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Given Thyroxine After Miscarriage. Got Pregnant. Test Showed Low TSH Level. Any Harm To Baby?

Posted on Tue, 14 May 2013

Question: Hi, I am a 31 year old female. I had a miscarriage in Nov due to unknown reasons. Since then got my thyroid tests done in march and TSH was at 7.7 mu/l with normal T4 range. I was put on 25 mcg XXXXXXX thyroxine on 4th march. I am currently 5 weeks pregnant and got my TSH test done at 4.3 mu/l. T4 results are still impending. I cant see my dr. until next week. I am worried if this wait may harm my baby. Please advice if I should up the current dosage or wait.

Answered by Dr. Shehzad Topiwala (5 hours later)

Yes the guidelines do recommend an increase in your thyroid dose during pregnancy. Evidence suggests that thyroid hormone dose should be increased by upto 30% or more by 4-5 weeks of gestation. So in general endocrinologists advise women of child bearing age to start taking an additional thyroid pill ( levothyroxine ) on each of the weekend days ( so that means , one pill daily , 2 on Saturday and 2 on Sunday ) the moment they find out they are pregnant. This can be done till an appointment with the doctor is made. Typically blood testing for thyroid function are then ordered by the doctor ( TSH, free T4) after about 4 weeks of dose change to ensure adequate replacement with levothyroxine. TSH targets are trimester specific but in general a TSH of less than 2.5 should be aimed for in the first trimester and upto 3 in the remainder of the pregnancy. These are broad guidelines and a thyroid expert is best trained to handle this. TSH and 'adjusted free T4' is typically checked within 30-40 days of first dose change till targets achieved and thereafter every 4-6 weeks. For more information please peruse this web link WWW.WWWW.WW

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (28 minutes later)

Thanks a ton Dr. SO do you reckon that I start additional 2 doses /week with immediate effect? This would have no harmful side effect on me or the baby?
Thanks in advance.

Answered by Dr. Shehzad Topiwala (1 hour later)

Generally speaking this is the recommendation. In this litigious country ie USA, i am not comfortable giving you categorical answers on an online platform. Your best bet is to call your doctors office

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar