Pregnant after a Loss

Hypothyroid mamas, c'mere please

I'm an active TTCALer that has been benched for the last 6 months. Right before being benched I was diagnosed with having a couple of anti-thyroid antibodies and having subclinical hypothyroidism. I don't have full blown Hashi's . . . yet (but it may be in my future).  They put me on .025 mg Synthroid and have been monitoring me.

Last month's TSH was 1.4 (a great number for me), but this months boomeranged up to 4.37 (the highest I've had in a year).  I'm concerned because I'm worried they are going to bench me even longer until my numbers stabilize more.  4.37 is within the old "normal" range, but outside of the newer range that the AACE suggests which has 3 as its highest value. From what I am reading, however, most of the literature with regards to hypothyroidism in pregnancy, the recommendation is a TSH value closer to a 1 for early pregnancy. 

Obviously, I am going to talk to my doc, but was curious to get some feedback. For you ladies that are undergoing treatment for hypothyroidism during pregnancy, what TSH and/or T4 levels are your docs targeting?

Thanks ladies!

 

Me: 36 yo, TTC #1 since Feb. 2012
BFP #1, 3/12, EDD 11/9/12, MMC 3/27/12, D&C 4/10/12

BFP #2: 11/16/12, EDD 7/25/13, MMC 12/5/12, D&C 12/6/12, Complete molar pregnancy confirmed 2/9/13, benched for 6 months until  August 2013

IUI #1, 8/16/13 Femara + Menopur, 3 mature follicles, BFN
IUI #2 (back-to-back, 9/12/13 and 9/13/13) Femara + Menopur, four mature follicles, BFFN
IUI #3, 10/8/13 Femara + Menopur, six mature follicles, BFN

BFP #3, 12/9/2013, while on treatment break, EDD: 8/22/2014  Please stick and grow, LO!

Additional Dx: hypothyroidism, TgAb positive & anti-TPO positive, POR/DOR (2/2013), and suspected endometriosis

******All AL always welcome******

Re: Hypothyroid mamas, c'mere please

  • I'm sorry that levels aren't stabilizing... ugh.

    My doctor wanted 1.5-2 before our IVF cycle. TSH levels tend to jump in pregnancy and she wanted some safe "wiggle room". 

    Mine in fact jumped from 1.23 to 3.4 at 5 weeks pregnant so its a good thing we were in that range. 

    Good luck! I hope that they can manage it with just increasing the dose and don't bench you!

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  • My target TSH is 1.0 - 1.5. How often are they testing your thyroid levels? I typically only have mine tested every 3 months after it was regulated pre-pregnancy and now have it checked every 4-6 weeks during pregnancy.. Also, have you changed the time you take the Synthroid or added any new medications...many medications or eating too soon after taking it will cause the medication to not be absorbed properly. 
    TTC #1 Since Oct 2011
    BFP #1 4/29/12 m/c 5/18/12 at 6w2d
    BFP #2 8/28/12 EDD 5/10/13 MC 9/22/12 at 6w4d
    BFP #3 12/31/12 EDD 9/12/13

    Me Dx: DOR   DH: all tests normal
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  • They are testing me every month--they just do it the same time that they do my molar pregnancy monitoring. They wanted to watch me fairly closely until we found the right dose. I have not added anything and never eat or drink anything until 30 minutes after taking it. The only thing that is different is I am exercising less and started drinking alcohol again.

    For the last 6 months my levels have been

    2.48
    3.09
    2.29
    2.48
    1.45
    4.37

     

    Me: 36 yo, TTC #1 since Feb. 2012
    BFP #1, 3/12, EDD 11/9/12, MMC 3/27/12, D&C 4/10/12

    BFP #2: 11/16/12, EDD 7/25/13, MMC 12/5/12, D&C 12/6/12, Complete molar pregnancy confirmed 2/9/13, benched for 6 months until  August 2013

    IUI #1, 8/16/13 Femara + Menopur, 3 mature follicles, BFN
    IUI #2 (back-to-back, 9/12/13 and 9/13/13) Femara + Menopur, four mature follicles, BFFN
    IUI #3, 10/8/13 Femara + Menopur, six mature follicles, BFN

    BFP #3, 12/9/2013, while on treatment break, EDD: 8/22/2014  Please stick and grow, LO!

