Hypothyroidism during & after Pregnancy

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20 weeks pregnant with diagnosis of subclinical hypothyroidism

April 2007

I am 20 weeks pregnant with my second child and 39 years old. I took two blood tests that came back with results of subclinical hypothyroidism. My level on the first was about 6.4 (done at 12 weeks when hormone is highest) and the second was 4.9 (done at 18 weeks). My doctor is recommending levoxyl treatment basically citing that the benefits outweigh the risks. I am of course worried about medicating myself during pregnancy, though have been researching it-has anyone else had this diagnosis and if so what course did you take when pregnant? thank you! J

I have postpartum hypothyroidism and have done a lot of reading, both about the condition in general and during pregnancy (since I am considering #2). From what I understand, a fetus relies on a mother's thyroid hormones for the first trimester. After that, the baby develops his/her own thyroid gland, and can produce the hormone himself. In the first trimester, the baby is at risk of developmental problems and even miscarriage if you do not treat the condition. After the first trimester, the greatest influence the medication will have will be on YOU--your moods, your appetite, your weight, your general well-being. I can imagine it being hard to know what symptoms are the pregnancy and which are the low thyroid, but I'm guessing if you chose it treat it you'll have a much better time being pregnant.

By my logic, keeping the thyroid levels in normal range help make the pregnancy healthier because your body is able to stay healthier. Having had an untreated thyroid condition, I wouldn't dream of going through a pregnancy without treatment if I needed it. Best of Luck

I've been hypothyroid for 10 years and had the condition throughout both of my pregnancies. I having been taking levoxyl daily for 10 years. Absolutely take it while you are pregnant! It is not a ''medication'' in the sense that it is altering a bodily function or fixing a disease process. It is simply replacement of a hormone that you need to have an adequate amount of. I see it more as a supplement than a medication, although obviously it is a prescribed and controlled substance. I have had no ill effects of levoxyl and am sure that not only would being low thyroid during pregnancy feel crappy, there may be ill effects on the fetus of your being low thyroid (don't quote me on that one, but ask your health care provider). anon
Hi, I also have hypothyroidism and have a healthy one month old boy. You really need to treat it while pregnant, too low levels can lead to cognitive impairment in the child. I took 175 mg. daily of levothyroxine while pregnant and my baby is fine so far. The risks of not treating it greatly outweigh the medication (neither my ob or my gp were concerned about the meds, they were concerned about me keeping my levels high enough). Hope this helps. took the meds
I have had type 1 diabetes since age 18 and I am now 32. I have no complications except borderline diabetic hypothyroid disease. I am not sure what my lab numbers are, but they always come out on the threshold like yours. I am also not sure what the relationship is between diabetic hypothyroid disease and the subclinical type you describe. However, as soon as I got pregnant at 30, my (hi-risk /endo/) OB required that I take a very low dose thyroid replacement during my pregnancy. They explained to me that it would bring my levels up to where they should be since the thyroid is overworked during pregnancy. I had regular blood tests throughout where they monitored it (among other things). I stopped taking it after I gave birth and my levels stabilized back to pre-preg levels which require no intervention, although it continues to be something my endocrinologist closely monitors. I had no problems while taking it, had a wonderful pregnancy as far as t1 diabetics go, and had a very healthy baby boy. One benefit would be that you may find that you get a little boost once you start taking it since the hypo might be draining your energy. I found that I was kind of tired more than I should have been (although the pregnancy would definitely cause that too). I would ask more about what kind of stresses it would cause baby/pregnancy if you did not take it and go with your gut feeling on it, or just see how it goes and ask if there would be any harm in taking it later if you see your numbers change for the worse. slightly hypo too
I had Graves Disease and subsequently had my thyroid removed. I take Synthroid and have done so for the past 15 years. During my pregnancy, three years ago, I continued on my medication and had my levels monitored regularly by both my obstetrician and endocrinologist. From what I learned, it is important, if not mandatory, to treat your thyroid disorder with the proper medication for your benefit and your baby. Your doctor should confirm this. Baby is doing great at 2.5 years old!!!!
Hi there. I am hypothyroid and now have a 3 month old son. Thyroid levels, I am told, are extrememly important to brain developement of the fetus. I had to double my regular medication during pregnancy. The baby is perfectly fine and happy now. I would take the medication, you don't want to risk brain develepment.... hypothroid mom
Hi there - hypothyroidism is not a big deal. I got diagnosed with it right before my husband and I were about to start trying to get pregnant. My doc recommended I wait and get the condition regulated before we start trying, which was frustrating because it does take a while - several months anyway, of figuring out what level of meds is correct for you. The idea of getting it regulated before you become pregnant (when possible) was because apparently pregnancy can change your levels around a bit, so it's harder to know how much med you need. But I didn't get the impression it would have been the end of the world if I had accidentally gotten pregnant at that point. But we were careful, and didn't. Then when I was in the safe range, we got pregnant, and yes, you continue to medicate through the pregnancy, and everything I read (and all the people I talked to) said it's a complete non-issue. The medication is giving you something that your body should be producing anyway. I had/have no side effects. I had a healthy baby.

