[rainie]

#1018361

Hi all,

I am new here. I am trying to get pregnant and have been suffering from infertility for many years. I got pregnant once but miscarried, at that time my level is TSH 0.9 and FT4 also 0.9 . My most current level is TSH 0.1 and Ft4 0.9 (range 0.8 to 1.. My question is should we dose our ATD based on Ft4 or the TSH? What is the best level to get pregnant? Is the TSH important?

Any ladies out here who got pregnant with Grave disease? What is your level at the time when you conceive? I am so stressed out. My endo wants to increase my ATD to up the TSH, but my Ft4 is almost hypo. What should i do?

[ldlight]

#1064250

I’d love to know the answer too. I won’t be having RAI but we’re going to TTC after I get my levels down as well ” title=”Very Happy” />

[mamabear]

#1064251

I Can’t stress this enough… any woman who is trying to get pregnant while your thyroid levels aren’t within range and you have an ok from your dr. SHOULD NOT try to conceive UNTIL those levels are within normal range and dr. says OK.

You are wasting your time and your sanity if you continue to TTC while not within normal range. ANY good medical OBGYN would never allow a woman with levels outside of range to ttc.

Thyroid levels that are not within range can cause infertility and if you do get pregnant can cause miscarriage. I have dealt with this as well (but not the miscarriage part). So please try to concentrate on your health and getting your levels proper with the correct dose.

I am not sure why dr’s allow woman who aren’t within range to TTC. Please stop ttc until your levels are within range. I know this is not something you want to hear but it is the truth. I was unable to get pregnant on my own while my levels were out of range, even after they were within range I had been going to a Reproductive Endocrinologist (RE) and I had had my hormone levels and my eggs checked and it is a process and it’s hard and there are drugs that can help along the way with pregnancy AFTER your levels are within range.

If you want to discuss things you can PM me.

How long have you been diagnosed with Graves? How long have you been TTC, what medicines have you used to try to get pregnant, if you have used anything? (like fertility drugs?)

Also just some info on your question: Every woman’s body has a different optinmum level to get pregnant. As long as your levels are within range there is always chance you can get pregnant but if the levels are at the lower end of the range or higher end of the range there is always a chance for miscarriage. Some dr’s like a TSH of 1.0 or 1.5 but again it depends on the dr. and the patient and the patience history. Due to everyone being different there is no "right" thing or perfect number for all. it’s the individual person.

[Kimberly]

#1064252

Hi Rainie – I think you got some good advice on TTC, although sorry it probably wasn’t what you wanted to hear. ” title=”Sad” /> Being pregnant and in a hypER *or* hypO state can potentially cause problems for both the mother and the baby. As for the TSH issue, I am re-posting a response from a couple of days ago regarding Anti-Thyroid Drugs and TSH. Best of luck to you!

---

Free T3 and Free T4 are better benchmarks for determining dosing than TSH. FT3/FT4 tests measure the actual amount of thyroid hormone that is available to the body. TSH is a substance produced by the pituitary gland that tells the thyroid whether to produce more or less thyroid hormone. However, TSH can remain suppressed (i.e. below normal) for quite some time in patients who are treated with anti-thyroid drugs. Some docs will look at a low TSH and tell us that means we are still hypER…but this is NOT the case if our FT3 and FT4 are normal or below normal.

Don’t be afraid to ask your doc to explain how he/she is making your dosing decision…*especially* if your TSH is below normal, but your FT3/FT4 are in the normal range or below normal. This is an easier conversation to have if you can get labs run *prior* to your appointment. That way, you can spend your visit discussing the results, rather than having labs done at the doc’s office…and then getting further instructions via phone.

Also, if you are feeling hypO symptoms (constipation, joint pain, weight gain, cold intolerance, etc.) definitely get a new set of labs run ASAP to see if you require a further dosage reduction. It’s important to get our hypERthyroidism under control…but we don’t want to end up in hypO territory, either!

[snelsen]

#1064253

Hi Rainie,
You got some good posts from Kimberly and mamabear. You might consider going to a high risk ob gyn, make that acquaintance, have them in close touch with your endo, when you are ready to try to get pregnant. I don’t know what TTC means, but I thought a bit about it, and guessing it means "trying to conceive?" Not sure how old you are, but I have learned in the past few years, that age (high thirties,early forties, is, by definition, a "high risk" patient. But, for sure, I really don’t know what I am talking about. However, having Grave’s’ and being pregnant seems to me an indication for you to go to a high risk ob/gyn.
It has been mentioned many times on this post-but, if at all possible, get your lab before your endo appt, so you have something to discuss at the appt, saves you a lot of frustration and phone calls.

After hearing the stories of others on this bulletin board, i sure feel lucky to be able to have access to all of my medical info electronically! I had labs yesterday at noon, and was able to see all of them at 10pm last night.
Shirley

[mamabear]

#1064254

yes TTC = Trying To Conceive ” title=”Very Happy” />

[rainie]

#1064255

Hi all,

Many thanks for your reply and advice.

My Ft4 has always been within the lab range, the Ft4 range is from 0.8 to 1.8 . It is the TSH that keep fluctuating. I did some research online and from my understanding, it is more important to look at the Ft4, instead of the TSH. Like what Kimberly just mentioned – Free T3 and Free T4 are better benchmarks for determining dosing than TSH. However, when i ask my endo about the TSH, she told me TSH is equally important as the Ft4/Ft3.

