TSH ok now, but T4 still low???

Marit · #1 (**permalink**) 08-06-2004, 03:09 PM

Hi! I found out I was hypothyroid last fall (I had testing done after 2 losses), and have been testing my blood regularly ever since in order to reach the optimal TTC level. My TSH was 4.3 when I first discovered I was hypo., and now fluctuates between 1 and 2. I'm trying to get it to stabilize close to 1. I don't have thyroid antibodies, so I really don't know what's causing my hypothyroidism.

My question is: Even though my TSH seems to respond well to the medication (Levaxin, it's called where I am), my T4 doesn’t go up much. Why is this? It mostly remains in the lower third of the normal range (different measuring levels over here than in the States), and I'd like to see it rise. Why is it so hard to get my T4 to go up, when my TSH is good? Even my endocrinologist doesn't seem to know (we're still hoping it will go up eventually). I've read that T4 should ideally be in the upper third of the normal range during pregnancy. It worries me that it's not. My T3 is good, btw. Am I fine or do I need to take action?

TIA!

califgrl · #2 (**permalink**) 08-07-2004, 07:58 AM

Hi Marit,

Well, it is good that you were properly diagnosed for the hypothyroidism! I was diagnosed with hypothyroidism as an infant, and luckily had some excellent doctors back then who were able to get me on the proper medication during my 1st month. In the 36 years since, I have seen many endo doctors and have often fluctuated in my TSH levels (sometimes up to 9 & 10!). Anyway, the good news is that I now have an excellent, well-attentive endo specialist (and my RE is knowledgeable about TSH also). My TSH levels are now ranging between 1-2 for the past 2 years, as we have been trying to regulate for quite some time. I am sure my earlier fluctuations contributed to my IF problems.

Yes, your normal TSH level should range from 1-2, and will often increase to 2.5 or 3 while you are pg, which is normal for pg. Of course, your dosage needs will increase and the endo will prescribe accordingly (during my last pg, my dosage went from .137 to .15, but endo thinks m/c was due to something else since TSH was OK then). Regarding the T3 & T4 levels, my endo has indicated that I am in the correct range, but these levels are known to fluctuate and the most important indicator for successful pg is the TSH level. My endo now has me do a blood test for TSH levels every month as I am going through my IUI cycles... just to be sure that I am still in the correct range. I would definitely recommend that you approach your endo for frequent blood tests to be sure your TSH level is in the correct range before you conceive. This will help your endo reach a good conclusion on the dosage increases once you get pg.

Hope this helps, and :gl

Marit · #3 (**permalink**) 08-07-2004, 04:25 PM

Thank you so much for your response! There has been a new turn of events, as I today found out that I am pregnant!

This was our last cycle trying before heading for IUI and eventually IVF, and I am so grateful and happy! Although, b/c I have had two losses I am also apprehensive. My losses happened before I found out that I was hypothyroid, and I've been on replacement hormone and had my blood tested ever since. Hopefully this will make the difference!

My endo is having me come in very frequently (every 3 weeks) b/c we are (were

) TTC (and about to start IUI's). But last week my TSH was 1.9 (higher than usual), so he told me increase the dosage and come in next week already! It's great that he's so pro-active since we're TTC! I now know that me being pregnant (but too early to know - I was 10 dpo), is likely to have caused my TSH to go up. (We were so puzzled by it, b/c we had increased the dosage last time, too - yet it went from 1.3 to 1.9!) So I'm calling him first thing Monday to inform him, but I'm increasing the dosage already starting tomorrow (and a tiny bit more than he suggested, since I now know that I am pregnant.)

Do you think this will be ok? I just don't want my TSH to be too high now and then not find out till next week! (B/c it's Sat. today I have to wait till Monday

.) I just want to be on the safe side!

It's reassuring to know that it's the TSH level that is the most important. Thank you so much for sharing your knowledge with me! I hope you will also recieve some good news soon!

califgrl · #4 (**permalink**) 08-07-2004, 09:17 PM

Marit,

Yes, I read your other post also, and how exciting for you that you are pregnant!! That is excellent news, and I am sure that you & DH are very thrilled!

Now that you are properly diagnosed for hypo & you mentioned that you are being monitored more frequently, you should definitely be in good shape and not have as many worries about hypo for your pregnancy!!

Sounds like a good TSH level that you have right now (1.9). You may want to be somewhat careful to increase too much (hyper is not good, either) until you talk to your endo. My endo suggested to take another 1/2 pill (1-2 times a week) if necessary - depending on results from TSH blood level tests - in the early pg time period until I could get in to see him, or just to call his nurse to ask for a recommendation based on test results. This is probably a safe bet, and at least you are gradually increasing as the NEJ article suggested.

Congratulations again & :gl to you for your pregnancy! Be sure to let us know what your endo says! It is interesting & helpful to share this info.

Here are some other links that I found recently on thyroid & pregnancy. You may find some interesting info and explanations here!

http://www.medicinenet.com/Hypothyroidism_During_Pregnancy/article.htm

http://www.thyroid.ca/Articles/EngE11A.html