Pregnant and thyroid at 7.5, about to start taking meds, what do I need to know? - Mothering Forums
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#1 of 30 Old 04-18-2012, 09:22 AM - Thread Starter
 
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Well looks like we know why I had two miscarriages last fall. My thyroid is 7.5, she's checking to see if they still have my blood to check the T levels. She's talking low dose, but which meds should I be asking for? I know my thyroid was off 2 years ago but selenium and iodine seemed to take care of that, then I stopped taking it irked.gif stupid me. Anyway, please give me some pointers, I am very anti-med, but I'm ready to take anything today if it means saving this kid.

 

x post in health


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#2 of 30 Old 04-18-2012, 12:36 PM
 
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There's others who are more knowledgeable about ARmour (dessicated thyroid) so I'll leave that for them.

 

For me, taking armour would have been a challenge to find, and so I was comfortable going with the Synthyroid to start and seeing where it took me. Before pregnant I did improve, though numbers weren't "perfect" (including FT3 and FT4), and symptoms were almost perfect, so I was happy to stay with it. Right away when I got pregnant my TSH went up, and they doubled my dose (from .025 - .050) and all my #'s after about 5 weeks were great (TSH 1.6, FT3 and FT4 in the mid-upper ranges) Hard to tell by symptoms - first tri is a mess, but I'm happy where I am. 

Just got my second set of numbers back, and they haven't fluctuated too much, so no changes needed. I'll go back every 5 weeks or so for bloodwork.

 

I do make sure to take my brazil nuts every day for the selenium, and stay away from goitrogens so not to aggravate my thyroid. I take my meds in the middle of the night actually. It's the only time I can take it away from other supp's and food to ensure good absorption (I'm up to pee anyway!) Plus I didn't want to risk throwing it up with morning sickness

 

I'm pretty anti-med too, but knowing how important good thyroid function is (especially in the first tri when babe is dependent on ours) and looking at the safety of synthyroid - I was very comfortable taking it. (I've had infertility/miscarriage issues too)

 

Good luck and Congratulations!

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#3 of 30 Old 04-18-2012, 01:08 PM
 
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First off - ARMOUR all the way!!! Secondly - Always get copies of your hypo bloodwork, it's really helpful.

 

Okay, so in regards to the medication aspect, I know it's hard to picture with how so many medications are (synthetic), but when you have hypothyroidism, the medication is just replacing the hormones that you aren't making. So it really isn't something synthetic at all, it's vital, and much better for you and your baby to be in the right range. I don't want to worry you, but I really would try and get into the normal range as quickly as possible. Lastly, (I have to go help the kids, but pm me if you'd like, I know a lot about hypoT) I would also ask the office if they tested you for antibodies, meaning whether it's a pregnancy issue, or autoimmune. Good luck!!


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#4 of 30 Old 04-18-2012, 01:20 PM
 
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You want to be more aggressive with meds if you are already pregnant.  Miscarriage (as you know, I'm sorry mama) and cognitive development is what you should be weighing this against.  You need to get that TSH number under 3.0 as soon as possible.  And you need to take synthroid starting today. 

 

The standard for treatment is synthroid (brand name for T4, generic = levothyroxine).  Synthroid is the bioidentical inactive hormone T4 that your body then converts to T3 (active hormone as needed) by shifting iodine around (hence why making sure you have enough iodine is often discussed with MILD thyroid problems).  A replacement dose (meaning you are getting most of your thyroid hormones from supplementing) is around 100mcg for an average size woman.  A TSH of 7.5 means you caught it before your entire thyroid shut down, but I'm guessing you'll need to start with a dosage in the 50-75mcg range.  Redo labs in 4 weeks (which is pushing it... 6 weeks is a bit better as synthroid has a really long half-life) for TSH and adjust accordingly. 

 

How far along are you?  Current research shows that our bodies needs ramp up by about 30% between weeks 5 and 16 - after that it usually stabalizes.  Current research protocals suggest labs every month through mid-pregnancy and then doing every 8 weeks if under control until delivery.  (PM me if you need references for your midwife/OB.)  You are aiming for TSH between just under 1.0 and 3.0 while pregnant.  (Most find this is an optimal range non-pregnant too.)

