Re: OB Dilemma & Blood Pressure Probs

[Guest guest]

Hi Tori,

You might want to double check with your endo, but beta blockers are not

recommended in pregnancy. And with your blood pressure so low, you should not

even be using beta blockers.

Many studies show that it's better to be on the hyper side rather than the

hypo side during pregnancy. Normally, most women become slightly hyper in

early pregnancy. this is a natural response caused by the hormone hCG that

helps ensure adequate thyroid hormone for the baby. Thyroid storm is not

related to pregnancy but it can occur in labor if levels are too high. Best

to you, Elaine

[Guest guest]

Hi Tori,

You might want to double check with your endo, but beta blockers are not

recommended in pregnancy. And with your blood pressure so low, you should not

even be using beta blockers.

Many studies show that it's better to be on the hyper side rather than the

hypo side during pregnancy. Normally, most women become slightly hyper in

early pregnancy. this is a natural response caused by the hormone hCG that

helps ensure adequate thyroid hormone for the baby. Thyroid storm is not

related to pregnancy but it can occur in labor if levels are too high. Best

to you, Elaine

[Guest guest]

Hi Tori -

Sorry you're feeling so lousy! I sure can relate though, I felt miserable

for most of all 3 pregnancies! The low blood pressure thing may be

completely unrelated to thyroid. I think I would talk to your regular doc

you see for thyroid and tell him/her about the low blood pressure and see if

you should still keep taking the beta blocker or perhaps wean off it. Did

the OB say _anything_ about continuing to take it? It may be that the lower

blood pressure is a result of all the extra fluid in your body from the

baby. With all 3 of my kids I had terribly low blood pressure. So low I'd

climb a flight of stairs and have to sit down at the top and wait until the

dizziness/lightheadedness, shortness of breath passed. Mine would commonly

be like 80/50. I couldn't stand for long at all or I'd pass out. Another

thing that set me off would be sitting in the seats of the car. We had a

Honda Accord at the time and the seats were naturally tilted just enough

that the baby would compress against my spine and cut off a bit of my

circulation and I'd nearly pass out while driving. Putting a pillow behind

me while driving did help. After the 1st kid, we got a minivan and the

upright seats in those were much better at preventing this. I'd have the low

pressure really bad in the mornings. Some things that helped were to drink

_a lot_ first thing in the morning. Sometimes I'd have a big glass of water

before I even got up. Drinking more fluids really did help. Anyway, I think

you're right to be concerned about the low pressure. Certainly it's not as

bad as having high blood pressure, but you don't want to go passing out and

possibly hurting yourself/baby while falling or driving! I would definitely

get another opinion about continuing the beta. Perhaps you should start

taking lower doses and seeing if that helps. I would be very careful

driving - get someone else to do it if you can until you get it sorted out.

I scared myself too many times almost passing out at the wheel!

As for the hypo/hyper debate, the most relevant info I have read is that it

is not good to be hypo during the first trimester. Baby can have mental

retardation, etc. if the mother's TSH is too high. I think B and

would have more pertinent info on this, since they're in similar situations.

Regarding the hospital for delivery, it kind of depends on what your comfort

level is. For me, with a first delivery, I would be more comfortable in the

bigger Level 1 hospital just in case there were complications. Trouble is

with a first delivery, you have no idea what it's going to be like. Maybe

the pelvis is too small for the baby's head and you need a C-section. Maybe

the baby gets stuck and starts to go into distress (no - I'm not intending

to scare you, really!) Anything could happen. If you are the kind of person

that likes to be prepared for the worst case, I'd go to the bigger hospital

in Seattle. If you're hospital-phobic and like the idea of the birthing

facility atmosphere, go for that. You ask for tours of the facilities and

you can also ask them specifically what types of emergencies they are

trained for. You might decide what you'd prefer after you check them out. I

have a very good friend who is terrified of hospitals and so had a home

birth with her first. They were also 25 mintues away from the nearest

hospital. Now, for me, that would really worry me! What if something went

wrong and you needed to get to the hospital right away? I'd be paranoid the

whole time! But, for her, it was the right choice. Their son was born on the

bathroom floor, but did have problems breathing, so the husband and midwife

had to take the baby to the hospital to have him checked out while the new

mom stayed home and got cleaned up. You've got lots of options, don't be

afraid to check them out and then decide what you'd like to do. Chances are

with a first delivery, you'll have more than enough time to get to the

hospital even if it's 30 miles away (it just may be a very _uncomfortable_

ride - been there, done that!)

Can't wait to see what your lab results are Monday. A lot of the symptoms

you're having can just be " pregnancy related " and not necessarily thyroid.

