Normative Data Of Tsh Values With Trimester
When thyroid physiology undergoes alteration in early pregnancy by way of increasing demand and increased secretion of thyroid hormone, the cutoffs used in non-pregnant women will not hold true in pregnancy. In early pregnancy, lower cutoffs are considered normal. The ATA recommends that reference range should be calculated locally, and if not available 0.4 to 4.5 should be considered normal range in non-pregnant adults. This cutoff should be maintained at 0.1 to 2.5 in the first trimester and at 0.2 to 3.0 in the second trimester and 0.3 to 3 in the third trimester as per ATA, 2011 as well as endocrinology society guidelines, 2012 .
However, on reviewing literature reports published thereafter, ATA revised their recommendations in 2017 . They recommended that the first trimester upper normal limit cutoff should be obtained by deducting 0.5 mIU/L from prepregnancy TSH value. But if it is not known then 4.0 mIU/L should be taken as upper limit of normal cutoff.
What Should I Eat During Pregnancy To Help Keep My Thyroid And My Babys Thyroid Working Well
Because the thyroid uses iodine to make thyroid hormone, iodine is an important mineral for you while youre pregnant. During pregnancy, your baby gets iodine from your diet. Youll need more iodine when youre pregnantabout 250 micrograms a day.1 Good sources of iodine are dairy foods, seafood, eggs, meat, poultry, and iodized saltsalt with added iodine. Experts recommend taking a prenatal vitamin with 150 micrograms of iodine to make sure youre getting enough, especially if you dont use iodized salt.1 You also need more iodine while youre breastfeeding since your baby gets iodine from breast milk. However, too much iodine from supplements such as seaweed can cause thyroid problems. Talk with your doctor about an eating plan thats right for you and what supplements you should take. Learn more about a healthy diet and nutrition during pregnancy.
Stage : The Breakdown Of The Immune Tolerance
In the second stage, you start seeing the breakdown of the thyroids immune tolerance, and the person will start to have a white blood cell infiltration into the thyroid gland. Some of these immune cells are going to start grouping there. This is when we will also start seeing elevated thyroid antibodies. This stage can go on for many years a decade or more before a person moves on to stage 3 or 4, when we start to actually see symptoms and changes in thyroid function.
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What Is The Thyroid
The thyroid is a tiny, butterfly-shaped gland in your neck. A gland is an organ that makes substances that help your body work. The thyroid makes hormones that play a big role in your health. For example, thyroid hormones can affect your heart rate and your metabolism .
Sometimes the thyroid gland makes too much or too little of certain hormones. When this happens, you have a thyroid disorder. Some women have a thyroid disorder that begins before pregnancy . Others may develop thyroid problems for the first time during pregnancy or soon after giving birth.
With treatment, a thyroid condition may not cause any problems during pregnancy. But untreated thyroid conditions can cause problems for you and your baby during pregnancy and after birth.
Types Of Low Tsh Levels
Low TSH levels can generally manifest as four types of thyroid conditions:
- Primary hyperthyroidism, which occurs when you have high thyroid hormone levels and low TSH levels.
- Mild hyperthyroidism is a thyroid condition that results in a low TSH level and normal thyroid hormone levels.
- Thyroiditis is an inflammation of the thyroid because of other conditions.
- Pituitary disease, which causes the pituitary gland to not produce enough TSH to properly stimulate the thyroid gland.
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What Can Cause Low Tsh And Hyperthyroidism
Here are some of the causes and types of hyperthyroidism:
- Graves’ disease: In over 70% of cases, an overactive thyroid is caused by Graves’ disease. Graves disease is an autoimmune disorder in which specific antibodies produced by the immune system trigger cells in the thyroid to go into overdrive on the production of thyroid hormone. It tends to run in families and is most common in young people with ovaries.
- Toxic nodular or multinodular goiter: A type of hyperthyroidism that happens when additional nodes grow on the thyroid, causing the overall production of thyroid hormone to increase
- Thyroiditis: Thyroiditis is inflammation of the thyroid gland. It can lead to both under- and overproduction of thyroid hormones.
- Too much synthetic thyroid hormone: Taking too much synthetic thyroid hormone can also result in thyroid hormone levels that are too high.
Guidelines On Early Detection And Treatment
A review of the history of guidelines for subclinical thyroid dysfunction provides insight into the reason for practice variation . In 1990 and again in 1998, the American College of Physicians found it is reasonable to screen women older than 50 years of age for unsuspected but symptomatic thyroid disease. The guideline specified that the goal of routine testing was to find overt, but overlooked, thyroid dysfunction, not subclinical hypothyroidism. Because the clinical significance of mildly elevated TSH test results was uncertain, the guideline recommended obtaining a free T4 test only when the TSH level was undetectable or 10 mIU/L or more. The ACP guideline panel used a systematic review of the literature to arrive at its recommendations.These guidelines expired in 2003.