Some background information, i am 28 years old. I have Grave disease for 2 years and i am on antithyroid medicine only. I’m not taking clomid or any fertility drug. My ovulation is normal and i ovulate regularly using the monitor to detect the LH surge.

So should i try to achieve TSH 1 or 1.5? Or should i look at my Ft4 value since the TSH can remain supressed?

I am also on a low iodine diet. I am not sure whether this is a good idea since my Ft4 is so low.

[snelsen]

#1064256

Hi, I am wondering WHY you are on a low iodine diet? I’d check with your endo. I can’t see any reason for that, unless it is medically necessary, and you understand the reason for it. Is is something you decided to do? I am not a medical professional, none of us are, but from my experience, this becomes relevant related to RAI, or in some thyroid cancers.

Another question. Your T4 looks fine, it is in normal range. Seems like it just needs to be monitered? That is one value, and you must have a series of your thryoid studies to see the trends? And I think you addressed that by saying that it has always been in the normal range over time. Normal ranges are arrived at by much clinical testing, they are not very arbitrary. Seems that your endo is treating your doses because of your suppressed TSH, that makes sense to me. He/she can’t very well made medication decisions on normal ranges, and that is the only thing out of whack.

I don’t know if you FEEL hyper, or if you don’t. Is your heart rate fast, are you heat intolerant, are you losing weight, are youa anxious, irritable, unable to sleep, having your body run like a overheated motor all the time? If all these things are applicable, then a pregnancy is not the right thing to do right now. Not a good idea for you or baby.

Since your other labs are in range, except for the TSH, it seems like your endo is working with you to get that up a bit.
Sounds like you have a good endo. Ask him/her if they will manage your thyroid when you are pregnant.
You are at a nice age to be getting ready to get pregnant (:

[rainie]

#1064257

Hi, antithyroid medicine is used to block iodine conversion to thyroid hormone. So if i limit my iodien intake, i need lesser antithyroid medicine. This is as per my endo’s advice. Does it make sense to you all? I also went to seek a second opinion, the other endo told me to eat per normal which includes seafood and dairy. I am not sure which is the correct path.

I am not feeling hyper, my heart rate is normal at 70 to 80 per min. I have no problem sleeping but sometimes i do wake up in the middle of the night not being able to fall asleep again. I do feel cold too.

[Kimberly]

#1064258

rainie wrote:So should i try to achieve TSH 1 or 1.5? Or should i look at my Ft4 value since the TSH can remain supressed?

I am also on a low iodine diet. I am not sure whether this is a good idea since my Ft4 is so low.

Hi Rainie – It *is* possible that your low-iodine diet is keeping your FT4 numbers from increasing, as iodine is necessary for making thyroid hormone. I would definitely discuss this with your doc.

We are not docs on this site, just fellow patients. While others can certainly share their own personal experiences, we can’t tell you what the optimal TSH level is for you to conceive. I think the suggestion to visit a high risk ob/gyn is a good one, as being hypER or hypO can cause complications with a pregnancy. You have already noted that your FT4 is at the bottom end of the normal range. Hopefully, you can get your dosage adjusted accordlingly so those levels will rise, but there is certainly the potential that they could fall into hypO territory.

Also, one other issue to consider…I can’t recall if you mentioned which Anti-Thyroid Drug you are on, but PTU is the preferred drug for women in the first trimester of pregnancy. There are a couple of potential birth defects that are RARE, but still seem to occur in higher rates with women who are on methimazole vs. PTU.

Best of luck!

[mamabear]

#1064259

R,
just saw what you wrote about LH surge and checking it, didn’t see that before I sent you a PM so have sent you another. Look at your in box! ” title=”Very Happy” />

[rainie]

#1064260

Yes i have seen a high risk obgyn who told me that my Ft4 is more important to look at, he prefer to keep it at mid range. However, my endo seems to disagree with him. My endo said the TSH is equally important. I find that their opinion is quite contradicting. Why is thyroid issue so complicating and why is there so many different ideas among doctors……………

Yes, my endo will change me to PTU during the 1st trimester. For now, the MMI is safer for me.

[Ski]

#1064261

Bottom line, the best level at which to get pregnant is the level where everything is balanced, everything is within the normal range, and YOU FEEL WELL. Both levels (T4 and TSH) have large ranges of normal. The reason is that there are people who live normally at the high end of the range, and there are other people who live normally at the low end of the range. If the optimum normal were the very middle of that range, lab tests would reflect just that number as "normal," not the range they give.

It is extremely important to find YOUR "sweet spot," especially prior to any pregnancy. It can take some time, and some patience. Keeping symptom diaries may help you speak with your doctor and get the cooperation you need to find that sweet spot. Doctors *love* empirical data.

In terms of making adjustments to reach the best dose and level, it’s true that, at first, when you’re using ATDs, the readings for T4 will come into focus sooner than the readings for TSH. After you’ve been at it a while, and your levels have been within a much tighter range for a long period of time, then you can begin to "trust" the TSH level in terms of making adjustments. TSH reflects more of an ongoing "average," one that takes weeks of readings into consideration, vs. the immediate level of T4. So both are important, and both should be in range before you try to conceive.

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