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Thyroid Problems/Hyperthyroid in pregnancy

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QUESTION: Hello Dr.

I'm 29yo female and I'm 4 weeks pregnant (that is, 2 weeks after actual conception).

In March 2015 I've been diagnosed with Hashimoto's thyroiditis ( the results were: antiTPO 115, antiTG 33, TSH 1.5).

I've repeated the thyroid tests today (10 June 2015) because I just found out I am pregnant and these are my results: FT3 7.7, FT4 2.6, TSH 0.0018. I went to an endocrinologist right away and he gave me an ultrasound which showed a normal thyroid with a bit of increase in vascularization. However he said I don't need any medication because this TSH supression is normal in early pregnancy and I should only repeat the test after 3 weeks. Also gave me another blood test for anti TSH receptors.

Do you agree? I don't know how mu HCG would have such an impact on a pregnancy as I am at the very beginning of it - the levels must be around 100-500 or so.

I'm worried I will lose the pregnancy because of this - I've already lost 2 of them before for unknown reasons.

Should I look for another endocrinologist?

ANSWER: Aline,
Your doctor is right. If you have Hashimotos' you wont need any medication right now. But monitoring TSH is very important. If TSH goes above normal, it needs immediate thyroxine supplementation. So according to the TSH levels you will need to be on/off medication. People who have autoimmune antibodies they tend to have miscarriages. We can only try to manage and hope for the best. I didnt understand your question about HCG. Can you please rephrase it?


Thanking you!


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---------- FOLLOW-UP ----------

QUESTION: Thank you very much for answering!

So no medication is needed for hyperthyroidism in pregnancy because I have Hashimoto's even if TSH is extremely low and FT3 and FT4 are elevated, is that correct? In the past 3 days I've been having a higher heart rate than normal (around 90-100bpm and I'm assuming it's the thyrotoxicosis).

The question about HCG was poorly formulated. I meant I know that HCG can look like TSH and that is why it makes the thyroid work harder -  but my HCG cannot be that high to suppress TSH like that. I'm only 4weeks along.

ANSWER: Aline,
First I must inform you that Hashimoto's thyroiditis is an autoimmune hypothyroidism. Its not hyperthyroidism. The autoimmune hyperthyroidism is called Graves disease. So are you sure you are positive for Hashimoto's. If there is any confusion, please send me your reports I will check and confirm.

But in Hashimoto's thyroiditis, patients are sometimes in hyper state and sometimes in hypo state. So It is possible that you have Hashimoto and you are currently in hyper state. Since Hashimoto is not primarily hyperthyroid condition, we do not treat them with antithyroid medication. Also hyper state is short lasting and patients come back to hypo again. When they become hypo then only they are given thyroxine supplementation to make them euthyroid/normal. We avoid antithyroid medication in hashimotos because it can cross placenta and destroy thyroid of fetus. The baby after birth may become permanent hypothyroid.

Thats why your doctor has correctly adviced that there is no need of any medication right now.

HCG > 2,00,000 IU/L do cause significant TSH suppression in few pregnant women. But after 2 weeks of conception, HCG is around 400-500. So it can not afftect thyroid function. Dont worry.


Thanking you!


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---------- FOLLOW-UP ----------

QUESTION: Thank you for the detailed response.

I was diagnosed with Hashimoto's by my doctor after the following test results in March this year:
TSH 1.5 [0.3-4]
Anti TPO antibodies 115 [<5]
Anti TG antibodies 33 [<4]
On the ultrasound the thyroid looked normal with one 4mm micronodule. I was told I have Hashimoto's autoimmune thyroiditis with euthyroidism and no treatment was necessary. Is that a correct diagnosis in your opinion?

After 2 weeks of pregnancy though, Ive started to have tachycardia (80bpm when sitting down and up to 145-160pbm when standing up) so I've checked my thyroid function again.

Yesterday TSH was 0.0018 [0.3-4], FT4 2.6 [0.7-1.5], FT3 7.7 [1.7-3.7].

Right now I'm awaiting results for the Anti TSH receptor antibodies test - from my understanding this will decide if I have Grave's or not. Can Grave's coexist with Hashi's?

One last question, is my pregnancy at high risk with these thyroid hormones or the higher heart rate? What can I do to protect the pregnancy as much as possible?

Answer
Aline,
Your doctor is right no need of medication at this point. Yes graves and Hshimoto can coexist in some cases. But these patients normally first present with graves. They develop hashimoto symptoms after they are treated with radio active iodine.

Aline, please dont mind I am very straight forward in this matter. I am not like other doctors who give false hopes to make money. Having autoimmune thyroid condition always increases risk of miscarriages. So close monitoring and continuous counselling with your doctor is necessary to have successful pregnancy. And rest is left to god. Doctors can try what is possible from their side.


Thanking you!


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