I do recommend though remembering to get your TSH checked not too long after you give birth because the pregnancy can change your levels once again. I think I'd been told to do it about a month later - time got away from me (imagine that!) and I waited 6 months or so, and by that time my TSH was a completely way off the mark number. A couple of increased levels of the med later (I take synthroid/levothroid - one is the generic name for the other) and I'm back in the good range.

I should note - I, even when I was wackily off the charts, am lucky enough not to ever suffer much in the way of symptoms for the hypothyroidism, which is why it was easy for me to forget to get it checked for so long. So just keep it in the back of your mind that you'll want to remember to get it checked again post-pregnancy. Write it down somewhere because your brain will be fairly busy with other things! :) Good luck!

me too! 2nd pregnancy was diagnosed. did my own research and agreed to take meds. AND was pleased I did. I felt so much better once TSH readings were corrected. Now PP I still take meds, though my dosage has changed. I was tested every 6 weeks during PG and now its every 2 months while BFing. spritelier!
I am not a doctor but what I'm writing I have culled from my experience having hypothyroidism. I have seen 2 different endocrinologists (one UCSF, one CPMC), both of whom I respect very much. I don't mean to scare you but the most recent research points to a TSH level of 2.0 as being the optimum level. I have hypothyroidism which was diagnosed in the midst of fertility treatments after miscarrying twice. If you're above 2.0, you have hypothyroidism, according to my endo's. My endo would not ''ok'' me to resume fertility treatments until my TSH was below 2.0 (from 8-13). The traditional thought has been that TSH of 5.0 or so is fine. There is a statistically significant diference in baby's IQ borne to mothers with a TSH greater than 2.0 compared to higher numbers. Extreme deficiencies in thyroid hormone (which means higher TSH) could result in poor brain development and other problems. (Your levels are not considered extreme.) But the bottom line is that the thyroid replacement hormone is simply replacing the hormone in your body that your body doesn't have anymore (driving the TSH up). You would not be medicating your body by taking the levoxythyrone in that it's not a foreign substance being introduced to your body. It's a synthetic version of what your body needs. Incidentally my sister in law started taking thyroid hormone replacement long before me, back when it was derived from pigs- this is the old version. She said when she started taking the human synthetic version she felt much better. I have only taken the human synthetic version so cannot speak to that issue., but the pig derivative is still out there. I don't know if the medication passes into mother's milk so if you start nusring I would consult an endocrinologist asap. I would do this anyway if I were you to prepare for the fluctuations that may occur after you give birth. I found the fertility endocrinologists unprepared to answer any of my questions about my thyroid hormone issues. anon
I took a low dose of levoxyl/Synthroid throughout my twin pregnancy. I had been diagnosed as low thyroid while trying to get pregnant and this was actually one of the treatments to help me get pregnant. It is a chronic condition and I still take the levoxyl today, 5 years after giving birth. I don't know what the research is but at the time none of my doctors advised me to stop taking it during pregnancy. My twins are healthy and happy, very bright, growing normally. For What It's Worth
I have been treating my hypothyroidism with synthroid for 5 years and just had a healthy little girl 5 weeks ago. Her newborn screen results show that her thyroid is totally normal. My understanding from my endocrinologist and obstetrician is that it is a much bigger problem to let hypothyroidism go untreated than to treat it. The synthroid is a synthetic substitute for the real thing, which I apprarently don't make enough of. I've been told that your body doesn't necessarily recognize the difference, it just needs to have enough. As long as you are at normal levels between your own thyroid hormone and the treatment being suggested by your physician, you would be eliminating any risks to your baby based on your condition. Not treating your thyroid has much worse consequences for you and your baby, and typically, doctors recommend treating subclinical thyroid disorders because a lot of times treatment can prevent them from getting worse.
I took synthroid through both my pregnancies. I consulted with my OB and pediatrician at the time I was expecting my first. There was no evidence of any risk to fetus. In fact, I think I was more concerned about having my dosage right and sometimes MDs will increase the dose, bc thyroid can dip lower during pregnancy (as with you?) and that can be more of a concern. Both my kids are perfectly healthy and developing beautifully. Deb
I don't have a thyroid anymore so took levoxyl throughout both of my two healthy pregnancies. I think you are being overcautious here. If you have been researching this you should know that thyroid hormone is not optional, nor a 'drug', nor are you 'medicating' yourself (whatever that means). Thyroid hormone is like insulin, your body needs it to function and to maintain a healthy pregnancy. If I were you I would be concerned about normal fetal development if you do not have adequate levels of thyroid hormone in your body. Maybe you should discuss further with your doctor what the specific 'risks' and 'benefits' are of this treatment. There are NO risks associated with maintaining a normal level of thyroid hormone in your body--most people's bodies will do this for them automatically. The risk associated with taking the hormone is that it could be hard to regulate and you could end up taking too high a dose and becoming hyperthyroid which is not good for the pregnancy either. Please ask your doctor to monitor your TSH levels closely (I had my blood tested every two weeks at the beginning of my pregnancy which was overkill but reassuring to me) and please ask your doctor to educate you a bit more before sending you to the internet to seek medical opinions. You should also find out the symptoms of being hypo and hyper thyroid. good luck
Recent research is suggesting that TSH should be at 1 for pregnancy - higher values (much higher) have been implicated in loss of IQ points. There is also a link to higher rates of miscarraige. Its great that your doc caught this - many would not - it also puts you at risk for thyroid issues post partum which are really tough - you are already tired & trying to lose weight - throw in thyroid stuff and it gets pretty complicated. I'd reccomend taking the medication. good luck
Elevated thyroid is not uncommon during pregnancy. You should read online about hypothyroid and pregnancy if you want to get a sense of what the medication does, why it's important, etc. Any number of sites have some good information, so you'll easily be able to pick up some more info.

