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Abnormal TFTs in pregnancy
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I have a 37 yo woman who was referred to me at 20 wks gestation for a TSH of 0.01 and free T4 1.8. She was clinically euthyroid and the baby's size was estimated to be normal and fetal heart rate normal.
I repeated the tests with free T3 and antibodies. Antibodies negative and free T3 elevated. TSH still suppressed.
I started PTU 50mg bid and repeat free T4 after 2 wks was 1.4 but free T3 still elevated and TSH still .01.
I continued treatment for another 2 weeks but then free T4 dropped to o.7 so I discontinued PTU. She was around 25 wks gestation. TSH was still .01 and free T3 had normalized.
I continued to get TFTs q1-2 wks and TSH continues to be .01 and freeT4 still 0.6-0.7 and freeT3 still in the 300's. (wnl) She is now 28 wks gestation so has been off of PTU for 3 wks. Baby's size still fine and fetal heart rate fine.
Should I start Levothyroxine therapy b/c of the low free T4 or continue to hold all treatment since freeT3 normal and TSh suppressed?
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