Hopefully that's it. Keep taking care of yourself and drink, drink, drink!

Hope you feel better! (I won't mention I felt the same way for 6

months...oops! I mentioned it!)

OB Dilemma & Blood Pressure Probs

> Hello Everyone,

>

> I haven't been very diligent with keeping up with the posts lately. At 10

> weeks pregnant, I've been feeling awful. I'm exhausted, achy, cold, and

have

> been having dizzy spells and severe shortness of breath. I'm scared I've

> gone way hypo--I should have lab results Monday that let me know if that's

> the case. Yesterday, I had a 'Meet and Greet' with an OB, at which my

blood

> pressure was a startling 120/10! That's not a typo, it was really that

low.

> I was terrified and was so out of it, I actually got lost on my way home.

I

> didn't take my beta blocker last night (I take 50 mg of atenolol twice a

> day--only needs to be taken once a day, so I wasn't really skipping a

whole

> dose) and took my blood pressure when I woke up this morning. Without any

> beta blocker for 24 hours, my systolic bp (taken 4 times) varied from 97 -

> 116 and diastolic bp was between 57 and 66. So, it was reassuring to see

it

> had risen, but that is before I took today's atenolol. I'll check it

again

> in a hour or two. Should I be worried or overly cautious? I'm scared

even

> to drive in case I pass out at the wheel.

>

> Now, my OB issues. The doctor I saw was highly recommended on a message

> board for Washington parents. She graduated from the Mayo Medical School

and

> seems nice enough. However, there were a few red flags that have me

> concerned. First of all, she sent me home with blood pressure so low, I

> could've collapsed on the spot. Also, she felt my thyroid and I felt she

was

> a bit rough with it (though I am overly sensitive about anything touching

my

> neck). My biggest concern was that she said that she prefers me to be on

the

> hypo side rather than hyper because of the threat of thyroid storm.

Although

> I certainly agree with her that I don't want my levels to get high enough

to

> be in danger of thyroid storm, everything I've read and heard about Graves

> and pregnancy supports keeping the mother slightly hyper. She is an older

> lady--not that that's a problem in itself, but I wonder if she has a

rather

> dated view of thyroid issues. What do you think? Should I run now or

give

> this chick another chance?

>

> One more question, then I'm all out of issues. I feel a bit like I'm

> badgering the group with all this, so forgive me if I am. The hospital

> closest to my home is a level 3 birthing facility. I'm not exactly sure

what

> this means as far as which situations they can or cannot handle, but they

> definitely don't handle infant surgery if that becomes necessary. If the

> baby were have complications that would warrant being transferred, the

> hospital could not transfer me until I had stayed there the minimum amount

of

> time (I think 24 hours for vaginal birth, 48 for cesarean). I would go

nuts

> if I had to be apart from my baby and husband in such a situation. So,

I'm

> wondering if I should plan to have the baby in a Seattle hospital (30

miles

> away) that can handle all sorts of problems or if a level 3 facility is

more

> than adequate to handle potential Graves complications. I hope my

pregnancy

> and the baby are perfectly healthy, but I want to be at least partially

> prepared if they aren't. The other night, I dreamed that I gave birth to

the

> most beautiful baby boy, perfect in every way. I saw his little face so

> clearly--he had dark hair, slightly olive skin, chubby little cheeks, and

his

> father's wonderful smile. I do so hope that's how it happens in reality.

I

> can hardly wait to see and hold him. I'm tearing up just thinking about

it.

>

> Ok, I'm off. The 1100 lights that I spent 2.5 days putting on our

Christmas

> tree decided to go out last night! So, I'll be spending the day trying to

> check each bulb and fuse. My cats probably knocked one bulb loose and now

> none of them will light. Ugh! Pray that it's one of the first few I

check.

> I don't have the patience to check all 1100.

>

> Peace & thanks for being my therapist for the day,

> Tori

>

>

>

[Guest guest]