 

As far as med options, some people prefer armour (a form of pig thyroid hormone) over synthroid because it contains a mixture of T4 and T3; the T3 seems to give that extra boost for symptoms but makes health care providers more nervous because T3 is more volitile on an hourly basis and harder to measure in labs. 

 

Also, don't beat yourself up about going off the selenium, etc.  Many who lose their thyroid function do so in fits and spurts over a long period of time... what works for a while all of a sudden isn't needed.  On the same hand, all of a sudden what worked then will not be enough now.  The estrogen in pregnancy amplifies this - you are doing the best you can!


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#5 of 30 Old 04-18-2012, 02:02 PM - Thread Starter
 
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Thanks for the replies ladies! I am 8 weeks tomorrow. The OB said they still have my blood and are running T3 and T4 on it, then she is going to call the Rx in once she knows what dose to give me, but it'll probably be tomorrow. I guess it's based on those numbers more than anything? She was talking about just getting it below 5, but it sounds like I need to tell her I'd feel happier with 3. So can someone give me more pros and cons of armour vs synthyroid? My OB was suggesting synth since they know it works and have lots of experience with it.

 

 

My parents and my uncle have all been successful getting their thyroid to function properly again with selenium and iodine supps. I was feeling better and the weight was coming off so I thought I was good. I knew about a year ago that things we getting out of wack again, but I just hated taking the ionic selenium so much so I convinced myself it was just my training making me feel awful :p I'm kicking myself now. I thought I was okay with waiting till tomorrow to get on something, but I think my hormones are kicking in cause I think I'm having an anxiety attack. I really don't want to lose this one. I told a couple of people over the weekend dispite insisting I wasn't going to tell anyone till the 2nd tri and I feel like I jinxed myself.

 

 

Is there any info on % of defects with this so early? Is it more likely to be detrimental early or mostly for those who find out later? Is there anybody out there whose tsh was high in the beginning and had a perfectly healthy babe that would like to chime in?

 

Thanks again for the responses, I really do appreciate it. Once I get my head lined up better I probably will PM you guys with some questions.


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#6 of 30 Old 04-18-2012, 02:47 PM
 
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Honestly, if I were you, in the interest of getting meds in sooner rather than later - I would be happy with the synthyroid. Armour I've heard can take some adjusting, since each dose can vary. 

 

I don't have a personal story of a high TSH in early pregnancy, but I know by the standards in our area (which use the very high "normal" reference ranges) there are probably a lot of women that are left untreated and go on to have healthy babies. 

You're thyroid is still working, that is good, it just needs some help with the increased needs. I second the suggestion to get a copy of your numbers, it's easier to keep track over time if you have you're own record.

 

Also it's already been mentioned, but try not to get too anxious to get retested too soon, the change is slow. For example, at 4 weeks past my med change I retested and was at around 2.5 TSH, I was hoping it would go lower, and my dr encouraged me to wait another week or 2 to test again. I waited one more week and my TSH was down to 1.5 - so I'm glad I waited and didn't insist on more meds.

Also, being hypo will naturally increase your anxiety (I was soo shaky when I was out of whack), so try to relax, and know that if you're starting meds tomorrow you're doing a good thing :)

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#7 of 30 Old 04-18-2012, 03:17 PM
 
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You are ok until tomorrow.  I didn't mean to add to the anxiety.  But this isn't something that can wait until next week IYKWIM.  Your baby is 100% dependent on you for its thyroid hormones until mid-pregnancy which are necessary for brain development. 

 

TSH under 5.0 is an old standard for non-pregnant women.  Most endocronologists believe that if you are not pregnant and showing symptoms with TSH between 3.0 and 5.0, you should up the dose.  Further, according to a 2007 position paper by the Endocrine Society (PM me an email for a pdf), evidence is good that pregnant women without thyroid issues have a TSH under 2.5 during the first trimester and 3.0 during the second and third; you should aim for that.  Plus, it gives you a bit of a buffer as your pregnancy continues.

 

The latest pregnancy related study to show how to manage dosage is called Thyroid Hormone Early Adjustment in Pregnancy (The THERAPY) Trial.  Again, I can email you the paper if you PM me an email.

