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Forum Name: Endocrinology Topics

Question: Pregnant, hypothyroid, rapidly rising tsh, dose question


 Mandor - Thu Aug 12, 2010 5:16 pm

Hi There,

My name is Amanda, I am a 28 year old female currently in my 8th week of my 4th pregnancy with 2 live children and 1 miscarriage recently. During my miscarriage, my tsh rose to 3.49 before my doctor increased my Synthroid dosage from 50mcg to 75mcg. Following the miscarriage, my tsh dropped all the way to 0.03 where it was when I got pregnant again. My dr. had me decrease my Synthroid dosage back to 50mcg daily. In less than 2 weeks, my tsh went from 0.03 to 0.54. I then upped my dosage to 50mcg for two days and then 75mcg on the third day. 19 days later, my tsh is at 2.73 and I am concerned with how rapidly it is rising. I am feeling very hypo again. My dr, unfortunately thinks that this is still normal, but I'm concerned with both the rate it is rising and the level it is at. I want to increase my dosage again, but she isn't convinced. I live in Canada and am seeing a family practitioner who refuses to refer me to an endocrinologist because she feels my tsh is within the normal range. I am working hard on a referral, but don't want to ignore my rising tsh in the meantime.

I know that progressive testing with T3 and T4 would be the most helpful in order to come to a firm conclusion, but unfortunately my dr. won't do this testing as she feels TSH is a good enough gauge so I don't have those numbers for you.

Should I increase my dose? If so, what would you consider a reasonable increase that will likely lower my tsh to within the 1-2 range? And, is my tsh level of 2.73 dangerous as far as the pregnancy goes? I really don't want to have another miscarriage. I have had one ultrasound already a week ago with a strong heartbeat if that helps at all.

Thank-you so much for your help.
 Dr.M.Aroon kamath - Sat Sep 04, 2010 1:10 am

User avatar Hi,
It is not advisable to try and correct the TSH levels in pregnancy without knowledge about the FT4 levels. TSH levels take time to change following dosage adjustments of thyroxin, and harm may be done to the growing fetus in the interim.

Both maternal hypo and hyperthyroidism are not good for the fetus as well as the mother but, between them, hyperthyroidism perhaps is more harmful from the point of view of the fetus. Therefore, rather than to risk pushing oneself into a hyperthyroid state, it is imperative that any changes in thyroxin dosage during pregnancy, should only be guided only by FT4 levels.
Good luck!

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