Hi Tori -

Sorry you're feeling so lousy! I sure can relate though, I felt miserable

for most of all 3 pregnancies! The low blood pressure thing may be

completely unrelated to thyroid. I think I would talk to your regular doc

you see for thyroid and tell him/her about the low blood pressure and see if

you should still keep taking the beta blocker or perhaps wean off it. Did

the OB say _anything_ about continuing to take it? It may be that the lower

blood pressure is a result of all the extra fluid in your body from the

baby. With all 3 of my kids I had terribly low blood pressure. So low I'd

climb a flight of stairs and have to sit down at the top and wait until the

dizziness/lightheadedness, shortness of breath passed. Mine would commonly

be like 80/50. I couldn't stand for long at all or I'd pass out. Another

thing that set me off would be sitting in the seats of the car. We had a

Honda Accord at the time and the seats were naturally tilted just enough

that the baby would compress against my spine and cut off a bit of my

circulation and I'd nearly pass out while driving. Putting a pillow behind

me while driving did help. After the 1st kid, we got a minivan and the

upright seats in those were much better at preventing this. I'd have the low

pressure really bad in the mornings. Some things that helped were to drink

_a lot_ first thing in the morning. Sometimes I'd have a big glass of water

before I even got up. Drinking more fluids really did help. Anyway, I think

you're right to be concerned about the low pressure. Certainly it's not as

bad as having high blood pressure, but you don't want to go passing out and

possibly hurting yourself/baby while falling or driving! I would definitely

get another opinion about continuing the beta. Perhaps you should start

taking lower doses and seeing if that helps. I would be very careful

driving - get someone else to do it if you can until you get it sorted out.

I scared myself too many times almost passing out at the wheel!

As for the hypo/hyper debate, the most relevant info I have read is that it

is not good to be hypo during the first trimester. Baby can have mental

retardation, etc. if the mother's TSH is too high. I think B and

would have more pertinent info on this, since they're in similar situations.

Regarding the hospital for delivery, it kind of depends on what your comfort

level is. For me, with a first delivery, I would be more comfortable in the

bigger Level 1 hospital just in case there were complications. Trouble is

with a first delivery, you have no idea what it's going to be like. Maybe

the pelvis is too small for the baby's head and you need a C-section. Maybe

the baby gets stuck and starts to go into distress (no - I'm not intending

to scare you, really!) Anything could happen. If you are the kind of person

that likes to be prepared for the worst case, I'd go to the bigger hospital

in Seattle. If you're hospital-phobic and like the idea of the birthing

facility atmosphere, go for that. You ask for tours of the facilities and

you can also ask them specifically what types of emergencies they are

trained for. You might decide what you'd prefer after you check them out. I

have a very good friend who is terrified of hospitals and so had a home

birth with her first. They were also 25 mintues away from the nearest

hospital. Now, for me, that would really worry me! What if something went

wrong and you needed to get to the hospital right away? I'd be paranoid the

whole time! But, for her, it was the right choice. Their son was born on the

bathroom floor, but did have problems breathing, so the husband and midwife

had to take the baby to the hospital to have him checked out while the new

mom stayed home and got cleaned up. You've got lots of options, don't be

afraid to check them out and then decide what you'd like to do. Chances are

with a first delivery, you'll have more than enough time to get to the

hospital even if it's 30 miles away (it just may be a very _uncomfortable_

ride - been there, done that!)

Can't wait to see what your lab results are Monday. A lot of the symptoms

you're having can just be " pregnancy related " and not necessarily thyroid.

Hopefully that's it. Keep taking care of yourself and drink, drink, drink!

Hope you feel better! (I won't mention I felt the same way for 6

months...oops! I mentioned it!)

OB Dilemma & Blood Pressure Probs

> Hello Everyone,

>

> I haven't been very diligent with keeping up with the posts lately. At 10

> weeks pregnant, I've been feeling awful. I'm exhausted, achy, cold, and

have

> been having dizzy spells and severe shortness of breath. I'm scared I've

> gone way hypo--I should have lab results Monday that let me know if that's

> the case. Yesterday, I had a 'Meet and Greet' with an OB, at which my

blood

> pressure was a startling 120/10! That's not a typo, it was really that

low.

> I was terrified and was so out of it, I actually got lost on my way home.

I

> didn't take my beta blocker last night (I take 50 mg of atenolol twice a

> day--only needs to be taken once a day, so I wasn't really skipping a

whole

> dose) and took my blood pressure when I woke up this morning. Without any

> beta blocker for 24 hours, my systolic bp (taken 4 times) varied from 97 -

> 116 and diastolic bp was between 57 and 66. So, it was reassuring to see

it

> had risen, but that is before I took today's atenolol. I'll check it

again

> in a hour or two. Should I be worried or overly cautious? I'm scared

even

> to drive in case I pass out at the wheel.

>

> Now, my OB issues. The doctor I saw was highly recommended on a message

> board for Washington parents. She graduated from the Mayo Medical School

and

> seems nice enough. However, there were a few red flags that have me

> concerned. First of all, she sent me home with blood pressure so low, I

> could've collapsed on the spot. Also, she felt my thyroid and I felt she

was

> a bit rough with it (though I am overly sensitive about anything touching

my

> neck). My biggest concern was that she said that she prefers me to be on

the

> hypo side rather than hyper because of the threat of thyroid storm.