In 1999, the American Association of Clinical Endocrinologists recommended screening asymptomatic women over the age of 60.In 2000, the American Thyroid Association recommended screening all patients over 35 years of age every 5 years . These organizations used a consensus process to develop guidelines and did not use systematic reviews in arriving at their recommendations.
Evidence for the association of subclinical hypothyroidism and adverse health outcomes and quality of evidence for risks and benefits of treatment: Findings of the American Association of Clinical Endocrinologists, the American Thyroid
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What Else Can Cause Low Or High Tsh
TSH levels can be impacted by illness , pregnancy, medications, food or supplements, and even a lack of sleep. There are also fluctuations in TSH throughout the day: TSH tends to be higher in the mornings and decreases throughout the day.
The small variations we just mentioned mean that occasionally TSH levels tested some time apart don’t match up. But even accounting for factors that can cause small amounts of variation between tests, TSH results are an important piece of insight about whats going on with your thyroid gland. If you get two TSH results that dont match up, for example one is in the high range and the other is in the normal” range, its possible that in the first test your level was temporarily elevated it doesnt necessarily mean that one of the test results is wrong.
If youve done multiple TSH tests and the results seem discordant, talk with your doctor. They can look at the two results in context of the reference ranges from the lab where you took your sample and help you interpret them. They may also order some additional testing to check other aspects of thyroid function.
Symptoms Associated With High Thyroid Peroxidase Antibodies
Thyroid peroxidase antibodies typically do not cause any major symptoms by themselves.
They can sometimes be associated with minor symptoms including a minor decrease in energy, feeling run-down, or just feeling blah.
These symptoms occur as your body attempts to deal with the immune dysfunction present as well as minor changes to thyroid function.
Most of the major symptoms associated with TPO antibodies come from the direct damage to the thyroid gland.
Remember the war zone that I mentioned previously?
Inflammation and damage to the thyroid gland may result in changes to thyroid function and this change to thyroid function results in symptoms that are hard to miss.
These symptoms vary based on whether you have a diagnosis of HYPERthyroidism or HYPOthyroidism .
You can use your symptoms, in conjunction with your antibodies and thyroid lab tests, to see where you fit.
#1. Symptoms of Hashimotos Thyroiditis:
#3. You may be asymptomatic.
Dont forget that some people, especially those who are pregnant, may have no symptoms at all!
We dont know how many people fit into this category, though, because most people do not get tested for thyroid peroxidase antibodies unless they are feeling poorly at which point they can be diagnosed.
Its also possible to be asymptomatic in the early stages of your disease, especially if you catch it early enough.
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What Triggers Elevated Tsi Levels
Graves’ disease is, by definition, an autoimmune disease.
An autoimmune disease means that your body is attacking itself due to some process which has lead to confusion of your immune system.
Under normal conditions, your body should NOT attack itself, and it should not have a problem differentiating between foreign invaders and your own tissue.
In autoimmune diseases, such as Graves’ disease, there is a cross-reactivity between your own tissue and your immune system.
The hallmark of Graves’ disease is the presence of TSI which latch on to and activate your thyroid gland resulting in an increase in thyroid hormone in your body.
But what triggers the creation of these antibodies?
What if we were able to stop the “trigger” or “prevent” it from triggering your immune system further?
As you can imagine, this is a topic which is under intense research currently because it would potentially mean a “cure” for autoimmune diseases.
Believe it or not, our current treatment for autoimmune diseases focuses on the suppression of the immune system rather than attempting to reverse the trigger of immune dysfunction.
But emerging research has shed light on to what may be triggering immune dysfunction.
I’ve included a brief list below of known triggers of autoimmune disease :
How Can You Measure Your Tsh Levels
If youre concerned about your thyroid or think you might have a thyroid condition, you can always check in with your healthcare provider about what lab tests they may recommend.
Another easy way to get a read on your TSH is with the Modern Fertility Hormone Test. Youll order a kit from our site, take a simple finger-prick blood test at home , and have results uploaded in a personalized dashboard within 10 days. Depending on your TSH result from the first round of testing, our clinical team may issue a free retest for both TSH and free T4 to get more insight into your thyroid function.
Hannah had been trying to conceive for a few months before deciding to take the Modern Fertility Hormone Test which provided “peace of mind” as well as “confirmation.””I have been struggling with thyroid symptoms for years and medical professionals have not taken me seriously. The blood work from the Modern Fertility test revealed that I have high levels of TSH and I am finally on the path toward treatment,” Hannah says. “I encourage everyone to take the Modern Fertility test. If you are planning to get pregnant or are trying, it may provide more insight into your health than you realize. Thanks to Modern Fertility, I am starting to feel normal again.
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Hypothyroidism Treatment During Pregnancy
Your doctor will prescribe a synthetic hormone called levothyroxine which is not only safe during pregnancy, its vital to both you and your baby. Work with your endocrinologist and obstetrician to determine the right dose for you. If you had preexisting hypothyroidism, they will likely need to increase your levels, since the body requires more thyroid hormones when its in baby-growing mode.
During pregnancy and postpartum, your thyroid hormone levels will be monitored every six to eight weeks to see if your dose needs further adjustment.