 

I don't have any personal experience with high early pregnancy TSH numbers.  I can't get/stay pregnant with a TSH over 2.5, so no help there. 

 

Finally, I'd start with Synthroid for the same reasons Springmum states.  Pregnancy already makes things unstable; I wouldn't want to add to that with Armour. 

 

Gotto run... infant is up.


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#8 of 30 Old 04-18-2012, 03:22 PM
 
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Is there any info on % of defects with this so early? Is it more likely to be detrimental early or mostly for those who find out later? Is there anybody out there whose tsh was high in the beginning and had a perfectly healthy babe that would like to chime in?

 

 



Under ten is still a really small problem with a thyroid. I wouldn't worry a speck. I was over 15 several times during the first months of my last pg (it's common to need more meds while pg) and my endo was not concerned at all. Miscarriages and other problems just really don't occur at those numbers.

 

You may not feel well however, and I have tried to keep my tsh under one for the last decade or so, but of course now they are saying if it's too low you may have increased chance of osteoporosis.

 

 

ETA- this is just secondhand info from an endocrinologist who helped me get pg at 45.

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#9 of 30 Old 04-18-2012, 05:03 PM
 
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to maintain a pregnancy u need a TSH of no higher than TWO!

no matter what do not take Armour thyroid meds, there is something wrong with their new formulation

years ago i took armour and it was great!

recently I tried twice the first time I ended up with TSH of 62!

the second time i tried i ended up with TSH of 88!

this medication may have NO thyroid hormone in it at all!

do not risk your pregnancy with Armour and get your TSH down to 2

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Under ten is still a really small problem with a thyroid. I wouldn't worry a speck. I was over 15 several times during the first months of my last pg (it's common to need more meds while pg) and my endo was not concerned at all. Miscarriages and other problems just really don't occur at those numbers.

 

You may not feel well however, and I have tried to keep my tsh under one for the last decade or so, but of course now they are saying if it's too low you may have increased chance of osteoporosis.

 

 

ETA- this is just secondhand info from an endocrinologist who helped me get pg at 45.

I am thoroughly confused. 10, 15, 45 ..are we quoting TSH numbers here? Or maybe the 45 was age but 10 and 15 - are they TSH numbers?

thanks

 

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Under ten is still a really small problem with a thyroid. I wouldn't worry a speck. I was over 15 several times during the first months of my last pg (it's common to need more meds while pg) and my endo was not concerned at all. Miscarriages and other problems just really don't occur at those numbers.

 

You may not feel well however, and I have tried to keep my tsh under one for the last decade or so, but of course now they are saying if it's too low you may have increased chance of osteoporosis.

 

 

ETA- this is just secondhand info from an endocrinologist who helped me get pg at 45.

I am thoroughly confused. 10, 15, 45 ..are we quoting TSH numbers here? Or maybe the 45 was age but 10 and 15 - are they TSH numbers?

thanks

 

 

Yes age 45 with high tsh. Just trying to give OP a pep talk.

 

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#12 of 30 Old 04-19-2012, 04:15 PM - Thread Starter
 
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Now I am very confused, My T4 wasa 8.3, which is normal. She said  my T3 was normal too, but then couldn't find it on the results sheet (I'm thinking they didn't run it) but she kept saying the important one is T4 and if it's normal there is nothing to treat.... Can someone explain that to me?


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Yes age 45 with high tsh. Just trying to give OP a pep talk.

 

 

So you are saying that if TSH were under 10 (or 15) during the first trimester of a pregnancy - then it is still OK?

 

Are you sure about this?

 

Reason I am asking is .. I was on 45 mg of Armour pre-pregnancy and then pregnancy made my number go up slightly  (TSH=3) so we upped the dose to 60 mg and tested twice so far (it was around 1.7 one time and 2.3 last week (two hours after my first dose of 30 mg..I take 2 tablets one in the morn and one in the evening)). 

 

Am wondering if it means it could have increased even more between the two doses (and nearer say 9 PM when I take my 2nd dose).. I don't know how much it could have increased but my safe best would be no more than 5 (if that since I was sub-clinically hypo before I got on these medications)

 

I was a bit worried... 

