Low thyroid?

[u/Fit_Art1866]

I have been seeing a MFM during my twin pregnancy who tends to be overly cautious. I am currently 23weeks with di-di twins.
My T4 measured as 0.82 and my T3 as 2.3
My MFM wants to put me on levothyroxine but I am hesitant because my numbers still seem to fall in range even if they are on the lower end, and I am worried about side effects on the babies. I have never had any thyroid issues before or any family history of them. Does anyone have similar experiences in their multiples pregnancy? Were you able to manage without additional medication? If you did choose to take medication, were there any adverse effects on your pregnancy or side effects once you stopped the medication post pregnancy?

Edit: My TSH was 0.981 at 20 weeks

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[u/Jennifer_2876]

Why did they check your t4 and t3 in the first place? Due to symptoms or just because? I haven't had my thyroid checked my whole pregnancy or even before

[u/Fit_Art1866 → u/Jennifer_2876]

Just because- there were no symptoms, my babies are in the 20+ and 30+ percentile too, so I feel they are growing fine

[u/Jennifer_2876 → u/Fit_Art1866]

In my country they are very anti medical intervention until actually necessary with properly accessed risk/reward ratio. Could you get second opinion? Like why do you need it if you don't have any symptoms and if the pregnancy is going good? What are the actual risks of taking the meds vs the benefits if you already don't have any problems from lower thyroid levels.

[u/SplitTop9839]

Pregnancy hormones do weird stuff to your thyroid, and multiples crank that up even more. My wife’s numbers were borderline with our twins and the MFM put her on a low dose -- her reasoning was that the ranges they use for singleton pregnancies might not be ideal when you’re growing two humans at once. Zero side effects for her or the babies, she tapered off a few weeks after delivery and everything was fine.

I get the hesitation though, it’s hard to add a medication when you’re just barely outside the "normal" window. Might be worth asking your MFM to explain what threshold they’re using specifically for twins -- sometimes they’re working off different reference ranges.

[u/Plastic-Lychee7210]

I will preface by saying I was on levothyroxine prior to pregnancy. But while pregnant with my twins, my dose doubled. Now almost 6 months PP, we just lowered it some. Pregnancy hormones make things go wild!

[u/FormerPumpkin480]

Before I dive in to my comment (I enjoy thyroid stuff lol) I’ll preface this by saying I am not your doctor and you should follow their guidance! BUT, it is typically the TSH that drives the decision on whether to start meds not so much the other values. Did they say what yours was? It’s normal for free T4 to decrease as pregnancy progresses. Regardless though, American Thyroid Association has said the possible benefit of levothyroxine for subclinical hypothyroidism is most concentrated/most evident in the first trimester. So, even if treatment is indicated, starting at 23 weeks is where the evidence for benefit is weakest. I take 50mcg levothyroxine, so a small dose, and it’s really no biggie. I was on it prior to pregnancy as well.

[u/Fit_Art1866 → u/FormerPumpkin480]

My TSH was 0.981 when they measured at 20 weeks

[u/FormerPumpkin480 → u/Fit_Art1866]

That’s very normal… So honestly I have no clue why they’re recommending medication. To my knowledge that’s not supported by any current guidelines.

[u/Jennifer_2876 → u/Fit_Art1866]

That's a normal level, very good in pregnancy isn't it? I really would reach for a second opinion on this. If you don't trust it get one, it's still your choice

[u/tarotdryrub]

Discovered my hypothyroidism during my first pregnancy, began levothyroxine, did not stop taking after as my levels did not resume to normal (have since been diagnosed Hashimoto’s) and continued to take throughout my twin pregnancy. My children are happy and healthy.

I’m not aware of any side effects. I actually think it is more detrimental to the babies to not have good levels of your thyroid hormone. Is there a side effect you’re concerned about?

[u/PurpleShift8546]

I was on the lowest dose of levothyroxine because my TSH was above 2.5 while trying to get pregnant. When I found out I was pregnant with my twins my TSH was up to 3 something and they increased my dose. .9 at 20 weeks is great so I’m not sure why they want to put you on it? I will say I had no issues stopping after giving birth.