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Pregnant With Twins, Thyroid Test Done, Taking Thyronorm. Correct Dosage For Me?

Posted on Thu, 13 Jun 2013

Question: Hi, I started my infertility treatement in 21/01/2011, at that time the following was my thyroid profile results:
T3: 1.04 ng/ml, T4: 7.5 mU/L, TSH: 3.57 mIU/ml, Free T4: 0.94 ng/ml.

Now I got pregnant in January 2013 by IVF procedure. And there was no thyroid profile test done before pregnancy.
I am now carrying twins. During my 20th week of pregnancy, thyroid profile test was done and the following are the results:
T3: 2.19 ng/ml (Range: 0.8 - 1.81)
T4: 10.8 mg/dl (Range: 3.2 - 12.6)
TSH: 3.01 mIU/ml (Range: 0.35 - 5.50)
Free T4: 0.84 ng/ml. (Range: 0.89 - 1.80)

The following are my gestational glucose tolerance results in 20th week:
Patients weight: 64
Patient height: 157
Glucose oral: 100 gms
Fasting: 83 blood glucose mgs/dl
60 mins: 172 blood glucose mgs/dl
120 mins: 133 blood glucose mgs/dl
180 mins: 94 blood glucose mgs/dl
I was told that I have mild sugar and this needs to be controlled thru diet.

I was also told that my Free T4 is less and have been prescribed Thyronorm 100mcg. After taking this, I feel very fast heart beats and I am hungry a lot. Since I am hungry all the time, I have got acidity as well. I have been taking thyronorm for past 4 days, and today I feel acidity is better.

I would like to know if my thyronorm dose prescription is too high (since my Free T4 is only a little less)? What would be the correct thyronorm dose for me?
Also would like to know if there is any link between my thyroid being less and high blood sugar? Will thyroid treatment automatically reduce my blood sugar level?
At this blood sugar level in 20th week of pregnancy, is diet control enough or is insulin needed?

Thanks in advance for your reply.

Answered by Dr. Mahesh Koregol (1 hour later)

Hi,

Thanks for your query.

I understand your concerns. Following is my reply:

1) You little variation of Free T4 . 100 mcg of thyronorm is very high and infact it does not need medication. I dont see any need of medicine as it causes palpitations ( fast heart beat) which you are facing now. Please stop medicines and see an endocrinologist for second opinion. Stop Medicines till then.

2) Your sugars are not very high. Especially your fasting sugars are good. You dont need insulin or medicines as of now. Diet control is good enough. You can discuss this issue with endocrinologist when you XXXXXXX him for thyroid second opinion.

I hope I clarified your doubts.

Regards,
Dr. Mahesh Koregol
IVF & Infertility Specialist

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

Follow up: Dr. Mahesh Koregol (1 hour later)

Hi Doctor,

Thank you for clarifying. I read in the internet that requirement for thyroid harmone is high during twin pregnancy and that hypothyrodism during
pregnancy can be XXXXXXX And if thyroid is less, then it can affect the IQ of the foetues.

1) Could you Please let me know if I have hypothyrodism?

2) Since I have less thyroid, will it not affect the IQ of the foetuses if I stop thyronorm? Can I stop the medication without further thyronorm supplementation? As the pregnancy progresses, will thyroid requirement be automatically taken care of?

3) Also I have taken thyronorm 100 mcg for 4 days. Will it in any way affect the foetuses so far?

Thank you.

Answered by Dr. Mahesh Koregol (21 minutes later)

Hi,

1) You donot have hypothyroidism. Its borderline elevation of only one parameter which need not be treated. You need to repeat values before treating.

2) Since TSH is fine it is unlikely to affect IQ of the child. You stop the thyronorm as you are having high dosage and hence palpitations. Thyroid hormone do get adjusted in pregnancy.

3) Medicines taken so far wont harm fetus. Not to worry.

Hope you are clear now.

regards,
Dr. Mahesh Koregol
IVF & Infertility Specialist

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