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Yes age 45 with high tsh. Just trying to give OP a pep talk.

 

 

So you are saying that if TSH were under 10 (or 15) during the first trimester of a pregnancy - then it is still OK?

 

Are you sure about this?

 

Reason I am asking is .. I was on 45 mg of Armour pre-pregnancy and then pregnancy made my number go up slightly  (TSH=3) so we upped the dose to 60 mg and tested twice so far (it was around 1.7 one time and 2.3 last week (two hours after my first dose of 30 mg..I take 2 tablets one in the morn and one in the evening)). 

 

Am wondering if it means it could have increased even more between the two doses (and nearer say 9 PM when I take my 2nd dose).. I don't know how much it could have increased but my safe best would be no more than 5 (if that since I was sub-clinically hypo before I got on these medications)

 

I was a bit worried... 

 

I'm saying you can be... I was, so that's my experience. There is so much talk about miscarriage/birth defects when you are hypo (and I know there is a higher rate of miscarriage for hypo moms- not denying that entirely) it gets to be a fearful situation for pg women. It's not an automatic, and just because you are hypo does not mean that is the cause of your miscarriage.

 

I don't know anything about Armour. I have taken synthroid since my ppd after dd1. Apparently my hypo was undiagnosed in that pregnancy, so have no idea how bad it was. I've just never had a problem managing my thyroid and (for me) it's not something to be afraid of. Treatment is simple and when I hear someone is fearful I like to tell them my story.

 

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#15 of 30 Old 04-19-2012, 05:09 PM - Thread Starter
 
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Well the more I'm reading it really depends on the individual person's body. There are a lot of people out there that feel like they cannot function above a 7, then there are others that function perfectly fine around 40. I've seen a lot of numbers that people believe are their threshold for healthy and not, for able to carry and not. And most of what I'm reading says TSH isn't important, what is is the T3 and T4. So it just comes down to there is no one answer, but now I've got to move on to figuring out what gland is causing a problem here and how to fix it and if it is going to cause more problems. There is no doubt in my mind that this is what caused my miscarriages. I have had three perfectly healthy children, then three miscarriages since the birth of my last one. The only change is something involved with my Thyroid or the axis of glands that go with it. I have had all the hypothyroid symptoms starting not long after DD3's birth. This is the problem, I just need help pinpointing what it is exactly.

 

The one thing I know for sure if I never want to get around 300 cause apparently that's when you go into a coma bigeyes.gif


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#16 of 30 Old 04-19-2012, 05:36 PM
 
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OP -I'm pretty sure high TSH and normal T4 (with normal blood tests to rule out pituitary issues) is classic subclinical hypothyroidism.  Interpretation = your thyroid is struggling to work effectively to keep T4 within range; your your pituitary is signaling the thyroid to work harder by increasing TSH; so far, your thyroid is getting the job done BUT it may not be able to continue to do so. 

 

One reason your your thyroid may be struggling to produce T4 is that it could be attacked by antibodies.  This condition (Hashimotos) is VERY common and testable with an antibody blood test.  Request that.  The bad news is that over time, anitbodies can scar the thyroid tissue making it to where you cannot produce enough T4 on your own no matter what.  Regardless, you have mild hypothyroidism and should be on the look out for it developing into full hypo the rest of your life.

 

OB is saying that T4 is the important number because T3 is made from T4.  Most people have problems making T4 although in some rare cases there is an issue with converting T4 to T3.  So, if your T4 is good, then you have enough raw material (T4) for your body to get the work of making T3 done.  Is that 8.3 number a total or a free T4?  Make sure you ask as they have different interpretations.  (Ask for a copy of the lab report EVERY time.)  It is smack in range for non-pregnant Total T4 BUT I think that total T4 concentrations have been found to be 50% higher in pregnant women suggesting that you are on the low end of normal for pregnancy.  (I wish I had a reference, but I don't.) 

