Hey there, OT - Did we meet in Boston, or here in San Diego? Trying to figure out which of my buddies got knocked up!
Okay, let's talk about your thyroid. I think you're right to be hesitant about a decrease in dose while pregnant. Usually requirements would increase, if they change at all (although autoimmune diseases can quiet down during pregnancy, so I suppose some Hashi's patients might actually improve). Here are the dilemmas:
TSH is considered by most endos to be the most "sensitive" measure of how much thyroid hormone you're getting (this measures the pituitary's reaction to your circulating hormone levels - goes up when you don't have enough thyroid hormone, goes down when you have too much). The problem with this approach is, while TSH isn't a bad tool for screening for new thyroid disease, many thyroid patients who are on thyroid hormone replacement find that their symptoms don't match that well with the TSH numbers. Doctors get over-reliant on this supposedly splendid test and fall into the trap of treating the "numbers" and not the patient. Some thyroid patients don't feel well unless their TSH is lowered into the "abnormal" range - others would feel very hyperthyroid if they did that.
Free T4 AND Free T3 are both important to measure. T4 is the less-active form of the hormone, which gets converted into the more-active T3. Doctors ASSume that your body is efficiently converting T4 to T3 when they give you a pure T4 drug like Synthroid. This works for most people but there are some who cannot convert T4 to T3 very well, they still have hypothyroid symptoms even when on Synthroid. Checking the Free T3 helps to verify that your body is converting okay. I notice you did not have a free T3 done, I would insist on one before changing your dose.
You don't include the normal ranges for your lab but it looks like your free T4 level is in the middle of the range, am I right?
Sometimes it is best to take a good look at how the patient is feeling and use that to guide dosage decisions. Unfortunately, that can be trickier than it sounds, as other things can cause similar symptoms, and sometimes people can have similar symptoms at either end of the range (I have fatigue, for instance, if I am too high OR too low).
Are you having any symptoms you think are due to hyperthyroidism? Typical symptoms would be rapid heartrate (increased resting pulse), feeling too warm (although pregnancy hormones do that too), loose or more frequent bowel movements, tremor (shaky hands), insomnia, anxiety (although I have this more when I am low), warm moist skin, and generally a "caffeinated" feeling like you've drunk too much coffee. I was also irritable when hyper, but pregnancy can do that too
Do any of these symptoms sound familiar? If you feel fine, then I would refuse to lower the dose until they at least repeat your bloodwork with a free T3 also.
