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INTERVAL B ETWEEN TESTS, AND, HYPOTHYROIDISM IN PREGNANCY

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TIMING OF TESTS

 QUESTION-My question is regarding the timely checking of T3, T4 and TSH levels when changing medications for hyperthyroidism due to Graves disease. My doctor just informed me that due to new regulations, I cannot have bloodwork done more frequently than every two months. The reasoning is that significant changes will not show up in the bloodwork any sooner than this.  I feel I am reacting negatively to my medication and want to try another but have Graves opthamopathy which is quite pronounced and my doctor fears that it could significantly worsen if I  try to adjust my medication in any way ( an experience she just had with another patient, with devastating results for the patient after only 1 month) .  I used to get my blood work done weekly when initially diagnosed several years ago ( my levels being above 4 times normal) and was hoping to do the same while trying new treatment methods now. Is there any scientific data to justify having more frequent blood screenings in this type of situation that can be shown to the regulatory board?  A minimum of every two months seems to me to be dangerous when dealing with severe thyroid disease.

RESPONSE  As I am in UK I am not familiar with these new regulations. Usually however a period of 2 months is not too long for repeat thyroid function tests when altering medication.
However I agree there are special situations in the management of Graves’ hyperthyroidism eg very sever disease with difficulty of control, where more frequent testing may be indicated. I do not know of hard evidence on this point. It does not appear that your situation is quite like that so unless you obtain an interim private test you will have to have the 2 monthly regime

PREGNANCY

QUETION  My thyroid was ablated in 1993 because of Grave’s and I’ve been on synthroid supplementation for 20 years. I am 43 years old and will be having a baby girl in August. I am writing I read your study and I am interested to know your opinion on my particular situation.
Me: Low thyroid function discovered at 8.5 weeks gestational age (conception date approx Dec 5, 12). On Jan 11, 2012, my TSH was 18 “high” (my usual TSH 1.1) ,  T3 was 100 “normal” and Free T4 was 95 “normal” (my usual T4 is about 134, so clearly 95 was on the low end of normal).  I am negative for TPO AB.
I didn’t believe the TSH results…I’ve never had a TSH even close to being that elevated. I was convinced that the lab just typed the decimal in the wrong spot. Sadly I was wrong. My endocrinologist increased my dose from .175 (take daily, skip Sunday) to .200mcg (daily). My TSH was normalized within 2 weeks of the adjustment and I have been running slightly low on the TSH levels since then… about 0.25, but within range.  1 month prior to becoming pregnant: TSH was 1.7.
The baby is growing at a normal rate. I have had no problems with my pregnancy and expect to give birth to a healthy baby girl in August.
My question is, Though my TSH was corrected by 10 weeks gestation, do you think my baby girl is moderately at risk for any IQ / developmental problems?  I have read conflicting studies; I have read that if the baby doesn’t receive adequate T4 during specific periods in early fetal life, that they “miss the boat” so to speak, but this study’s findings: October 2011 issue of the journal Thyroid in an article titled “Subclinical hypothyroidism in pregnancy: intellectual development of offspring,” say not any difference if treated.
The latter study is consistent with my particular situation, because like me, these women were already receiving Levothyroxine prior to becoming pregnant and were treated early.
Your honestly and personal opinion and experience are appreciated. Nonetheless, despite my concerns, I am excited to have add another little person into our family. Thank you for reading my email. I look forward to your reply.
RESPONSE  I dont think you need to worry. You were taking T4 at the time although possibly not enough. However your T4 levels were reasonable and it is T4 that the baby needs. I do not think the risk for intellectual problems in the baby is significant at all and I would suggest that you enjoy the rest of your pregnancy