Unstable TSH levels & pregnancy - Mothering Forums

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Old 08-29-2007, 10:39 AM - Thread Starter
 
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I'm hoping you guys can shed some insight on my very perplexing test results. I've been hypothyroid for about 7 years now. When I was preg with ds, I became more and more hypothyroid, and I think that's pretty typical. This pregnancy, the opposite seems to be happening. My levels are so eradic and we can't get them normalized. Here are my test results so far:

4/07 - pre-pregnancy --- took 60 mg 2 hrs before test --- TSH 3.4
7/07 - 4 weeks preg ---- took 120 mg 3 hrs before test --- TSH 0.2
8/07 - 8 weeks preg ---- took 60 mg 3 hrs before test --- TSH 0.03

I know that being hyper or hypo is bad for the baby and am getting really worried because my levels aren't responding to changes in dosage. My dose for the past 2 yrs has been 120 mg of Armour which I used to divide in half, then started taking it all in the morning because I was forgetting the second dose. My dr thought my tests were showing I was hyper because Armour is a fast acting thyroid, so she suspected I was hyper in the a.m. and hypo in the p.m. I started splitting my dose again, but obviously I became even more hyper. Should I quit taking it altogether? I'm getting really worried about the baby! As long as my T3 and T4 levels are OK, will the baby be OK? I hate to so on synthroid, but maybe it would stabilize my levels at least while I preg??
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Old 08-29-2007, 01:23 PM
 
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The point is to get the T3 and T4 levels stable, that's what's doing the work in your body. The TSH is just how much of that it's taking to stimulate the thyroid to produce enough of the T3 and 4. It's secondary. It's a measure of how hard your pituitary is having to work. The relationship between TSH and the T3 and 4 is also indicative of how well the Thyroid is responding to the TSH.

btw, low TSH is usually better. Means the pituitary isn't having to do so much for the thyroid to be doing enough.

What my endocrinoligist said, the one time I've seen her so far, is that people often don't wait long enough to see if they're stable or not, then change their dosage in response to a number, which makes the swings more pronounced. It takes a good couple of months to see if any given dose is right-to stabilize at that level, or at least a good few weeks.

Armour isn't entirely fast acting. What happens is that T3 is the "fast acting" hormone in that that is the active form, which the liver makes by converting T4 into T3.

So the T3 in the Armour is available immediately, and the T4 is there to be converted as needed.

"What will you do once you know?"
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Old 08-29-2007, 10:42 PM - Thread Starter
 
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Originally Posted by Meiri View Post
The point is to get the T3 and T4 levels stable, that's what's doing the work in your body. The TSH is just how much of that it's taking to stimulate the thyroid to produce enough of the T3 and 4. It's secondary. It's a measure of how hard your pituitary is having to work. The relationship between TSH and the T3 and 4 is also indicative of how well the Thyroid is responding to the TSH.

btw, low TSH is usually better. Means the pituitary isn't having to do so much for the thyroid to be doing enough.

What my endocrinoligist said, the one time I've seen her so far, is that people often don't wait long enough to see if they're stable or not, then change their dosage in response to a number, which makes the swings more pronounced. It takes a good couple of months to see if any given dose is right-to stabilize at that level, or at least a good few weeks.

Armour isn't entirely fast acting. What happens is that T3 is the "fast acting" hormone in that that is the active form, which the liver makes by converting T4 into T3.

So the T3 in the Armour is available immediately, and the T4 is there to be converted as needed.
Your post was very very helpful to me. Thank you for replying. So what you're saying is that as long as my T3 and T4 are normal, I shouldn't worry about my TSH? Just want to make sure I'm "getting it"!
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Old 08-30-2007, 01:25 AM
 
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That's pretty much what I was saying. You should ask your endocrinologist of course. I am not a doctor. The point of TSH is to stimulate the thyroid to produce enough T3 and 4. If it's producing enough, the TSH will be nice and low. If it's flagging in production, the pituitary will send more TSH to tell it to pick up production.

It could be also that it's taking more TSH to tell the thyroid to produce enough. That's where I've been, so my endo put me on a low dose of Armour.

Go to your library and look for The Thyroid Book or The Thyroid Book for Women, (may be a word off in those titles) both by the same female author. She gives very clear and thorough explanations of how things work, treatment options if they aren't working well, pros and cons of different meds and treatments.

I've found that when I have a good basic knowledge of my condition, I work more effectively with any doc I see.

I also have to remind my regular doc, when she's ordering bloodwork, to order all 3 or 4 thyroid tests. A TSH by itself isn't very helpful IMO. What needs to be known is the relationship between it and what the thyroid produces. Low TSH with low T3/T4 means something different from Low TSH with high T3/T4, and different from high TSH with low T3/T4 or high TSH with high T3/T4.

It also takes time, don't micro-manage yourself on this.

"What will you do once you know?"
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Old 08-30-2007, 10:44 AM - Thread Starter
 
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This thread has been very good for me. I do need to pay more attention to my T3 and T4. I know they've always been in the "normal" range but haven't paid much attention to where they are within the range. I know that when my TSH gets over 3.0 or so, my periods become irregular, so my T3 and T4 must be flucuating also. Do you happen to know whether there is an "ideal" range of T3 and T4 in pregnancy? I've heard that it's best to keep TSH around 1.0 during preg but have never read anything specific about T3 and T4 in preg. Right now that's what I'm most concerned about. TIA!
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Old 08-30-2007, 07:20 PM
 
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I don't know what the current range recommendations are, hence my suggestion that you find one of those books.

There's also The Thyroid Thread on this forum.

Also, you can do a search online. As I recall, Thyroid.about.com has good info. Be leary of anyone selling stuff though. Their info may or may not be skewed. Also, before any appointment with your endo, write down your questions. Ask lots of questions too.

"What will you do once you know?"
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Old 08-30-2007, 07:24 PM
 
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You also want to make sure it's the FREE T4 and T3 they are testing. My understanding is that's what's availale for your body. I also believe that TSH can be affected bc you have all the excess hormones during preg (I think) so not a good measure.

I think most people feel best with their frees in the top quarter of the range. Not sure of any difference if preg.

If you OB or FP is managing this, you may want to see an endo, although they aren't always great w/ this stuff either (and many are armour-phobes). My endo, after not needing to adjust my meds according to my first trimester labs tod me to retest in the third trimester. I had my OB check labs monthly and did need to up my dose at 16 weeks, but was stable after that.

I thin the 1.0 TSH during preg is just based on 1.5 being an avg TSH in a healthy population. My TSH is .03 but that is where it stays when my frees are in the right range. So just bc TSH is so below range,doesn't automatically signal hyper.

Be proactive with this, but don't stress yourself out.
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Old 09-01-2007, 12:36 AM
 
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I have to run so I didn't read previous posts... but I did want to ask if you have had your thyroid antibodies tested b/c conditions like Hashimoto's can cause flux between hyper and hypo.
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Old 09-02-2007, 05:27 AM - Thread Starter
 
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I have to run so I didn't read previous posts... but I did want to ask if you have had your thyroid antibodies tested b/c conditions like Hashimoto's can cause flux between hyper and hypo.
I don't think I've had this test run recently but know I had it at least a couple of times in the past (most recent I recall was about 4 yrs ago). It's always come back neg for antibodies. I have a very significant family history of non-autoimmune hypo (everyone in my mom's side of the family), so I don't think that's what is going on.
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