''My doctor is recommending levoxyl treatment basically citing that the benefits outweigh the risks. I am of course worried about medicating myself during pregnancy.''

You have good instincts, you shouldn't medicate yourself and you should listen to your doc. anon

Post-partum thyroid issues - see an endocrinologist?

March 2007

I'm looking for an endocrinologist, preferably in the Berkeley/Oakland area, possiblt SF, for a second opinion on treating my post-partum hypothyroidism. My internist doesn't have much experience with this condition. I'd prefer someone who specializes in/sees lots of patients with thyroid issues before, during, and after pregnancy. Good bedside manner is a plus. anonymous

I've been seeing my primary care provider at east bay internal medicine - my reccomendation will be luke-warm - nothing wrong with her exactly but I am still trying to get my meds right and its frustrating. she does not move fast which may be more to do with the thyroid than her style. just out of school & very knowledgeable on what pregnancy does to thyroid. good at getting back to you on email - phone is a bit harder. I am considering going to a Reproductive Endocrinologist at this point as am having lots of period difficulties but have no names yet. good luck

Editor note: also see reviews of endocrinologists

Is low thyroid interfering with pregnancy?

Jan 2006

Hi, I just turned 39 and had a miscarriage at 8 weeks about two months ago. My OB/GYN told me not to wait to try again, so we have tried twice since then, but so far nothing. I guess my request for advice is twofold: one, how long does it generally take to conceive after a miscarriage, and how long should I wait before I seek intervention (like with Clomid)? Two, I have many of the symptoms of an underactive thyroid. I have had thyroid levels tested, but doc says they are normal. I know that a thyroid issue can impair fertility, so what should I do? Is it possible to have hypothyroid but have tests come out normal? Thanks so much for your help, I really appreciate it!

