elevated tsh level in early pregnancy

amydaws

11 Posts
Reply elevated tsh level in early pregnancy Posted on: Oct 3, 2011 at 8:36pm
Hello,
I'm currently 6w3d pg with 1 baby...prior to conception I was on 100mcg of levothyroxin, once daily. My TSH level then was 1.82 and my Free T4 was 1.04.

Once I got a positive pregnancy test, my RE had me double my dose twice a day, so 5 days a week was 100mcg and 2 days a week was 200mcg. Today my TSH level was 3.05 & my Free T4 was 1.17. I'm concerned these levels have gone up dramatically despite increasing my thyroid medication dose. My RE's clinic considers any TSH level under 4 as "normal" but I know in the immunology work, that is not accurate. I want to take my thyroid function seriously and not let it mess this pregnancy up. Any advice would be greatly appreciated.

Amy D

Background on me:
3 previous losses, 1 at 12w, 1 at 12w2d, twin loss-->baby A at 9w, and Baby B at 14w.
Dx with lupus anticoagulant (being treated with lovenox twice a day)
Dx with incompetent cervix (treated with a prepregnancy abdominal cerclage)

Dr. Braverman

2026 Posts
Re: elevated tsh level in early pregnancy Posted on: Oct 6, 2011 at 2:09am
Ok I just saw this post, better that you are on the lovenox, I do disagree about the TSH level however. I would want to be sure these losses are due to incompetant cervix as these losses generally occur later in the pregnancies.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

amydaws

11 Posts
Reply Re: elevated tsh level in early pregnancy Posted on: Oct 6, 2011 at 2:12pm
Thank you for your reply Dr Braverman. I know my history is much more complicated then TSH levels and we're praying we got it all figured out this time.

With all my losses, the babies are alive, until they just come out. They are all chromsomally normal too. With all losses, I had u/s's at least the day of the loss that showed good heart beats, growth everything. So as I said, the losses are very sudden.

My first 2 losses (both around 12 weeks) are hopefully a result of an undiagnosed lupus anticoagulant.

My third loss (at 14 weeks), I was on lovenox twice a day and had to go to the ER due to heavy bleeding and I had an ultrasound that showed the baby doing fine, good heart rate and everything. Then I felt the pop of my membranes rupture and the baby came out. That's what led specialists to believe I may also have an early form of IC. So we opted for a prepreganancy Transabdomonial Cerclage.

So the idea is, now, a TAC plus a closely monitored anticoagulation therapy will result in a take home baby.

I have had some immune testing done about 1 week after my 3rd loss. My NK Cells were slightly elevated at 11.1%, and I have a 1.2 Dq Alpha match with my husband. But none of these issues seemed drastic enough to seek out an immune treatment. And our RPL Dr doesn't really believe in immune tx either. ...I'm a believer but not sure if it's specifically what I need.

Also one other strange thing, is all 4 of my pregnancies implant low in my uterus. I know that's generally not a problem, but it's a very annoying coincidence. Hysteroscopy shows a normal uterus, so I'm not sure why that keeps happening. Perhaps the low implantation is what causes the early form of IC??? Who knows?

...I'm a pretty complicated case I guess! Just hoping we've got it all figured out this time!

Dr. Braverman

2026 Posts
Re: elevated tsh level in early pregnancy Posted on: Oct 7, 2011 at 7:09pm
I think most likely you have. the Nka and a single DQalpha test are really not at all sufficient to rule in our out immune problems so its hard to say the IC and LAC are the only problems. I hope all works out as it most likely will if here are any other problems please complete the immune w/u properly. good luck.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.