 

I'm surprised the OB says nothing to treat.  The Endocrine Society suggests that you still treat with T4... see 1.1.6 in that 2007 paper.  It would probably mean starting with a pretty low dose (25-50mcg).   The suggestions to treat follows the idea that subcinical generally turns to full hypo if left untreated long enough and pregnancy is not the time to wait around.  If nothing else, I would be requesting to have TSH and T4 monitored monthly through mid pregnancy, at delivery, and at 6 weeks out.

 

Buzzer - I have to respectfully disagree with you.  I'm glad things worked out for you, but many of us cannot get/stay pregnant with those kind of numbers.  Scientific evidence is strong that a TSH number of 15 could be problematic for getting pregnant, maintaining the pregnancy, fetal brain development, and pre-term delivery.  Why an endo would let those kind of numbers go, especially in the first trimester, is a mystery to me.  If it were me, I'd be looking for a different endo for thyroid treatment. 

 

Blessed - TSH numbers are pretty stable from hour to hour, day to day; TSH takes weeks to change.  When taking a form of T3 (which you are if you are taking Armour that has mostly T4 and some T3), there are issues surrounding the timing of the tests for T3 because T3 is not as stable.  But you can believe those TSH numbers.


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Here is a reference for the Total T4 in pregnancy issue.  http://labmed.ucsf.edu/labmanual/db/data/tests/918.html  While your labs reference values may differ slightly, this shows how Total T4 increases in pregnancy making your T4 on the low end of normal.

 


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Buzzer - I have to respectfully disagree with you.  I'm glad things worked out for you, but many of us cannot get/stay pregnant with those kind of numbers.  Scientific evidence is strong that a TSH number of 15 could be problematic for getting pregnant, maintaining the pregnancy, fetal brain development, and pre-term delivery.  Why an endo would let those kind of numbers go, especially in the first trimester, is a mystery to me.  If it were me, I'd be looking for a different endo for thyroid treatment. 

 

 

 

 

I wasn't trying to imply that it's never a problem, sorry if my wording was not clear. She's already pg and seeking treatment, so I was telling her a positive story. And my endo did not leave it untreated. My tsh spiked several times during the first trimester and we adjusted the dosage of synthroid. I have been treated for hypo for 20 some years (I have hashi's) and get weary of the horror stories. I had people tell me my baby would have birth defects and even that I had no business being pregnant. And yes, I agree with everything you said.

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Here is a reference for the Total T4 in pregnancy issue.  http://labmed.ucsf.edu/labmanual/db/data/tests/918.html  While your labs reference values may differ slightly, this shows how Total T4 increases in pregnancy making your T4 on the low end of normal.

 

 

:( the link didn't work and I can't seem to find it on their site.

 

Ah never mind found it! Thanks!


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So yesterday I got my thyroid checked again since I was curious

 

these are the results today (but caveat before. Am on 60 mg of Armour. I take 30 mg at 9 AM and 30 mg at 9 PM)

These were at 6.30 PM

 

TSH =  1.75

Free direct T4= 0.65 (range = 0.82 - 1.77)

T3 = 231 (normal range = 71 to 180)

 

Can anyone interpret what that means (t3 and t4 I mean) 

 

since I am taking Armour which is mostly T4 shouldn't my T4 have been higher? But considering that T4 is converted to T3 (if T4 is low then how come T3 is high?) and TSH has been pretty stable all these weeks? am confused

 

Can someone explain without sending me into a panic... (especially vulnerable these days)

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Buzzer - thanks for the clarification.  I'm really trying not to be alarmist, but sometimes I find people who are fairly natural living minded tend to downplay the real risks in pregnancy of going untreated.  Sometimes people mistakenly think thyroid issues is closer to a vitamin deficency than say a life supporting hormone akin to insulin.  And it can get out of control really fast during and after pregnancy which is what happened with my first... even with a family history of hypo, some signs I was going that way and doing all the pregnancy and post-partum screens, I somehow managed to end up with a TSH of 36 postpartum and was nearly suicidal from sheer exhaustion by that point.  Hence my fairly aggressive language.  But, you are correct to say that TSH =7.5  if she is already 8 weeks pregnant is likely not to cause great harm to her baby, etc.  And, I generally feel that people should treat thyroid by symptoms when not pregnant.  I appreciate your insights.

