Good morning. Hope all are fine 🙂 and doing well 🙏 I would to ask if any one of our colleagues has experience or guidelines regarding low FT4 during pregnancy and normal TSH IF central hypothyroidism is unlikely?? To treat or not treat especially we expect to rise by 1.5 fold during pregnancy. Thanks
Moreover Low FT4 is associated with risk of gestation diabetes and pre-eclampsia in some studies.
No need to treat if only FT4 is low.
Follow TSH ranges according to trimester to treat
Good morning to you too.
Your question regarding low FT4, with normal TSH, during pregnancy is of some interest to me and perhaps I can answer it: please be aware however that the information I supply below is my opinion only.
this opinion is supported by information in the literature, but will be energetically opposed by mainstream medicine in general and the majority of endocrinologists in particular.
Your decision, as to whether or not you will apply said information in the care of your patients, is and must be your own decision: prior to applying it, you should query the literature, ensure that you have sufficient knowledge and be secure in your opinion of the subject and your approach to patient care.
You may find my answer oblique: in my opinion, low FT4 is not a concern, as long as intracellular T3 availability is satisfactory: what is important, ensuring normal development of the fetus (particularly, the fetal brain), is availability of T3 inside the mother’s cells. T3 is mainly produced in peripheral cells, so the serum T3 is a reflection of intracellular T3 availability.
If the serum T3 is low (
Since there is no prospective controlled study about the subject demonstrating the superiority of the treatment with levothyroxine in the low T4 syndrome versus no treatment during pregnancy, my conclusion would be: "Up to the present time, there is no proof about the benefit of treatment versus no treatment in the low T4 during pregnancy." According to the literature, it is more common in regions of iodine deficiency. The decision would be a personal one.
You're welcome, Imad.
I should thank you for referring to my note as "valuable input" – most doctors conclude that a comment is worthless if it makes any mention of reverse T3!
I would like to make as many doctors as possible aware of the importance of the T3/rT3 ratio. which is ignored by mainstream medicine.
The point is that whatever the illness, intracellular hypothyroidism MIGHT be a factor and if it is present, the patient will do much better on their regular treatment if it is corrected.
Therefore I would recommend checking the T3/rT3 ratio as a routine investigation for every ill person.
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