Hyperthyroid and lots of questions

[JessieBird]

Hi everyone -

I posted about this last week but now have some more accurate info and lots more questions so I figured I'd start a new thread (and I can't find the old one...).

So as many of you figured, I am hypERthyroid not hypothyroid. It is my TSH that is very low. It was tested at 0.05 two weeks ago and the same three weeks before that, when I was hospitalized for hyperemesis gravadarum.

A diagnosis has a huge impact on my care - if I am truly hyperthyroid, then by law where I live, I can't be followed by my midwives at the birthing centre that I know and love. By law I have to be transferred to OB care, I think high risk OB care at that (yet to clarify that point) and will have no choice but to birth in the hospital. Of course, if there are serious risks that require that sort of approach, then a-okay but I'm wary. The only person who can make this determination is an endocrinologist. My file has been sent over to them and I'm still waiting for a call to book the appointment.

So here are my questions:

- I have read a lot about "transient hyperthyroidism" as related to HG. What are the odds that's what is going on here? If it is transient, how long does it take to normalize? If I were retested next week, for example, should we see an increase my TSH? Or does it take longer than that? If it matters, I haven't vomited at all for the past two weeks and I think that the HG is over and done with now. Today I didn't even take any diclectin and I feel fine. (YIPPPPEEEE!)

- If my level does not go up, and so it appears that I have real hyperthyroidism that is here to stay, what are the risks to me and baby? I can't seem to find much info (there's lots more about hypo out there!). What can I expect in terms of treatment and prenatal care? Any differences at the birth?

I really appreciate any info you can provide. I know I could just be patient and get all this from the endocrinologist and my MW but I really value the diversity of opinions and breadth of knowledge here on MDC and any info you can provide will really help me to know what to ask them.

Thanks again for your time!

[MamaMonica]

I'm moving this to Health and Healing, where I hope you get more responses

[GoBecGo]

Hi there, i was on your other thread, so i'm here too!

I think the risks with hyperthyroidism are increased when it is uncontrolled or poorly controlled (same as hyPOthyroidism).

The specific risks to the mother are:
Higher risk of high BP
Higher risk of PE
Higher risk of anaemia
Higher risk of infection

The risks to the baby (which seem to kick in only when the hyperthyroidism is severe and uncontrolled) are:
preterm birth
low birth weight

there is also a risk that the baby could be born hyperthyroid, and if you have to take strong meds to control the thyroid there's a risk they could damage the baby's thyroid, making it hypothyroid.

It is a real bummer that your state won't allow midwifery care - are there independent midwives around you could talk to? I know the NHS is a bit funny about booking a homebirth for anyone with thyroid issues, even when well controlled, but my IM has no issue with supporting a healthy woman with a well-controlled thyroid issue. Maybe you can look into it once you've seen the endo.

You can request an antibody test to see if this is transient HG hyperthyroidism or an underlying condition - if it's Graves, the most common cause of hyperthyroidism, there will probably be thyroid autoantibody titers and anti-TSH receptors in your blood - a sign that your immune system is malfunctioning and interfering with your thyroid function. It's something your endo will very likely want to check for because it determines your future treatment.

Overall i guess i would say that you should make sure you see the endo, and get them to go through exactly what's going on, and make decisions from there. My midwife has said that there is generally no reason to birth in hospital in the absence of complications, but that the baby may need to have additional check-ups to ensure s/he isn't hyperthyroid or hypothyroid after birth - if your condition was uncontrolled or only discovered weeks before birth i can see you might want to deliver in the hospital in case the baby was very ill at birth. It is definitely ok to ask for concrete medical reasons why you should not birth the way you want to, and it is ok to present your own findings. Last time i was pregnant i was clueless, my hypothyroidism was undiagnosed and uncontrolled and i got an NHS HB by the skin of my teeth. This time i am well-informed and proactive and i feel much more well, and have found my care providers have reacted positively to someone who is eager to learn the facts and be a partner in their own care.

Best of luck.

[JessieBird]

Thank you so much! I had no idea that I could be tested for antibodies. It would give me great reassurance to be able to do that rather than just wait and see if it's transient or not. My MW called last night to say that the endocrinologist just got back from vacation and their office has quite a backlog to deal with, that's why I hadn't gotten a call yet. Hrmpf. I'm going to go to my family doctor to see if I can get a speedier referral to a different endo. MW doesn't feel any urgency though, I'm not sure if I should be annoyed or reassured by that.