Although

> I certainly agree with her that I don't want my levels to get high enough

to

> be in danger of thyroid storm, everything I've read and heard about Graves

> and pregnancy supports keeping the mother slightly hyper. She is an older

> lady--not that that's a problem in itself, but I wonder if she has a

rather

> dated view of thyroid issues. What do you think? Should I run now or

give

> this chick another chance?

>

> One more question, then I'm all out of issues. I feel a bit like I'm

> badgering the group with all this, so forgive me if I am. The hospital

> closest to my home is a level 3 birthing facility. I'm not exactly sure

what

> this means as far as which situations they can or cannot handle, but they

> definitely don't handle infant surgery if that becomes necessary. If the

> baby were have complications that would warrant being transferred, the

> hospital could not transfer me until I had stayed there the minimum amount

of

> time (I think 24 hours for vaginal birth, 48 for cesarean). I would go

nuts

> if I had to be apart from my baby and husband in such a situation. So,

I'm

> wondering if I should plan to have the baby in a Seattle hospital (30

miles

> away) that can handle all sorts of problems or if a level 3 facility is

more

> than adequate to handle potential Graves complications. I hope my

pregnancy

> and the baby are perfectly healthy, but I want to be at least partially

> prepared if they aren't. The other night, I dreamed that I gave birth to

the

> most beautiful baby boy, perfect in every way. I saw his little face so

> clearly--he had dark hair, slightly olive skin, chubby little cheeks, and

his

> father's wonderful smile. I do so hope that's how it happens in reality.

I

> can hardly wait to see and hold him. I'm tearing up just thinking about

it.

>

> Ok, I'm off. The 1100 lights that I spent 2.5 days putting on our

Christmas

> tree decided to go out last night! So, I'll be spending the day trying to

> check each bulb and fuse. My cats probably knocked one bulb loose and now

> none of them will light. Ugh! Pray that it's one of the first few I

check.

> I don't have the patience to check all 1100.

>

> Peace & thanks for being my therapist for the day,

> Tori

>

>

>

[Guest guest]

Tori,

I do disagree with your ob, although this isn't reason to dump her, but to talk

to her again and reconfirm her feelings.

From what Elaine has reported, what I've read, and what my ob-gyn AND endo (who

is on Shomon's top doc list and who is Almost God say is that sometimes

becoming a bit hyper during pregnancy is NOT an issue. Indeed, thyroid levels

that dip a LITTLE in either direction and then are caught and regulated will not

harm your baby.

But my endo has had me running a little high rather than low and the pregnancy

is going better for it. Part of this picture is very very individual -- because

of high blood pressure concerns, U's doc would prefer to err on the side

of hypo. For me, I'm one of those unusual people who get high blood pressure

while hypo, which is all the more reason to keep my thyroid levels in the higher

half of normal.

One difference I have found during this pregnancy (with thyroid disease) adn the

ohters (without, although who knows for sure) is that my blood pressure

throughout boht other pregnancies was the SAME was it was when I wans't

pregnant, which is about 100/60 to 90/60. This pregnancy, my blood pressure

has stayed at about 120/60. Nobody but me thinks this is interesting since

that's a normal reading - but I find it odd that ever since I've had Graves then

Hashi's, my blood pressure has never returned to its normally very low state but

been a bit higher.

Anyway, I'd do some reading and investigate this a little further. Also, how

much hypo is a little hypo for her? Remember, she may mean it doesn't matter if

you slip out of that normal range much (e.g., a hair above 5 or with a TSH of

4.9) yet there are now recommendations that the normal range be changed to TOP

off at 2.5!!! So if her rule of thumb is that your'e okay if you're all the way

at a tsh of 5, yet the rules are changing, and she's unaware . . . well, I'd be

concerned about that.

As for the birth center, I have to agree that more may be better than less in

your case. Do you have to decide right away? You have thirty weeks left

Wihtin the next few weeks, perhaps you can tell if thigngs appear to be running

very very smoothy adn you're willing to take your chances with the birth center

because all looks normal. But if you're struggling to balance your thyroid and

feeling uncertain and things don't seem stable or EASY, you may want to stay

with a larger hospital. I guess that's what I did: when I got pg at 39

post-Graves, with my thyroid intact and the theoretical potential for becoming

hyper again, I went ahead and let my otherwise mellow ob label me 'high risk'

and slot me for all kinds of bells and whistles should I need them. By week 20,

I was clearly out of the woods and things were going so well I wasn't a 'risk'

any longer. By week 30 when the receptionist told me to start coming in every

two weeks, the ob-gyn said, oh let's keep going once a month till the last

month. Things are going that well.

But I was prepared for more and I think you should be too -- you can always

downgrade later if you don't make a permanent decision on where to give birth

right now?