I can't speak to the miscarriage/thyroid issues specifically, but based on my own experiences with infertility I'd say don't wait to try the Clomid (and to move on to something stronger if that doesn't do the trick) if you suspect you need a boost, especially given your age. We wasted 3 years doing nothing and then trying Clomid, when what we really needed was a different drug - after all that time, I got pregnant my first cycle with injectables. Good luck to you and sorry to hear about your loss. I think both my friends who miscarried were pregnant again with healthy babies within 4-6 months. Straight to the drugs next time
My sister-in-law, who lives in S. California, was in a situation that sounds much like yours. She too was in her late thirties and had trouble conceiving, and I think she had a miscarriage. She too thought that she had low thyroid, but her blood tests came up on the low side of normal. She ended up going to a physician in LA who also does sort of alternative medicine and he gave her thyroid medication. She was pregnant within two months and gave birth to a son. 16 month later, she gave birth to twins. If you backchannel me, I can contact her and see if she would be open to corresponding with you. Good luck! elza
The TSH levels that most labs use as normal are a bit higher than many experts feel they should be, so if your doctor is using the lab range to determine if your level is right nor not, you still could be hypothyroid (higher TSH = hypo, or under functioning, thyroid), particularly if you are symptomatic. In addition there are other tests that may more accurately determine the activity of your thyroid There is a great article about this on the about.com thyroid page. Low thyroid can indeed affect your fertility, so if you are suspicious, you may want to look into it more closely. Tara Levy
I'm not sure what the average period is for getting pregnant after miscarriage, I think it depends a lot on why you are miscarrying. I had 5 miscarriages between my first child (born right before I turned 36) and my second (born right before turning 40). For me, I had no trouble conceiving: I could miscarry in April, conceive again in May, only to miscarry again in June/July. But having talked to lots of other women who have miscarried, I think this is unusual.

I have a ''low but normal'' thyroid (my mother has been on Synthroid since I was born) and I do think it makes a difference. I've been tested several times as I show many of the symptoms of low thryoid and have often fantasized that my energy levels, etc. would be better if I could take the pill. But each time it comes back ''low but within normal range'' and my doctor tells me to live with it.

So while I suspect my thyroid levels might have had something to do with the miscarriages, since I did manage to get and stay pregnant the second time (and you probably will too, don't lose hope, though it didn't happen to us until I'd basically given up...and therefore maybe relaxed a bit?), I haven't pursued it further.

Good luck! anon

No sex drive and postpartum hypothyroidism

June 2003

My child is 21 mos now and I weaned him at 11 mos. I thought my sex drive would slowly come back after weaning, but to the contrary, it continued dwindling until it finally disappeared (completely, absolutely disappeared). I was so alarmed that I insisted to have my hormones checked (my ob-gyn kept telling me that it was psychological). It turned out that I was very hypothyroid. Now I am being treated, but I find it difficult to believe that things can go back to normal after hitting so low. Also, in all of my readings, the loss of sex drive in hypothyroid individuals is just mentioned in passing and not listed as a main symptom, when for me it has been the most disturbing one (pretty much the only one). I could not find any specific reference to this in the website. It would help to hear from other people whose sex drive has returned after thyroid levels went back to normal. Thanks! Anon

The Thyroid Sourcebook is excellent as are the many internet sites for research. Dosage for any thyroid condition is tricky. Once my dose was on the mark all systems were go and have been for six plus years :) living in balance
I was diagnosed with hypothyroidism when my 1st son was 6 months old...it was hard to tell if lack of sex drive was the hypothyroidism or exhaustion from having a new baby. As soon as I went on thyroid hormone I felt better within days...all my symptoms (I had every one in the book) went away. My sex drive returned. Lack of sex drive could be related to other hormones too. Have you had a complete blood panel done to check everything? Good luck anon
I have borderline hypothyroidism that is now being treated. From my psychiatrist who I see for depression, I learned that thyroid problems can cause any and all symptoms, even mimicing psychiatric disorders (doesn't mean it's all in your head just cuz the symptoms are psychiatric!). I am being treated at a higher dose than usual, pushing me to the upper range of normal, to treat the depression (an accepted treatment used even in people who do not test low, although it is not known by most GP's or unsophisticated psychiatrists). This treatment is supported by my progressive Kaiser internist, even though she would not have known to do it herself. It has been very helpful, affecting both my energy level and state of mind. Don't give up, and seek out a good, up-to-date psychiatrist if you suspect that you may be being under-treated. anon