In addition to medication, be sure to eat a healthy balanced diet and take a prenatal vitamin. Most likely your doctor will also suggest a supplement of 150 micrograms iodine a day during pregnancy , since iodine is important for thyroid health. Youll also find iodine in seafood and iodized salt, so opt for that over sea salt.
Is Hypothyroidism Dangerous To My Pregnancy
Delays in development
Fortunately, the effects of hypothyroidism on pregnancy are preventable: Its easy to diagnose an underactive thyroid through blood tests. Treatment with levothyroxine works well and is safe during pregnancy.
Hypothyroidism can make it more difficult to get pregnant, and for women who do get pregnant, it can be dangerous. But hypothyroidism is both avoidable and treatable. If you have a thyroid condition, consult your provider before trying to conceive. If you are already pregnant, notify your provider if you have any of the above risk factors or symptoms. The symptoms of hypothyroidism are a lot like what you might feel in pregnancy, so listen to your body, and always be honest about how you feel.
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Should People With Thyroid Problems Avoid These Foods
Soy: If you have hypothyroidism, yes. Eating too much soy causes problems only for those with hypothyroidism, which occurs when your thyroid gland does not make enough thyroid hormones, Dr. Nasr says.
The main problem is that soy may hinder absorption of the hormones that such patients take.
Some studies show that if you eat a lot of soy, or drink a big glass of soy milk, within one hour of taking a thyroid hormone, it might affect absorption, Dr. Nasr says. Many individuals depend on a consistent absorption of those hormones to achieve a steady state.
Generally, expertsrecommend that people who have a borderline thyroid one thats a littleunderactive but youre still trying to preserve thyroid function do not toconsume large amounts of soy every day, he adds.
Turnips and rootvegetables: No. These vegetables aresometimes thought to cause thyroid problems, but thats not the case, Dr. Nasrsays. They are good for your diet, regardless of any thyroid issues.
One root vegetable that is the exception is cassava, a common staple in certain parts of Africa. This plant is known to produce toxins that can slow an already underactive thyroid, especially in the presence of an iodine deficiency, Dr. Nasr says. But thats not relevant here in the United States, unless you cook cassava and you eat it every day.
More Than Half Of Babies Born Hypothyroid Grow Out Of It
Some children will need lifelong treatment, while others require only short-term hormone supplementation. Figuring out which child has transient congenital hypothyroidism and who has the permanent hormone condition is the ongoing question.
To address this clinical concern, Dr. Saba and her team evaluated 92 children at age 3 who were diagnosed with congenital hypothyroidism at birth. All the toddlers had an anatomically normal thyroid when they were born in Paris between 2002 and 2012.2 All were treated with levothyroxine.
The researchers found that more than half the children no longer had a low thyroid level by the time they turned 3 years of age these toddlers were determined to have a transient form of the condition.1 The thyroid hormone levels in these babies had normalized so the doctor was able to discontinue the levothyroxine supplementation.
At the median age of 18 months, this proved the midpoint for babies needing levothyroxine replacement therapywith half of them no longer needing the hormone above this age, and the other half stopping the medication even earlier).1
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What Does It Mean To Have High Tsh Levels
On the flip side, high TSH levels point to an underactive thyroid. Why? When the pituitary gland senses that thyroid hormone levels in the blood are low, it produces a lot of TSH to try to get the thyroid to kick thyroid production into gear. The term for the diagnosis of underactive thyroid is hypothyroidism. In general, if your thyroid gland isnt producing enough thyroid hormones, the pace of body systems will slow down. Hypothyroidism is diagnosed when TSH is above 4.0 uIU/mL on more than one test taken in a short period of time.
Physicians distinguish between overt hypothyroidism and subclinical hypothyroidism . There is some disagreement in the medical community around whether treatment is needed for subclinical hypothyroidism.
Healthy Tsh In Pregnancy Vs Outside Of Pregnancy
The information I’ve referenced above is recommended based off of several studies.
There is one big problem, though:
Most of the studies that we have on pregnant women include gathered information and data, not true double blind, placebo controlled tests .
Furthermore, the information here is generalized, but we know that each person is unique and different.
Normal TSH levels based off of individuals, age, ethnicity, and numerous other factors.
So how can we create a “standard” range and then apply it to everyone?
And the studies I’ve referenced above indicate that you should keep the TSH less than 2.5 in the first trimester and with another breath also claim that normal TSH standard reference range from lab companies is as high as 4.5.
So how can studies of healthy individuals show that a healthy TSH is less than 2.5 and then recommend that same level for pregnant women knowing that pregnancy places an increased demand on the thyroid?
How is it possible for some women to be completely “normal” with a TSH of 0.1 ranging all the way up to 2.4?
This range is MASSIVE.
It doesn’t make a lot of sense, but this is the data that we are left with and we have to sort it out.
My personal recommendation and feeling, based off of treating hundreds of people, is that a healthy and normal TSH is probably much closer to 1.0 in the nonpregnant state.
Why do I make these recommendations?
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