Hello. I have been TTC for 2 years and was getting ready to start IVF when I was dx with Graves in March of this year. I took methimazole for a month but had an allergic reaction. I've been on PTU since with no problems. Endo started me on 50mg PTU 2x daily and now I'm taking only 1 in morning (for about a month now).

I've been waiting for my thyroid levels to regulate before egg retrieval for IVF due to anesthesia concerns. My RE wants clearance from my endo before proceeding. I've been to two endos and also seeing a nutritionist and holistic PCP. My first endo cleared me for egg retrieval in June. However my PCP reviewed my labs and told me I have antibodies for Graves and hashis and recommended I wait to begin IVF (not sure why. I was pretty emotional and couldn't think to ask right questions). So I went to the second endo in July. He told me I initially presented with Graves but didn't clarify my question about antibodies. He told me my levels were getting low and suggested I keep TTC naturally. (He thinks IVF is usually unnecessary.)He reduced my PTU dose to 1x daily.

I'm 38 and have a 5 year old daughter who was conceived naturally. But I also have really low AMH and high FSH, and one Fallopian tube (removed due to cyst last year). My fertility doc recommended I see MFM to review my thyroid labs.

To confuse things more my nutritionist who works in conjunction with PCP has me on several supplements. She's trying to help me fix my gut bacteria imbalance which she said is contributing to my Graves. She has me on a supplement called Thytrophin which contains bovine thyroid cells. She said it distracts the antibodies from attacking my thyroid. However the second endo told me not to take that supplement.


Labs 3/23:
T4 free 2.49 (0.7-1.48)
T3 total 3.29 (0.58-1.59)
TPO 38 (0-34)
TSI 504 (0-139)
TSH .01 (.358-3.74)

Labs 7/25:
T4 free 0.7 (0.8-1.8)
T3 free 2.8 (2.3-4.2)
TPO 17 (<9)
TSI 663 (<140)
TSH .09 (.40-4.5)

It looks like my Graves is still really active because of high TSI but my free T3/4 is low. How can that be?

At this point I just want to get cleared for egg retrieval to freeze the eggs I have. Hopefully then I can see how things with my thyroid go to determine if continuing IVF is safe.



My questions:

I am so confused with these differing opinions and don't know who to trust about treating my thyroid and starting IVF. What thyroid levels are safe for anesthesia and pregnancy?Are there concerns with taking PTU during entire pregnancy? Will IVF drugs cause a problem with my thyroid levels? Is Thytrophin ok for me to take?

Hi,
Your TSI is high because your thyroid hormone levels are far too low. when we start becoming hypothyroid, through a process of homeostasis, our gland tries to fix the problem by speeding up its activity. this includes increased activity of the white cells within the gland and they produce more TSH receptor antibodies. You should be on the lowest dose needed to keep your FT4 near the high end of the reference scale.
I wouldn't take the thyrotroph supplement as it too can cause increased thyroid antibody production.

Once your thyroid hormone levels are optimal (and TSH will be low because of the antibodies so ignore this result) your TSI will fall and you should be fine to start IVF. I have two IVF grandchildren so know the process. You could conceive naturally but if you want to move things along IVF is an excellent solution. Just be sure to keep a close eye on your FT4. Low levels can injure fetal growth, fertility, and pregnancy in general. Clearly, your endo hasn't been following the guidelines for dosing. best, elaine