Pregnancy with High TSH and normal FT3 and FT4

31 years old female with 5 weeks of amenorrhea presented with first trimester symptoms. before pregnancy her TSH was 6 and on tablet levothyroxine 12.5 mg. Her present reports suggestive of TSH 16.35 but normal Ft4 and Ft3. what should be the management?

Patient’s report shows high TSH with normal free T3,T4 s/o inadequate dosage, please increase dose by 25 mcg So total 37.5 mcg/ day Thyroid hormone has an important role in brain development of the baby during pregnancy. So hypothyroidism in the mother, especially early in pregnancy, can affect the baby's brain development Hance it is paramount important to keep thyroid hormones in normal range.
I agree
Dx-pregnancy with subclinical hypothyroidism. Initial TSH 6microiu/ml . Levothroxin 12.5mcg 1od. Advise-Thyroxin peroxidase antibody titer Plasma. Since her present T3 and T4 level is normal and TSH level is raised only hence no need of incresing levothroxin dose.continue same dose till level of T3 and T4 is not reduced below normal.Monthly monitor of Thyroid profile is mandatory to titrate the dose of levothyroxin.till delivery.and after delivery for 6months.also for new born baby too. Calcium and iron supplements should be continued and given 3hrs before or after levotyroxin dose. Lack of levothroxin in hypothroid mother will persue mentally week baby and miscarriage and even still birth may be there.during pregnancy iodine supplementation must be cared.
Valuable opinion
Titrate the dose of tsh make it 50mcg od
Thank you doctor

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