 

Blessed - Your TSH number looks good.  Your free T4 suggests you need more supplementation while your T3 says you have more than enough.  I'm getting out of my comfort zone, but I think this is one of those issues that comes up with Armour.... because there is T3 in there, you can get that T3 too high while not really having a 'high enough' T4 number.  Armour, rather than your body, is likely making too much T3.  If you feel ok, I'd leave it.  If you are feeling anxious, irritable, any of those hypo symptoms and past mid pregnancy where needs have leveled off, I'd think about decreasing.


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#22 of 30 Old 04-20-2012, 01:21 PM
 
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Originally Posted by UrbanMamma View Post

Buzzer - thanks for the clarification.  I'm really trying not to be alarmist, but sometimes I find people who are fairly natural living minded tend to downplay the real risks in pregnancy of going untreated.  Sometimes people mistakenly think thyroid issues is closer to a vitamin deficency than say a life supporting hormone akin to insulin.  And it can get out of control really fast during and after pregnancy which is what happened with my first... even with a family history of hypo, some signs I was going that way and doing all the pregnancy and post-partum screens, I somehow managed to end up with a TSH of 36 postpartum and was nearly suicidal from sheer exhaustion by that point.  Hence my fairly aggressive language.  But, you are correct to say that TSH =7.5  if she is already 8 weeks pregnant is likely not to cause great harm to her baby, etc.  And, I generally feel that people should treat thyroid by symptoms when not pregnant.  I appreciate your insights.

 

Blessed - Your TSH number looks good.  Your free T4 suggests you need more supplementation while your T3 says you have more than enough.  I'm getting out of my comfort zone, but I think this is one of those issues that comes up with Armour.... because there is T3 in there, you can get that T3 too high while not really having a 'high enough' T4 number.  Armour, rather than your body, is likely making too much T3.  If you feel ok, I'd leave it.  If you are feeling anxious, irritable, any of those hypo symptoms and past mid pregnancy where needs have leveled off, I'd think about decreasing.

 

Thank you. I am feeling completely OK so I will leave it for now. But I will keep a close check on it throughout the pregnancy.....

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#23 of 30 Old 04-22-2012, 07:05 PM
 
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Interesting discussion. I am 18 weeks, and my TSH and T4 were normal, but my T3 was pretty low. I have a family history of thyroid problems, but I know it was all going fine last fall when I had blood work done. My midwife has been in contact with my general practitioner, so I am waiting to see what they recommend.
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#24 of 30 Old 04-24-2012, 08:59 PM
 
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Hi,

 

Just had a doubt... the fact that my T3 is high.. does it mean that now I am hyper-thyroid whereas I am supposed to be hypothyroid and my overcorrecting it has made me hyperthyroid?

 

 

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#25 of 30 Old 05-09-2012, 06:31 AM - Thread Starter
 
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Well went to see an Endo and her opinion was I need synthetic T4. The OB ran a total T4 and she said being pregnant there are too many other things to mess that up. She expects my free T4 to be low and went ahead and started me on a low dose, hope it's not too late for this little one to be healthy.


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#26 of 30 Old 05-09-2012, 07:38 AM
 
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I'm glad you found an answer. Hope the rest of your pg goes well.

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#27 of 30 Old 05-09-2012, 07:50 AM - Thread Starter
 
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Thanks buzzer! Today is the day I first found out something was wrong with the last one. My next appt is at 12 weeks exactly, just have to stay positive and keep from freaking myself out for one more week.


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#28 of 30 Old 05-09-2012, 12:09 PM - Thread Starter
 
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AH! Holy crap, someone tell me how this happens. In three weeks w/o meds my numbers are now normal?????


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#29 of 30 Old 05-12-2012, 05:48 AM
 
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So you haven't started the T4 right? I thought from your earlier post you were on a low dose?

 

thyroid numbers are not definite - they are always changing. They can fluctuate up and down. During pregnancy your body will be trying hard to compensate and get everything working the way it should. What does your Dr say now?

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#30 of 30 Old 05-12-2012, 06:38 AM - Thread Starter
 
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I took the T4 for two days, but stopped now. Dr wants me to pull blood every three weeks for the next few months and just keep an eye on it shrug.gif


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