The Wellness Q&A with Elaine Moore

Welcome to the Wellness Q&A where members can ask Elaine Moore any health-related question. Moore is a medical writer and retired clinical laboratory scientist with over 30 years experience in immunology. Get started by selecting Member Questions. This is a question-and-answer forum, and each thread represents a member question or set of questions. The question will only appear once it's answered. Thank you for joining.


Graves Pregnancy- Levels still HIGH.
Last Post 21 May 2023 04:14 PM by Elaine Moore. 1 Replies.
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LalalalalaUser is Offline New Member New Member Posts:
11 May 2023 08:04 PM
    Hi Elaine,
    Thank you for taking the time to answer my question. I am extremely worried at the moment.

    Here’s my current story,

    I am currently 5 weeks pregnant with my 3rd child.
    I received a Graves Disease diagnosis around January this year- was referred through to an endo- who put me on 15mg of Carbimazole (5mg x 3 times a day) and basically said that once my levels were regulated- I would have to have my thyroid removed as I will most likely never go into remission. She said that if I wanted to have any more kids (I already have 2) that is the best treatment to facilitate pregnancy and strongly recommended I do not fall pregnant until after having my thyroid removed and hormone replacement levels were regulated. Basically said this will get rid of my Graves Disease and I will go hypo- but that’s much easier to treat than Graves- Dr agrees with this.
    Problem is, I have fallen pregnant, completely unplanned. I spoke to my endo the day I found out- she said it’s very risky and would be a very complicated pregnancy. She said antibodies cross the placenta and can cause hyperthyroidism or hypothyroidism in fetus and babies- as well as Carbimazole can cause birth defects and there’s a higher risk for me because I am on a higher dose. She swapped me over to PTU- which I started taking straight away- I am on 450mg (150mg x 3 times a day).
    Doctor agrees with endo- and basically both of them emphasised how bad it is to be pregnant right now- which led me to think a termination would be the best choice- Dr said that he agrees with that decision as it’s too risky and complicated.
    Last bloods were 20th April and due for another one this week. Results were:

    Free T4 25.1 pmol/L. R Range 9.0-19.0.
    Free T3. 8.0. pmol/L. R Range 2.6-6.0.
    TSH. <0.004. R Range 0.40-3.50.
    TRAb. 8.0 IU/L. R Range. < 1.8

    Now, I know these are not optimal at all but In your experience- considering antibody levels this high- and with FT3 & FT4 high also- as well as TSH so low- what do you think?
    Have you seen or heard of others I similar situations who have gone on to have healthy babies- would this be rare or would it be more rare to have complications of the extent that my endo and Dr told me to expect?
    I am so confused and I just have no idea what to do. This is the hardest decision I have ever had to make and so far I’ve received such contradicting information that I am utterly at a loss.
    I should also mention- I live in Australia.
    Anything honest advise you think would be helpful would be extremely appreciated.

    Elaine MooreUser is Offline Veteran Member Veteran Member Posts:4011
    21 May 2023 04:14 PM
    Your levels were high in April but by now they would have fallen and your PTU dose reduced. You should be fine. PTU is used for the first trimester and patients are later switched to methimazole or carbimazole. These drugs have all been safely used in pregnancy for more than 60 years.
    TRAB measures both blocking and stimulating (TSI) TSH receptor antibodies and your level isn't very high. It would be better to have a TSI level as the stimulating antibodies cause hyperthyroidism.
    I've seen tons of women in your situation go on to have healthy babies.
    You just want to make sure your FT4 and FT3 remain optimal and not too low. TSH will stay suppressed or low for some time and this level is misleading. A low tSH while on treatment doesn't mean that you're still hyperthyroid as all TSH receptor antibodies falsely lower the result.
    Keep copies of all your labs so you can make sure your treatment is being properly monitored.
    best, elaine
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