Prayers/Positive thoughts/ knowledge..please

[camprunner]

On Monday, I had an appointment with my midwives. We finally heard the heartbeat with a doppler 140-145 range at 15 weeks.  I also had a routine blood work for my Thyroid done since I was borderline hypo in the first trimester.  My midwife was saying that if I was hypothyroid it was no big deal, she'd just prescribe synthoid and it would probably be ok.  Fast forward to today, she calls and suggested that since my TSH came back high that I see a high risk ob. Then added that my T3's were low and my T4's were high. I *think* I got that part right. I was trying to decide whether I needed a referral to a high risk ob or my family doctor who has been treating my thyroid already. ( We've decided on the high risk ob even though we have no maternity insurance)

But then, I'm looking this stuff up and it looks like it might be a pituitary problem rather than a thyroid problem?  I can find almost nothing about how this change would affect the baby. 

So prayers and positive thoughts are always welcome. Insight would be great if you are knowledgable in this sort of thing.

[MamaChef]

First off, hugs and said a prayer for you. 

So are you on armour?  How is your family doc treating your thyroid?  I have a couple theories on why she might want you see a high risk ob, but need that info first.. did any of your other labs come back abnormal?  Do you know what your levels were?

[camprunner]

I went off the Armour in July and when the doc prescribed NatureThroid instead, I just quit taking it because I started having panic attacks and hyper type symptoms. My antibodies had gone down since I'd been gluten free so I assumed I'd probably be ok...and to an extent I was until now. I just had the thyroid panel done  and other than my TSH being 3.8 and the T4 being high and the T3 being low. I don't have much more information. 

Thanks so much. I'd love to hear your theories.

Edited to add that when my thyroid was checked at 8 weeks the TSH was 2.97

[MamaChef]

Find out your actual numbers and then you can figure out what is going on.. or maybe you can get in with the high risk OB quickly and they can decipher it.

Being hypothyroid in the first tri is completely normal.  HCG and TSH have an inverse relationship.  So when HCG is highest around 10-12 weeks, TSH is lowest.  Completely expected that you would have low TSH if you got tested between 8-14 weeks.

At 15 weeks your blood volume is expanding rapidly.. so is your T4.  If you were hypothyroid prior to pregnancy sometimes T4 can be kicked up a notch to try and compensate starting in the second trimester.  So this could be something pretty normal, but folks get all weird when labs come back outta their scope of comfort and the referral is probably just a cover the bases kind of thing.

I was going to say that your panic attacks would make complete sense if you were hyperthyroid, especially on armour!  Id think you'd have been absolutely sick as a dog though if that was the case.  They might have just been slightly elevated and pushing the edge of the panic without being true hyperthyroid.

What your midwife would be worried about is Graves Disease.  It can have some serious effects if left uncontrolled so it's best just to go check everything out.  But what is way more likely and occurs in 15-20% of women (most just dont know it because they dont get their thyroid tested) is that you are having transient gestational thyrotoxicosis (http://humupd.oxfordjournals.org/content/10/2/95.full - good section in this journal on it..)and everything will just level itself out :)

http://www.thyroid.org/patients/patient_brochures/pregnancy.html

The good news is that regardless of if this is just a super precaution or if it's something you need to pay attention to, it's all completely manageable especially caught this early.

Edited by MamaChef - 12/8/10 at 11:32pm

[MamaChef]

Look at Thyroxine production rate and increased plasma volume in this text..

http://www.thyroidmanager.org/Chapter14/14-text.htm

[beckyand3littlemonsters]

[camprunner]

MamaChef, thank you. I'm hoping it's a precaution.  I just want the baby to be ok and no to lose my homebirth.  I confirmed everything that I told you but forgot to ask for numbers and the f  Thyroxin is normal.   I tend to think that my lab  tests just came back strange and she doesn't have experience interpreting them so is referring me to someone more experienced which is why we hired her right?

[camprunner]

Ok. Homebirth midwife called back and said she talked to the high risk ob who said that it wasn't an emergency to get in to see them and that I should start synthroid which leads me to believe that this is CYA on the part of the midwife for now. 

[MamaChef]

Well, that's good.  I hope that makes you feel a bit better.  Midwives are often just not skilled in reading those types of labs.  Did she tell you your levels?  Did the OB tell her how much synthyroid you are supposed to be on?  I might double check that with your family practice doc that had been managing treating your thyroid previously but it all just sounds like her being super cautious.