    Additional Dx: hypothyroidism, TgAb positive & anti-TPO positive, POR/DOR (2/2013), and suspected endometriosis

    ******All AL always welcome******
  • Thanks so much for both of your responses!
    Me: 36 yo, TTC #1 since Feb. 2012
    BFP #1, 3/12, EDD 11/9/12, MMC 3/27/12, D&C 4/10/12

    BFP #2: 11/16/12, EDD 7/25/13, MMC 12/5/12, D&C 12/6/12, Complete molar pregnancy confirmed 2/9/13, benched for 6 months until  August 2013

    IUI #1, 8/16/13 Femara + Menopur, 3 mature follicles, BFN
    IUI #2 (back-to-back, 9/12/13 and 9/13/13) Femara + Menopur, four mature follicles, BFFN
    IUI #3, 10/8/13 Femara + Menopur, six mature follicles, BFN

    BFP #3, 12/9/2013, while on treatment break, EDD: 8/22/2014  Please stick and grow, LO!

    Additional Dx: hypothyroidism, TgAb positive & anti-TPO positive, POR/DOR (2/2013), and suspected endometriosis

    ******All AL always welcome******
  • It's good that they have you on Synthroid!   The generic can vary by up to 12% (so if you were on 100 micrograms, you could really be getting 88 micrograms or 112 micrograms if you were taking generic).

    I have been taking a T4 replacement for a couple years, but I didn't know how out of whack my thyroid really was until I went to an endocrinologist last August after my miscarriage last July.   I went from taking 50 micrograms of Synthroid in May to 125 in September, without much change in my TSH levels.  

    I had the tests for the antibodies last September- and I had really high levels of the anti-thyroid peroxidase antibody.  Thyroid peroxidase is the enzyme that converts T4 to T3 (which is the active form).  They could have put me on 500 mcg of synthroid, and it wouldn't have made a difference for me- since I couldn't use it.

    So...  we added in cytomel, which is all that they have changed throughout this pregnancy.   

    And back to your questions...

    TSH closer to 1.0 is ideal for TTC.   If you are on replacement meds (synthroid/cytomel/armour, etc), your TSH should be at or below 2.5 anyway (take the range of "normal' which is usually 0.5-4.5, add them, divide by 2-  this should be the target for everyone on replacement meds).

    TSH closer to 1.0 is also what is now recommended for the first trimester.

    TSH of around 2-3 is what is recommended for the second & third trimesters.  

    I also get my free T3  checked.  My levels were perfect until I was 20-24 weeks (which is when I was able to finally eat again!)  TSH has been a little high, but T3 is still within range.

    I have an article (i.e. actual scientific journal article) that came out last August about the  new recommendations.  PM me if you would like a copy. 

    TTC since Feb 2012. Me: 39, DH: 37
    BFP #1 5/27/12- m/c 7/9/12 @ 10w2d (cytotec induced @11w).
    Fibroids, Hashimoto's Hypothyroidism
    BFP #2 11/18/12  EDD 7/27/13
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  • image babystoli:

    It's good that they have you on Synthroid!   The generic can vary by up to 12% (so if you were on 100 micrograms, you could really be getting 88 micrograms or 112 micrograms if you were taking generic).

    I have been taking a T4 replacement for a couple years, but I didn't know how out of whack my thyroid really was until I went to an endocrinologist last August after my miscarriage last July.   I went from taking 50 micrograms of Synthroid in May to 125 in September, without much change in my TSH levels.  

    I had the tests for the antibodies last September- and I had really high levels of the anti-thyroid peroxidase antibody.  Thyroid peroxidase is the enzyme that converts T4 to T3 (which is the active form).  They could have put me on 500 mcg of synthroid, and it wouldn't have made a difference for me- since I couldn't use it.

    So...  we added in cytomel, which is all that they have changed throughout this pregnancy.   

    And back to your questions...

    TSH closer to 1.0 is ideal for TTC.   If you are on replacement meds (synthroid/cytomel/armour, etc), your TSH should be at or below 2.5 anyway (take the range of "normal' which is usually 0.5-4.5, add them, divide by 2-  this should be the target for everyone on replacement meds).