Keep us posted! The first trimester can be a very queasy experience and it

sounds like you're in the thick of it. Dry popcorn and acupuncture wrist bands

helped me with all three pgs.

Best -

From: L@...

To: graves_support

Sent: Saturday, December 14, 2002 1:06 PM

Subject: OB Dilemma & Blood Pressure Probs

Hello Everyone,

I haven't been very diligent with keeping up with the posts lately. At 10

weeks pregnant, I've been feeling awful. I'm exhausted, achy, cold, and have

been having dizzy spells and severe shortness of breath. I'm scared I've

gone way hypo--I should have lab results Monday that let me know if that's

the case. Yesterday, I had a 'Meet and Greet' with an OB, at which my blood

pressure was a startling 120/10! That's not a typo, it was really that low.

I was terrified and was so out of it, I actually got lost on my way home. I

didn't take my beta blocker last night (I take 50 mg of atenolol twice a

day--only needs to be taken once a day, so I wasn't really skipping a whole

dose) and took my blood pressure when I woke up this morning. Without any

beta blocker for 24 hours, my systolic bp (taken 4 times) varied from 97 -

116 and diastolic bp was between 57 and 66. So, it was reassuring to see it

had risen, but that is before I took today's atenolol. I'll check it again

in a hour or two. Should I be worried or overly cautious? I'm scared even

to drive in case I pass out at the wheel.

Now, my OB issues. The doctor I saw was highly recommended on a message

board for Washington parents. She graduated from the Mayo Medical School and

seems nice enough. However, there were a few red flags that have me

concerned. First of all, she sent me home with blood pressure so low, I

could've collapsed on the spot. Also, she felt my thyroid and I felt she was

a bit rough with it (though I am overly sensitive about anything touching my

neck). My biggest concern was that she said that she prefers me to be on the

hypo side rather than hyper because of the threat of thyroid storm. Although

I certainly agree with her that I don't want my levels to get high enough to

be in danger of thyroid storm, everything I've read and heard about Graves

and pregnancy supports keeping the mother slightly hyper. She is an older

lady--not that that's a problem in itself, but I wonder if she has a rather

dated view of thyroid issues. What do you think? Should I run now or give

this chick another chance?

One more question, then I'm all out of issues. I feel a bit like I'm

badgering the group with all this, so forgive me if I am. The hospital

closest to my home is a level 3 birthing facility. I'm not exactly sure what

this means as far as which situations they can or cannot handle, but they

definitely don't handle infant surgery if that becomes necessary. If the

baby were have complications that would warrant being transferred, the

hospital could not transfer me until I had stayed there the minimum amount of

time (I think 24 hours for vaginal birth, 48 for cesarean). I would go nuts

if I had to be apart from my baby and husband in such a situation. So, I'm

wondering if I should plan to have the baby in a Seattle hospital (30 miles

away) that can handle all sorts of problems or if a level 3 facility is more

than adequate to handle potential Graves complications. I hope my pregnancy

and the baby are perfectly healthy, but I want to be at least partially

prepared if they aren't. The other night, I dreamed that I gave birth to the

most beautiful baby boy, perfect in every way. I saw his little face so

clearly--he had dark hair, slightly olive skin, chubby little cheeks, and his

father's wonderful smile. I do so hope that's how it happens in reality. I

can hardly wait to see and hold him. I'm tearing up just thinking about it.

Ok, I'm off. The 1100 lights that I spent 2.5 days putting on our Christmas

tree decided to go out last night! So, I'll be spending the day trying to

check each bulb and fuse. My cats probably knocked one bulb loose and now

none of them will light. Ugh! Pray that it's one of the first few I check.

I don't have the patience to check all 1100.

Peace & thanks for being my therapist for the day,

Tori

[Guest guest]

Tori,

I do disagree with your ob, although this isn't reason to dump her, but to talk

to her again and reconfirm her feelings.

From what Elaine has reported, what I've read, and what my ob-gyn AND endo (who

is on Shomon's top doc list and who is Almost God say is that sometimes

becoming a bit hyper during pregnancy is NOT an issue. Indeed, thyroid levels

that dip a LITTLE in either direction and then are caught and regulated will not

harm your baby.

But my endo has had me running a little high rather than low and the pregnancy

is going better for it. Part of this picture is very very individual -- because

of high blood pressure concerns, U's doc would prefer to err on the side

of hypo. For me, I'm one of those unusual people who get high blood pressure

while hypo, which is all the more reason to keep my thyroid levels in the higher

half of normal.

