Hyperthyroidism Diagnosis During Pregnancy

[JuliaC]

Good afternoon! I have been struggling with thyroid symptoms for the last 7 years. My initial test results were a TSH level of 1.3 (no T3 or T4 tests were run at that time). This March, my TSH levels were at 0.58, and I requested a visit to an endocrinologist. Everyone on my mother's side has hyperthyroidism despite always testing within the normal ranges - they are all either on medication or have had surgery to remove the thyroid.

By the time I got to see the endocrinologist, I was 15 weeks pregnant. I was diagnosed by an endocrinologist with hyperthyroidism during week 15 of my pregnancy (TSH <0.01, T3 (total) 2.7, T4, free 1.24). I was put on 50 mg of PTU 3 times/day (150 mg total/day). I began taking the medication just over 1 month ago and noticed an almost immediate improvement in my symptoms.

Although my OB initially agreed that I should take the medication, he has since determined that I cannot be hyperthyroid because it "cannot be diagnosed during pregnancy." He wants me to stop taking the PTU immediately and ignore the endocrinologist.

I cannot get my OB and endocrinologist to talk to one another and have been left to research the condition and its relationship to pregnancy on my own.

Can you help me answer the following questions:
1. Can hyperthyroidism be diagnosed during the second trimester of pregnancy?
2. Was a diagnosis of mild hyperthyroidism possible in my case?
3. Is medication prudent in my case, given the risks of uncontrolled hyperthyroidism during pregnancy?

I appreciate any help you are able to give me, and I have other lab results you may be interested in seeing that I am more than happy to share.

My sincere regards and thanks,

Julia

[Debbie Miller, RN]

Hello,

Women of childbearing age are quite prone to thyroid disorders so if it was not diagnosed prior to pregnancy, it seems logical it could occur even after and it is frequently diagnosed in pregnancy. However, treatment options in pregnancy are limited since the most commonly used medications are not considered safe. Surgery is sometimes necessary if treatment is indicated during pregnancy but of course this is not without risk to the baby.

This may be the reason your doctor recommends that you not take the medication. If the doctor feels yours is a mild case, it may be the best option. But, it is important that you have a relationship of trust with your doctor so if this is not working, perhaps a second opinion is in order. I would think the two types of doctors would welcome an exchange to discuss your condition but you would likely need to release them to disclose information first.

It is safe to take the medications during breastfeeding, in case you are wondering about that. Usually, drugs such as propylthiouracil (PTU) and methimazole (MMI) are used and these can be started after delivery if needed.

I can't overemphasize the importance of the doctor patient relationship so if you are more comfortable you can change providers. Meanwhile, perhaps you should talk with your endocrinologist even if the doctors aren't talking together. Maybe there is more to the picture here.

Best wishes.