     

    Thanks so much! I am positive for TgAb, but I am not sure about anti-thyroid peroxidase. I have an appointment on Thursday and will definitely ask. I definitely want a copy of your article (although I think I may have it) and will PM you. Thanks!

    Me: 36 yo, TTC #1 since Feb. 2012
    BFP #1, 3/12, EDD 11/9/12, MMC 3/27/12, D&C 4/10/12

    BFP #2: 11/16/12, EDD 7/25/13, MMC 12/5/12, D&C 12/6/12, Complete molar pregnancy confirmed 2/9/13, benched for 6 months until  August 2013

    IUI #1, 8/16/13 Femara + Menopur, 3 mature follicles, BFN
    IUI #2 (back-to-back, 9/12/13 and 9/13/13) Femara + Menopur, four mature follicles, BFFN
    IUI #3, 10/8/13 Femara + Menopur, six mature follicles, BFN

    BFP #3, 12/9/2013, while on treatment break, EDD: 8/22/2014  Please stick and grow, LO!

    Additional Dx: hypothyroidism, TgAb positive & anti-TPO positive, POR/DOR (2/2013), and suspected endometriosis

    ******All AL always welcome******
  • My old RE wanted my level between 1 and 2 so he put me on 25mcg. I started out around a 3.56 I think. I stabilized quickly (this was back in late 2010) and stayed within that range until this current pregnancy. By this point I was seeing a new RE who I trust a LOT more than the old one but was really discouraged by the fact that he was not the least bit concerned about my rising TSH levels telling me that my 3.8 was perfectly fine. He saw absolutely no reason to increase my meds. I asked my OB who admitted she simply didn't know what to do regarding dosage so she sent me to a MFM where I've been closely monitored throughout this pregnancy. But even my MFM sees no point in increasing my meds.

     Since our little girl hasn't been affected by the levels and they've stayed between 3.4 and 3.8 throughout this pregnancy I've felt a bit more reassured but I remember really being in a panic when originally no one would listen to my concerns. So I don't know if we've just been lucky or if their really isn't anything to worry about. But apparently, my current RE, OB, and MFM are all okay with anything under 4.5 whereas my old RE was up to date on the literature and really wanted it less than 2.

    It's so difficult to know what to do when doctor's disagree on every little thing. But do whatever you feel is best. Good luck!


    My Blog: Grow Baby Grow

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    First off, huge (((((((((hugs)))))))))))

    I remember how frustrating it was being benched while my endo adjusted my meds each month and tested me over and over again!

    My endo originally wanted my TSH level to be between 1-3 before I was given the green light to TTC.  Since being pregnant, he's wanted my level close to 1.  I've hovered just above 1 this whole time, only having to change my dosage once.

    TTC: 10/2011
    BFP #1: 3/3/12, EDD: 11/11/12, Missed M/C: 4/3/12 @ 8 weeks 2 days, D&C: 4/6/12
    BFP #2: 6/29/12, EDD: 3/8/13, Natural M/C: 7/16/12 @ 6 weeks 2 days
    Hashimoto's Thyroiditis, Hypothyroidism
    BFP #3: 1/14/13, EDD: 9/25/13
    Never in our arms, forever in our hearts...
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  • No advice here but I did want to give *HUGS*
    BFP#1 9/28/2012 - EDD 6/3/2013 - MMC discovered 11/21/2012 @ 12w2d - D&C 11/24/2012
    BFP#2 4/4/2013 - Born at 37w3d on 11/26/13 via emergency c-section
    Loving our beautiful rainbow baby boy Archer!
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    ~*All AL Welcome*~
  • image Bookshelves:
    I don't know anything about all this, but I just read your post on TTCAL and wanted to send you the biggest of biggest hugs. I <3 you, and I'm so sorry to see you in pain. xoxo

    Same here. ((hugs))

     

    imageimage
    BFP with #1 (twins!) 11/18/2011 - missed m/c at 8weeks3days; d&c 1/19/2012; myomectomy to remove 18cm+,10cm & 5cm fibroids 4/2012; TTC again 7/2012; BFP #2 (twins) 11/13/2012; missed m/c at 7weeks;
    BFP #3: baby girl born 3/5/2014

    Balaustine: an anthology about wanting family
  • image Laurakat81:

    My old RE wanted my level between 1 and 2 so he put me on 25mcg. I started out around a 3.56 I think. I stabilized quickly (this was back in late 2010) and stayed within that range until this current pregnancy. By this point I was seeing a new RE who I trust a LOT more than the old one but was really discouraged by the fact that he was not the least bit concerned about my rising TSH levels telling me that my 3.8 was perfectly fine. He saw absolutely no reason to increase my meds. I asked my OB who admitted she simply didn't know what to do regarding dosage so she sent me to a MFM where I've been closely monitored throughout this pregnancy. But even my MFM sees no point in increasing my meds.