One difference I have found during this pregnancy (with thyroid disease) adn the

ohters (without, although who knows for sure) is that my blood pressure

throughout boht other pregnancies was the SAME was it was when I wans't

pregnant, which is about 100/60 to 90/60. This pregnancy, my blood pressure

has stayed at about 120/60. Nobody but me thinks this is interesting since

that's a normal reading - but I find it odd that ever since I've had Graves then

Hashi's, my blood pressure has never returned to its normally very low state but

been a bit higher.

Anyway, I'd do some reading and investigate this a little further. Also, how

much hypo is a little hypo for her? Remember, she may mean it doesn't matter if

you slip out of that normal range much (e.g., a hair above 5 or with a TSH of

4.9) yet there are now recommendations that the normal range be changed to TOP

off at 2.5!!! So if her rule of thumb is that your'e okay if you're all the way

at a tsh of 5, yet the rules are changing, and she's unaware . . . well, I'd be

concerned about that.

As for the birth center, I have to agree that more may be better than less in

your case. Do you have to decide right away? You have thirty weeks left

Wihtin the next few weeks, perhaps you can tell if thigngs appear to be running

very very smoothy adn you're willing to take your chances with the birth center

because all looks normal. But if you're struggling to balance your thyroid and

feeling uncertain and things don't seem stable or EASY, you may want to stay

with a larger hospital. I guess that's what I did: when I got pg at 39

post-Graves, with my thyroid intact and the theoretical potential for becoming

hyper again, I went ahead and let my otherwise mellow ob label me 'high risk'

and slot me for all kinds of bells and whistles should I need them. By week 20,

I was clearly out of the woods and things were going so well I wasn't a 'risk'

any longer. By week 30 when the receptionist told me to start coming in every

two weeks, the ob-gyn said, oh let's keep going once a month till the last

month. Things are going that well.

But I was prepared for more and I think you should be too -- you can always

downgrade later if you don't make a permanent decision on where to give birth

right now?

Keep us posted! The first trimester can be a very queasy experience and it

sounds like you're in the thick of it. Dry popcorn and acupuncture wrist bands

helped me with all three pgs.

Best -

From: L@...

To: graves_support

Sent: Saturday, December 14, 2002 1:06 PM

Subject: OB Dilemma & Blood Pressure Probs

Hello Everyone,

I haven't been very diligent with keeping up with the posts lately. At 10

weeks pregnant, I've been feeling awful. I'm exhausted, achy, cold, and have

been having dizzy spells and severe shortness of breath. I'm scared I've

gone way hypo--I should have lab results Monday that let me know if that's

the case. Yesterday, I had a 'Meet and Greet' with an OB, at which my blood

pressure was a startling 120/10! That's not a typo, it was really that low.

I was terrified and was so out of it, I actually got lost on my way home. I

didn't take my beta blocker last night (I take 50 mg of atenolol twice a

day--only needs to be taken once a day, so I wasn't really skipping a whole

dose) and took my blood pressure when I woke up this morning. Without any

beta blocker for 24 hours, my systolic bp (taken 4 times) varied from 97 -

116 and diastolic bp was between 57 and 66. So, it was reassuring to see it

had risen, but that is before I took today's atenolol. I'll check it again

in a hour or two. Should I be worried or overly cautious? I'm scared even

to drive in case I pass out at the wheel.

Now, my OB issues. The doctor I saw was highly recommended on a message

board for Washington parents. She graduated from the Mayo Medical School and

seems nice enough. However, there were a few red flags that have me

concerned. First of all, she sent me home with blood pressure so low, I

could've collapsed on the spot. Also, she felt my thyroid and I felt she was

a bit rough with it (though I am overly sensitive about anything touching my

neck). My biggest concern was that she said that she prefers me to be on the

hypo side rather than hyper because of the threat of thyroid storm. Although

I certainly agree with her that I don't want my levels to get high enough to

be in danger of thyroid storm, everything I've read and heard about Graves

and pregnancy supports keeping the mother slightly hyper. She is an older

lady--not that that's a problem in itself, but I wonder if she has a rather

dated view of thyroid issues. What do you think? Should I run now or give

this chick another chance?

One more question, then I'm all out of issues. I feel a bit like I'm

badgering the group with all this, so forgive me if I am. The hospital

closest to my home is a level 3 birthing facility. I'm not exactly sure what

this means as far as which situations they can or cannot handle, but they

definitely don't handle infant surgery if that becomes necessary. If the

baby were have complications that would warrant being transferred, the

hospital could not transfer me until I had stayed there the minimum amount of

time (I think 24 hours for vaginal birth, 48 for cesarean). I would go nuts

if I had to be apart from my baby and husband in such a situation. So, I'm

wondering if I should plan to have the baby in a Seattle hospital (30 miles

away) that can handle all sorts of problems or if a level 3 facility is more

than adequate to handle potential Graves complications. I hope my pregnancy

and the baby are perfectly healthy, but I want to be at least partially

prepared if they aren't. The other night, I dreamed that I gave birth to the

most beautiful baby boy, perfect in every way. I saw his little face so

clearly--he had dark hair, slightly olive skin, chubby little cheeks, and his

father's wonderful smile. I do so hope that's how it happens in reality. I

can hardly wait to see and hold him. I'm tearing up just thinking about it.

