grave, TT, pregnancy

[alex32]

Dear doctor please help. Graves disease since july 2008, thyroidectomy in October 2008, TSH low and Ft3 Ft4 low after thyroidectomy. Suddenly I tested TSH  again and it came up to 8! Ft3 and Ft4 were the same as before (with low tsh). I increased medication from 150 to 175, and I found out that I was pregnant (4 weeks  with tsh 4). I increased T4 again, to 200 and tsh went down to 1.5 at 7 weeks of pregnancy. I continued with this dose and I tested again at 11 weeks of pregnancy, tsh was 7.5. I increased to 250, I tested after 3 weeks and tsh was 4. I did not increased more because the effects of full dose will come after 6 weeks ( anyway I had increased by 0.50 and not by 0.25). Now I tested again (17 weeks) and I hope  that I will have good results. My question is :a) will these numbers of tsh affect my baby? b) does it matter that when I conceived tsh was that high (nearly 8)? c) Do you think that I follow correct increasing of medication? what else would you suggest? Sorry for all these questions but I am really worry. please also note that I tested regarding adibodies and I am negative. I will test again at the beginning of last semester. Special thanks

[Mark Lupo, M.D.]

TSI is not likely to change and is not directly related to TSH measurements.

[alex32]

thank u!!! If TSI is negative at the first trimester, how possible is to be positive (out of normal) at the last trimester? Does tsh has anything to do with this?

[Mark Lupo, M.D.]

With these levels, it is not likely there is any adverse effect on the baby.
TSH of 8 is only moderately high and while not ideal, the risk is low.
Sounds like the dose changes are reasonable -- goal TSH is 0.3-2.0 (for our lab) during pregnancy.  

With graves, the TSH may be low for many months after definitive treatment -- so your levels after surgery are typical.  

The other thing that needs testing is the TSI antibody (Graves specific) around week 24-28.  If very high (more than 3-5x normal) there is increased risk for the baby to be born with graves.