[sillysmile]

Was it the midwife who suggested the synthroid, or the high-risk ob? I'm not sure how low your t3 levels are, but if it's only slightly out of range, and you're not symptomatic, I'd consider holding off on that. Your t4 levels are high, suggesting that your thyroid still functioning pretty well. Synthroid is just going to give you more t4. However I'm not familiar with your history or the reasons that you were on Armour, so take that fwiw. I'm not a clinician, just a med student. Hopefully you can have the consult and they will continue to monitor you but sign off on the home birth. As mamachef said, thyroid hormones bounce around a lot during pregnancy, and it's usually not a problem at all.

[imogenlily]

Hey - I don't know anything useful about thyroids or hormones/meds, but I am sending prayers your way. Take care, mama!

[Amila]

Hmm...I once tested positive for TPO antibodies as well as one other anti-thyroid antibody, though my TSh and other labs for thyroid were all normal. I took synthroid 50 mg as a precaution throughout my pregnancy since they are associated with miscarriage...this was never considered an issue as far as homebirth with both my family doc and my midwife...so long as it is being monitored I don't know why you would be considered high risk...good luck!

[camprunner]

Thanks so much for all the replies. 

Originally Posted by Amila 

Hmm...I once tested positive for TPO antibodies as well as one other anti-thyroid antibody, though my TSh and other labs for thyroid were all normal. I took synthroid 50 mg as a precaution throughout my pregnancy since they are associated with miscarriage...this was never considered an issue as far as homebirth with both my family doc and my midwife...so long as it is being monitored I don't know why you would be considered high risk...good luck!

Yes, I've had TPO antibodies before and that's why I was on Armour. Eventually my TSH was high but didn't come back down until I was on a gluten free diet and the TPOs came down as well.

 

Was it the midwife who suggested the synthroid, or the high-risk ob? I'm not sure how low your t3 levels are, but if it's only slightly out of range, and you're not symptomatic, I'd consider holding off on that. Your t4 levels are high, suggesting that your thyroid still functioning pretty well. Synthroid is just going to give you more t4. However I'm not familiar with your history or the reasons that you were on Armour, so take that fwiw. I'm not a clinician, just a med student. Hopefully you can have the consult and they will continue to monitor you but sign off on the home birth. As mamachef said, thyroid hormones bounce around a lot during pregnancy, and it's usually not a problem at all. 

The Midwife would have prescribed  synthoid if she'd understood my labs but when she called me this morning she said "I consulted Dr. ______ and he/she said that it is no rush for you to get in to see them but that you should be put on Synthoid immediately" So it was the high risk ob. However, after the research I did last night I was slightly concerned about getting more t4 as well but I don't have an MD behind my name (and though I really hate doctors, I'm trying to curb my predjudice for the baby's sake at the moment).  I am very worried about getting more anxious and more panic attacks BUT my husband was quick to point out that these are sometimes symptoms of hypothyroid for me so maybe they will actually get better.

[sillysmile]

I'm guessing that if the ob aid that, then your t3 levels must be very low. I wonder if you could reach the doc by phone for a better explanation if you're not able to get in quickly? It might also put your mind at ease to doublecheck (with the doc) the thyroid panel levels with the dose prescribed. It does sound like your midwife is being very cautious, but that's a good thing as long as you can remind yourself that this is just precautionary, and that there's a very very high likelihood that your baby is at no risk at all.

[camprunner]

Thanks sillysmile. I'm going to try to trust my midwife until I see the doc. I'm not sure what not getting me in right away means but I'm thinking I'll see a doc within the next two weeks or so. Until then, I never know if what the doc suggested will work until I try it. 

[camprunner]

Just wanted to update. I've been on the Synthroid for almost 2 days now. By afternoon yesterday and evening, I was extremley calm and I am continuing to feel my dry mouth becoming more moist and my dry skin becoming less dry.  By late last night, I did have trouble sleeping again and a little anxiety but I'm assuming the medication was wearing off. I think that once the medication is completely in my system, the symptoms will be gone.

Continue with prayers as I really only want to see this high risk ob twice (at a maximum) since I have no maternity insurance. Particularly worried about any labs they may take. My midwife's prices are reasonable....other doctors I've been, not so much.

[MrsBone]

Originally Posted by MamaChef 

Find out your actual numbers and then you can figure out what is going on.. or maybe you can get in with the high risk OB quickly and they can decipher it.