     Since our little girl hasn't been affected by the levels and they've stayed between 3.4 and 3.8 throughout this pregnancy I've felt a bit more reassured but I remember really being in a panic when originally no one would listen to my concerns. So I don't know if we've just been lucky or if their really isn't anything to worry about. But apparently, my current RE, OB, and MFM are all okay with anything under 4.5 whereas my old RE was up to date on the literature and really wanted it less than 2.

    It's so difficult to know what to do when doctor's disagree on every little thing. But do whatever you feel is best. Good luck!

     

    It is sooooo difficult when they disagree! And even the main professional organizations and recommendations disagree so it is hard to know who to trust. 

    Me: 36 yo, TTC #1 since Feb. 2012
    BFP #1, 3/12, EDD 11/9/12, MMC 3/27/12, D&C 4/10/12

    BFP #2: 11/16/12, EDD 7/25/13, MMC 12/5/12, D&C 12/6/12, Complete molar pregnancy confirmed 2/9/13, benched for 6 months until  August 2013

    IUI #1, 8/16/13 Femara + Menopur, 3 mature follicles, BFN
    IUI #2 (back-to-back, 9/12/13 and 9/13/13) Femara + Menopur, four mature follicles, BFFN
    IUI #3, 10/8/13 Femara + Menopur, six mature follicles, BFN

    BFP #3, 12/9/2013, while on treatment break, EDD: 8/22/2014  Please stick and grow, LO!

    Additional Dx: hypothyroidism, TgAb positive & anti-TPO positive, POR/DOR (2/2013), and suspected endometriosis

    ******All AL always welcome******
  • image ellajune2012:

    image Bookshelves:
    I don't know anything about all this, but I just read your post on TTCAL and wanted to send you the biggest of biggest hugs. I <3 you, and I'm so sorry to see you in pain. xoxo

    Same here. ((hugs))

     

     

    Thanks, loves!

    Me: 36 yo, TTC #1 since Feb. 2012
    BFP #1, 3/12, EDD 11/9/12, MMC 3/27/12, D&C 4/10/12

    BFP #2: 11/16/12, EDD 7/25/13, MMC 12/5/12, D&C 12/6/12, Complete molar pregnancy confirmed 2/9/13, benched for 6 months until  August 2013

    IUI #1, 8/16/13 Femara + Menopur, 3 mature follicles, BFN
    IUI #2 (back-to-back, 9/12/13 and 9/13/13) Femara + Menopur, four mature follicles, BFFN
    IUI #3, 10/8/13 Femara + Menopur, six mature follicles, BFN

    BFP #3, 12/9/2013, while on treatment break, EDD: 8/22/2014  Please stick and grow, LO!

    Additional Dx: hypothyroidism, TgAb positive & anti-TPO positive, POR/DOR (2/2013), and suspected endometriosis

    ******All AL always welcome******
  • ((HUGS)) Thyroid stuff is so complicated!

    I have Hashi's. My endo is aiming for me to be right around 1 for TSH, but we haven't gotten there yet. I just started meds shortly before getting pregnant (and believe that the Hashi's may have had something to do with my earlier m/c, though I have no proof of that). At my last check I was at 2.4 and she bumped my meds to 75mcg from 50. I have to get it monitored monthly, and she said not to be surprised if my dose doubles through the course of pregnancy. She also specifically wants me on Synthroid throughout the pregnancy.

    GL! It's not easy to manage a chronic medical condition through all of this. More ((HUGS)) for good measure!

    Suzy & Brian November 3, 2007 "...this one time, at band camp..." ;-)
    TTC #1 since 9/2012
    BFP #1 2/16/13, EDD 10/13/13, CP 2/21/13
    BFP #2 6/2/13
    Baby J-Bug 2/8/14 My Wedding Bio from back in the day
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