Ok, I'm off. The 1100 lights that I spent 2.5 days putting on our Christmas

tree decided to go out last night! So, I'll be spending the day trying to

check each bulb and fuse. My cats probably knocked one bulb loose and now

none of them will light. Ugh! Pray that it's one of the first few I check.

I don't have the patience to check all 1100.

Peace & thanks for being my therapist for the day,

Tori

[Guest guest]

I feel a bit like I'm

> badgering the group with all this, so forgive me if I am.

Not at all and I would say that even if your concerns weren't valid and

lucidly expressed. What else is this group for?

Fertility issues and Graves is a constant concern, with as many members

and newbies as there are. You wouldn't even know what the questions are

if others hadn't shared their experiences before. I hope these thoughts

will help you get through the experience: A lot of what you're going

through is par for the course, and you're paving the way for others

grappling with these concerns.

Take care, and you will feel better. (I do have some experience with

pregnancy ;-) (Also, you may have read in the baby books that the

beginning is hard, and the beached-whale stage toward the end is hard but

there are a few good months in between? Well, when you get to my point

those golden moments last about 3 hours, sometime in month 5 ;-) Fay

________________________________________________________________

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[Guest guest]

I feel a bit like I'm

> badgering the group with all this, so forgive me if I am.

Not at all and I would say that even if your concerns weren't valid and

lucidly expressed. What else is this group for?

Fertility issues and Graves is a constant concern, with as many members

and newbies as there are. You wouldn't even know what the questions are

if others hadn't shared their experiences before. I hope these thoughts

will help you get through the experience: A lot of what you're going

through is par for the course, and you're paving the way for others

grappling with these concerns.

Take care, and you will feel better. (I do have some experience with

pregnancy ;-) (Also, you may have read in the baby books that the

beginning is hard, and the beached-whale stage toward the end is hard but

there are a few good months in between? Well, when you get to my point

those golden moments last about 3 hours, sometime in month 5 ;-) Fay

________________________________________________________________

Sign Up for Juno Platinum Internet Access Today

Only $9.95 per month!

Visit www.juno.com

[Guest guest]

Hi ,

Thanks for sharing your pregnancy experiences with me. It makes me feel

better to know my doubts about the OB weren't unfounded and that blood

pressure fluctuations aren't so uncommon. My blood pressure has never been

high, even at my most hyper. That it dipped so low while I was experiencing

lots of other hypo symptoms further supports my suspicion that my thyroid

levels have dipped too low. One other thing that bothered me about this OB

was that she dismissed my concerns that I was experiencing hypo symptoms as

normal pregnancy stuff when I knew otherwise. I only had one 'Meet and

Greet' appointment with this doc, so I don't feel bad about dumping her. She

also was a bit defensive when I asked her about the possibility of the baby

having to be transferred to a hospital with more intensive care capabilities.

I just didn't get a good vibe from her.

I know it seems incredibly early in the pregnancy to be worried about where

to give birth, but the doctors are tied to individual hospitals. So, when I

choose a doctor, I'm also choosing to deliver at the hospital at which they

work. It's a difficult choice for me to make so early in the pregnancy for

exactly the reasons you mentioned. I've narrowed it down to two hospitals,

each with their own advantages:

Evergreen, from all accounts, including Pam B's, a wonderful hospital that

has been named one of the top ten places to have a baby. It's a level 3

facility and if the baby were to need intensive care, I'd be able to stay in

the same private room with him rather than having him go to a nursery. The

problem is I don't know what it means to be a level 3 facility. I don't

understand under which circumstances the baby would have to be transferred to

a hospital with more intensive care capabilities and if those are

circumstances that I, as a Graves patient, should even worry about or if the

potential complications from Graves are " mild " enough to be sufficiently

cared for in a level 3 hospital.

Swedish Hospital is my other choice. It is also a great hospital, and has

the capabilities to handle whatever complications that arise, including

newborn surgery, if needed. Unlike Evergreen, however, if something were to

happen which required intensive care, the baby would have to go to a special

care nursery rather than stay in the room with me. It is further away from

my home than is Evergreen, but I doubt I'll be fortunate enough to have such

an easy labor that whatever difference in travel time matters much, eh?