Being hypothyroid in the first tri is completely normal.  HCG and TSH have an inverse relationship.  So when HCG is highest around 10-12 weeks, TSH is lowest.  Completely expected that you would have low TSH if you got tested between 8-14 weeks.

At 15 weeks your blood volume is expanding rapidly.. so is your T4.  If you were hypothyroid prior to pregnancy sometimes T4 can be kicked up a notch to try and compensate starting in the second trimester.  So this could be something pretty normal, but folks get all weird when labs come back outta their scope of comfort and the referral is probably just a cover the bases kind of thing.

I was going to say that your panic attacks would make complete sense if you were hyperthyroid, especially on armour!  Id think you'd have been absolutely sick as a dog though if that was the case.  They might have just been slightly elevated and pushing the edge of the panic without being true hyperthyroid.

What your midwife would be worried about is Graves Disease.  It can have some serious effects if left uncontrolled so it's best just to go check everything out.  But what is way more likely and occurs in 15-20% of women (most just dont know it because they dont get their thyroid tested) is that you are having transient gestational thyrotoxicosis (http://humupd.oxfordjournals.org/content/10/2/95.full - good section in this journal on it..)and everything will just level itself out :)

http://www.thyroid.org/patients/patient_brochures/pregnancy.html

The good news is that regardless of if this is just a super precaution or if it's something you need to pay attention to, it's all completely manageable especially caught this early.

If she is hypo, wouldn't her TSH be high, not low? I'm confused. That was always my understanding. I don't much about T3 and T4 though, it seems like my doc doesn't really look at those numbers. I'm on armour and doing fine, but during pregnancy my TSH tends to get high, requiring more medicine to bring my levels back to normal. I cant imagine why you would be considered high risk though..did they give you a reason? Are you able to control your thyroid levels with meds?
 

[MamaChef]

No, I meant to say hyperthyroid.  I was just typing late.  Sorry about the confusion.

Originally Posted by MrsBone 

Originally Posted by MamaChef 

Find out your actual numbers and then you can figure out what is going on.. or maybe you can get in with the high risk OB quickly and they can decipher it.

Being hypothyroid in the first tri is completely normal.  HCG and TSH have an inverse relationship.  So when HCG is highest around 10-12 weeks, TSH is lowest.  Completely expected that you would have low TSH if you got tested between 8-14 weeks.

At 15 weeks your blood volume is expanding rapidly.. so is your T4.  If you were hypothyroid prior to pregnancy sometimes T4 can be kicked up a notch to try and compensate starting in the second trimester.  So this could be something pretty normal, but folks get all weird when labs come back outta their scope of comfort and the referral is probably just a cover the bases kind of thing.

I was going to say that your panic attacks would make complete sense if you were hyperthyroid, especially on armour!  Id think you'd have been absolutely sick as a dog though if that was the case.  They might have just been slightly elevated and pushing the edge of the panic without being true hyperthyroid.

What your midwife would be worried about is Graves Disease.  It can have some serious effects if left uncontrolled so it's best just to go check everything out.  But what is way more likely and occurs in 15-20% of women (most just dont know it because they dont get their thyroid tested) is that you are having transient gestational thyrotoxicosis (http://humupd.oxfordjournals.org/content/10/2/95.full - good section in this journal on it..)and everything will just level itself out :)

http://www.thyroid.org/patients/patient_brochures/pregnancy.html

The good news is that regardless of if this is just a super precaution or if it's something you need to pay attention to, it's all completely manageable especially caught this early.

If she is hypo, wouldn't her TSH be high, not low? I'm confused. That was always my understanding. I don't much about T3 and T4 though, it seems like my doc doesn't really look at those numbers. I'm on armour and doing fine, but during pregnancy my TSH tends to get high, requiring more medicine to bring my levels back to normal. I cant imagine why you would be considered high risk though..did they give you a reason? Are you able to control your thyroid levels with meds?
 

[sillysmile]

So glad to hear that your symptoms are improving!

[camprunner]

  I cant imagine why you would be considered high risk though..did they give you a reason? Are you able to control your thyroid levels with meds?
 

No, no reason which is why I was flipping out a little when she first called. She did say it was because my labs did "a complete shift" from when I was tested at 8 weeks.  I think honestly  the numbers weren't as definitive as she suspected. Before, my TSH really hasn't been all that high when I wasn't pregnant  but I was on the meds as a precaution due to TPO antibodies. However, I do think that I will be able to control it on meds especially since the symptoms are improving quickly.