Postpartum hyperthyroid

Nov 2002

Since giving birth to my daughter 9 months ago, I've lost a lot of wieght, and am now almost 20 lbs below my prepregnancy weight. I was chalking it up to the breastfeeding, until a friend suggested I have my thyroid checked. Sure enough, I was diagnosed with mild hyperthyroid, which I now understand is not uncommon postpartum. My docter has prescribed methimazole, but I am still breastfeeding, so the medicine is contraindicated due to the meds being passed through breastmilk. Since I have a mild case of hyperthyroid, I am interested in alternatives to medication so that I can continue to breastfeed. Anyone have this problem postpartum? Any advise, or input on treatment options? How about herbs or dietary changes? Thanks in advance for any feedback. Amy

Amy, I am a trained lactation counselor with the Santa Clara County Nursing Mother's Counsel.

According to the LLL Answer Book, methimazole is compatible with breastfeeding. Here's a reference to bring to your doctor: Cooper DS, Bode HH, Nath B, et al. ''Methimazole pharmacology in man: studies using or newly developed radioimmunoassay for methimazole.'' Journal of Clinical Endocrinological Metabolism. 1984;58:473

FWIW, most medications are OK for breastfeeding, except illegal drugs (cocaine, heroin, etc), radioactive drugs, and most psychotropic drugs. It is not uncommon for MDs to be unknowledgeable about medications and mother's milk. Please contact La Leche League or a lactation consultant for more information. Hope this helps, Laurel

I have HYPOthyroidism so all the things I need to AVOID might be helpful for you. The literature certainly suggests this! Rebecca Wood (WHOLE FOODS ENCYCLOPEDIA) suggested that using sea vegetables, even though they contain iodine, can modulate thyroid activity. Raw cruciferous vegetables, soy and carrot juice are goitrogenic and therefore can inhibit thyroid function. I had a client with asthma and hyperthyroidism. Interestingly, when we addressed her food sensitivities/allergies through an elimination diet, she was able to reduce her meds for both the asthma and thyroid issue (same med as you have been prescribed). Good luck! Nori
I am currently being treated for a more severe hyperthyroid with a beta-blocker that is safe to use while breastfeeding. I was diagnosed about 3 months post-partum. I do not feel 100% better but my symptoms are more tolerable (extremely high heart rate, muscle treamors, anxiety, being hot & sweaty, etc.) I do think it is something you need to take care of. Evidently, I was close to what is called ''Thyroid Storm'' which is more serious and can require hospitalization. Luckily, I have a very competent doc. that figured this all out when I went to see him for joint pain. Ask your doctor about a beta-blocker. According to him, even though it does not attact the thyroid it does decrease the symptoms. I have had no side-effects. Both my doctor, and the research I have seen, say this should go away (yea) or switch into hypothyroid (yuck). Feel better. Another Amy
I experienced a postpartum hyperthyroid condition shortly after the birth of my second child. My most prominent symptom was a very rapid heartbeat, as much as if I had done strenuous excercise, from just waking up and getting out of bed. My heart was just racing! I was treated with propylthyuricil (PPU) in a low dose since I was also breatfeeding. After 18 months of the medication and monitoring from my endocrinologist, the condition fortunately has gone into remission. Still I am being monitored every few months via a blood test to make sure that it does not recurred. In my case, should the condition recur, I would need to do radioactive iodine treatment to dissolve the hyperactive thyroid and then take supplements for the rest of my life. So I really want this conditon to stay in remission. I did not research any alternative methods. anon
I am surprised that your doctor didn't perscribe PTU. This is the drug you should check if you are nursing. I take 100 mg of PTU a day and am still nursing. I checked on the dose with the pediatrician and he said that was fine. There is a good thyroid discussion group that you might want to look at: http://maelstrom.stjohns.edu/archives/thyroid.html Helena