Guess whose providers inappropriately recommended treatment for subclinical hypothyroidism in pregnancy because they didn't understand the difference between hypothyroidism and subclinical hypothyroidism: Mine!
The story went like this: I agreed to have my TSH checked in each trimester because my TSH had been elevated in the past (that's another health story entirely). TSH can do weird things in pregnancy, but rarely do people actually develop new hypothyroidism while they're pregnant. So, ok, fine. Let's make sure I'm not one of those rare people who develops hypothyroidism for the first time in my life while I'm pregnant. Cool beans.
My TSH was less than 2.5 in the first trimester. Perfect. In my second trimester is was 3.38. I have my suspicions about why it was a little higher than my normal that day, but whatever. That also belongs in another health story entirely.
Well, I get a phone call from my OB office nurse telling me that the midwife wants to increase my dose of thyroid medication. (Psych: I was not taking thyroid medication, which they should've known because they ask at EVERY appointment. Y'all know how it is.) The nurse agrees to talk to the midwife about this and call me back.
The nurse calls me back an hour or so later and says, "The midwife wants you to start taking thyroid medication. What's your pharmacy?" I said, "I'm pretty sure that that's not actually indicated because I've looked this up before. Do you know what recommendations the midwife is basing this on?" The nurse gets a little bit miffed and says, "No, I'm just telling you what she said. Is it the same pharmacy you've used in the past?" How dismissive!
"Ok, well, I'm going to look it up again, but I'm pretty sure I'm not going to take the thyroid medication."
"Ok, I guess. You can do whatever you want. It's your care. I'm going to call in the prescription anyway."
Cue a million phone calls from CVS telling me that I need to come pick up my prescription.
At my next prenatal appointment, the obstetrician wanted to recheck my TSH since I'd started the thyroid medication (LOL). I explained that I hadn't started taking it because it’s not indicated for someone with a TSH under 4.0, normal free T4, and no thyroid autoantibodies. I handed her copies of ACOG’s most recent practice bulletin about thyroid disease in pregnancy, relevant UpToDate articles, and the most recent research that found increased risk of gestational hypertension when people in my demographic were started on thyroid medication in pregnancy.
One of my favorite things to do when I decline one medical intervention is to agree to another one in its place. Sounds silly, but it makes medical professionals feel like they’re still *doing something* about whatever problem they think is happening. It also shows that I’m still receptive to their care, but only if it’s evidence-based and agreeable to me. In this case, I told the obstetrician that I’d get my blood drawn again to check my free T4 and I’d start taking thyroid medication if my free T4 was low. She seemed a little flustered, but agreed to my plan.
Moral of the story: If you’re pregnant, it’s so important that you get informed, become medically literate, and always ask your providers to prove that their recommendations are accurate if anything ever sounds “off” to you.
