing to me how many will prescribe something with no clue as to side effects in association with a particular patient. Anyway, PTU for the first 3 months and then the MMI can be restarted for the rest of the pregnancy, but I would be talking to your prescribing doctor about switching before the implantation procedure.

Here is Mary Shomon's write up explaining the American Thyroid Association's guidelines for pregnancy and Graves Disease: http://thyroid.about.com/od/hormonepregnantmenopause1/a/Graves-Disease-Pregnancy.htm

Personally? I'd be delaying the IVF and finding a doctor that would recommend surgery. Anti-thyroids cross the placental barrier and are hard on the liver, and that would make me nervous. Whatever you decide though, best of luck.


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## Octavia (Aug 1, 2011)

christina20003 said:


> Off topic, how do I get notification when people reply to my post? I know the board has changed since I first started using it and I used to get notifications automatically when people replied. This time I had to come back and look to see.


Go to Thread Tools (in the purple bar just above your initial post in the thread) and click Subscribe to Thread, then go from there.


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