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#1 of 34 Old 12-08-2010, 07:56 PM - Thread Starter
 
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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.

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#2 of 34 Old 12-08-2010, 09:13 PM
 
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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?

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#3 of 34 Old 12-08-2010, 09:50 PM - Thread Starter
 
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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

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#4 of 34 Old 12-08-2010, 10:38 PM
 
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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.

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#5 of 34 Old 12-08-2010, 10:55 PM
 
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Look at Thyroxine production rate and increased plasma volume in this text..

 

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

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#6 of 34 Old 12-09-2010, 05:10 AM
 
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#7 of 34 Old 12-09-2010, 06:17 AM - Thread Starter
 
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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?

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#8 of 34 Old 12-09-2010, 10:57 AM - Thread Starter
 
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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. 

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#9 of 34 Old 12-09-2010, 11:56 AM
 
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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.

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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.

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#11 of 34 Old 12-09-2010, 01:58 PM
 
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Hey - I don't know anything useful about thyroids or hormones/meds, but I am sending prayers your way. Take care, mama!

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#12 of 34 Old 12-09-2010, 02:19 PM
 
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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!


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#13 of 34 Old 12-09-2010, 02:50 PM - Thread Starter
 
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Thanks so much for all the replies. 

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Originally Posted by Amila View Post

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.

 

 

Quote:
 

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.

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#14 of 34 Old 12-09-2010, 05:55 PM
 
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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.

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#15 of 34 Old 12-09-2010, 06:53 PM - Thread Starter
 
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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. 

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#16 of 34 Old 12-11-2010, 05:54 PM - Thread Starter
 
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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.

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#17 of 34 Old 12-11-2010, 07:23 PM
 
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Quote:
Originally Posted by MamaChef View Post

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?
 


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#18 of 34 Old 12-11-2010, 09:06 PM
 
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No, I meant to say hyperthyroid.  I was just typing late.  Sorry about the confusion.

Quote:
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Quote:
Originally Posted by MamaChef View Post

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?
 



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#19 of 34 Old 12-11-2010, 11:48 PM
 
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So glad to hear that your symptoms are improving!

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#20 of 34 Old 12-12-2010, 08:35 AM - Thread Starter
 
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  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.

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#21 of 34 Old 12-14-2010, 12:44 PM - Thread Starter
 
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Well I made my appointment today with the perinatologist. It turns out he doesn't want to see me until 19 weeks which will be  a little three weeks after I started medication. I'm hoping that he will do his scan and check my blood and decide that all is fine and tell me not to come back!  I was quoted $2200 for one visit. 

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#22 of 34 Old 12-14-2010, 11:39 PM
 
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Wow that is absolutely criminal. The specialist we saw today quoted us $2500 for a genetic test (of which we might need two), and we're having a hard time determining if it's covered. Craziness.

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#23 of 34 Old 12-15-2010, 04:32 AM
 
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Quote:
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Well I made my appointment today with the perinatologist. It turns out he doesn't want to see me until 19 weeks which will be  a little three weeks after I started medication. I'm hoping that he will do his scan and check my blood and decide that all is fine and tell me not to come back!  I was quoted $2200 for one visit. 


Have you looked into state medicaid? I qualified even though we make too much for my kids to qualify because we didn't have health insurance. I think if you're underinsured they should cover you too.
 


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#24 of 34 Old 12-15-2010, 10:31 AM - Thread Starter
 
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We have insurance. We just made a calculated decision not to purchase maternity since generally, they don't cover midwifery services anyway. However, I've determined that for Maternity insurance to have been worth it, we'd have to have over $8,500 in medical bills and would have covered less than half of my midwifery fees since I'm seeing a CNM. Just praying my levels and everything else are so good that we don't have to go back!

 

Yeah, see that's the thing. "Complications" of pregnancy are covered under my insurance but thyroid disorders are not specifically mentioned so I'm guessing I'd be better off as a self pay.

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#25 of 34 Old 12-16-2010, 05:02 AM
 
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you should still check into medical assistance.  our insurance doesn't cover maternity either.  i didn't realize it until after i discovered i was pregnant with the twins last year.  (i knew it didn't cover delivery but for some reason i thought prenatal care was covered)   i was shocked to discover that we qualified because they don't look at savings or investments at all, only income.  and the limits are pretty high, at least in PA.  


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#26 of 34 Old 12-16-2010, 10:19 PM
 
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I'm going through some thyroid issues as well, but with low tsh. I had no idea some insurance companies don't cover pregnancy. That's awful!   I hope everything works out with your thyroid levels and you won't have to see the high risk ob. That price is insane. I wonder what the criteria  is for receiving medicaid. I know people who had pregnancies while uninsured and received hep while others didn't qualify and ended up with medical debt. Their financial situations seemed the same to me.


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#27 of 34 Old 12-16-2010, 10:48 PM - Thread Starter
 
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Well, it was a calculated decision we made. I think I will be able to pay for most of it out of the HSA so long as it's only a couple of appointments.   I'm up tonight. I think I'm having a hard time adjusting to the medication. After a few days I was sleeping all the time. A few days after that, I'm having trouble sleeping again :(

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#28 of 34 Old 12-18-2010, 06:50 AM
 
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If your synthroid regulates things okay, is there still a concern?  Can't you retest and find out once you've been on it for a while?  I've been hypothyroid since the birth of my first, and no one freaked out at all when my levels weren't normal with my blood test at the beginning of my pregnancy.  The doctor said my reflexes are normal and we didn't have to increase the dose of meds--I asked to anyway because I could not function at all.  They've always said the blood tests aren't great for diagnosis anway--they go more by the reflexes and the way a patient feels.  We haven't even retested even though the dose was increased over 30%. 

 

I'm just wondering what the urgency is.  What is this doctor going to check, and how will it affect your  treatment?  Can't you have another blood test first, before escalating the concern?  What would they check for on a scan?  Why a specialist?  I understand the lack of insurance.  My maternity coverage doesn't kick in until Jan 8th.  I'm on my own until then and am constantly trying to avoid unnecessary recommendations.  (Not saying yours is unnecessary.)  Just trying to help you ask all the questions you need to.


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#29 of 34 Old 12-23-2010, 07:13 PM
 
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I'm on Synthroid (100mcg currently) and have my levels tested every 6-8 weeks during pregnancy. My OB also wants me on the brand name during pregnancy because she says it is more stable and keeps the levels more even. No other big issues with it other than adjusting my dosages up/down as needed asap.


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#30 of 34 Old 12-24-2010, 12:38 PM - Thread Starter
 
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No. It's not a big deal. It's just that I wasn't on my medicine when I got pregnant and my midwife feels uncomfortable so I'm having to see specialists because she's concerned about it getting regulated and concerned that my time off medication has hurt the baby. We'll probably find out more at my appointments on the 3rd, 4th, and 5th of January. For now, I'm only on 50 mg of Synthroid.  My TSH isn't THAT high. Just enough to be a concern in my opinion.

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