Monday, April 25, 2005

Pregnancy Problems without Support from her Thyroidologist

32 Y/O female calls about her thyroid condition after 2 misscarriages. She is my patient, and was treated with radioiodine for Graves' Disease 3 years ago.She was last seen 2 years ago, and stated she was seeing her internist for her thyroid hormone RX's, and did not feel she needed to see me. During the last two years, she had two miscarriages. She a prior a prenancy which resulted in a healthy baby. The last one prompted her return for my opinion. She had elevated TSH when she last conceived ( TSH 7.0 ). She took prenatal vitamins which contained iron, at the same time as her thyroid hormone.She stated none of the other doctors, including her OB told her iron caused decreased absorbtion of the thyroid hormone,. and hypothyroidism. She also was never told that she needed prenatal vitamins with iodine during the pregnancy. However she was lucky, that the vitamins, called
Citracal had 150 mcg of iodine. She was never told of the potential danger of the Graves' thyroid stimulation antibody, TSI, which can not hurt her, because she had her thyroid gland destroyed by Radioactive iodine, but could stimulate her baby's thyroid, causing Neonatal Graves Disease. This is a rare, but serious disease she could pass to her baby. A blood test, which was never done in the two pregnancies, could have diagnosed this and allowed early therapy. I told her she was high risk, due to her Graves' thyroid diease and therapy, and needed to be sure her TSH was normal 0.5-2.0, before conception. IQ and neuologic problems occur if you are hypothyroid at conception. Also 6 weeks after conception, there is a 20-50% increase in thyroid hormone needed during the pregnancy. Finally, The thyroid blood hormones need to be kept in the upper normal range, during the pregnancy, and 6 week post delivery, there is a lowering of the dose back to pre-pregnancy levels. She felt she did not need me during the prior pregnancies, but clearly realized she was wrong. I am monitoring her thyroid status this time.


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