Also, I've found a doctor at Swedish that I really like, but Pam B recently

sent me the name of a good doc at Evergreen to try as well.

Such tough decisions! It would be so much easier if I could just pick a

doctor I like and decide where to give birth when I have more info about how

risky the delivery will actually be.

Thanks again for your advice,

Tori

In a message dated 12/14/2002 3:24:02 PM Pacific Standard Time,

petri017@... writes:

> Tori,

>

> I do disagree with your ob, although this isn't reason to dump her, but to

> talk to her again and reconfirm her feelings.

>

> From what Elaine has reported, what I've read, and what my ob-gyn AND endo

> (who is on Shomon's top doc list and who is Almost God say is that

> sometimes becoming a bit hyper during pregnancy is NOT an issue. Indeed,

> thyroid levels that dip a LITTLE in either direction and then are caught

> and regulated will not harm your baby.

>

> But my endo has had me running a little high rather than low and the

> pregnancy is going better for it. Part of this picture is very very

> individual -- because of high blood pressure concerns, U's doc would

> prefer to err on the side of hypo. For me, I'm one of those unusual people

> who get high blood pressure while hypo, which is all the more reason to

> keep my thyroid levels in the higher half of normal.

>

> One difference I have found during this pregnancy (with thyroid disease)

> adn the ohters (without, although who knows for sure) is that my blood

> pressure throughout boht other pregnancies was the SAME was it was when I

> wans't pregnant, which is about 100/60 to 90/60. This pregnancy, my blood

> pressure has stayed at about 120/60. Nobody but me thinks this is

> interesting since that's a normal reading - but I find it odd that ever

> since I've had Graves then Hashi's, my blood pressure has never returned to

> its normally very low state but been a bit higher.

>

> Anyway, I'd do some reading and investigate this a little further. Also,

> how much hypo is a little hypo for her? Remember, she may mean it doesn't

> matter if you slip out of that normal range much (e.g., a hair above 5 or

> with a TSH of 4.9) yet there are now recommendations that the normal range

> be changed to TOP off at 2.5!!! So if her rule of thumb is that your'e

> okay if you're all the way at a tsh of 5, yet the rules are changing, and

> she's unaware . . . well, I'd be concerned about that.

>

> As for the birth center, I have to agree that more may be better than less

> in your case. Do you have to decide right away? You have thirty weeks

> left Wihtin the next few weeks, perhaps you can tell if thigngs appear

> to be running very very smoothy adn you're willing to take your chances

> with the birth center because all looks normal. But if you're struggling

> to balance your thyroid and feeling uncertain and things don't seem stable

> or EASY, you may want to stay with a larger hospital. I guess that's what

> I did: when I got pg at 39 post-Graves, with my thyroid intact and the

> theoretical potential for becoming hyper again, I went ahead and let my

> otherwise mellow ob label me 'high risk' and slot me for all kinds of bells

> and whistles should I need them. By week 20, I was clearly out of the

> woods and things were going so well I wasn't a 'risk' any longer. By week

> 30 when the receptionist told me to start coming in every two weeks, the

> ob-gyn said, oh let's keep going once a month till the last month. Things

> are going that well.

>

> But I was prepared for more and I think you should be too -- you can always

> downgrade later if you don't make a permanent decision on where to give

> birth right now?

>

> Keep us posted! The first trimester can be a very queasy experience and

> it sounds like you're in the thick of it. Dry popcorn and acupuncture

> wrist bands helped me with all three pgs.

>

> Best -

>

>

>

[Guest guest]

Tori,

I don't think I actually posted it, but congratulations on your

pregnancy!

You seem to be worrying a lot about emergency facilities for the baby.

Are you expecting some kind of problem that might require that? What do

you think the baby will need? Is this from the Graves or is there some

other problem?

It is a shame you have to make the decision so early. Have you talked

to any of the docs at either of the two hospitals you mentioned?

-- in Fla.

[Guest guest]

Tori,

I don't think I actually posted it, but congratulations on your

pregnancy!

You seem to be worrying a lot about emergency facilities for the baby.

Are you expecting some kind of problem that might require that? What do

you think the baby will need? Is this from the Graves or is there some

other problem?

It is a shame you have to make the decision so early. Have you talked

to any of the docs at either of the two hospitals you mentioned?

-- in Fla.

[Guest guest]

Hi ,

Thanks for the good wishes!

I think I should back up a little. I always pictured having my babies

outside of a hospital setting, either at home or at a birthing center with a

midwife. When I found out I'm pregnant, I started seeing a fabulous team of

midwives and had my heart set on giving birth at their birthing center (which

is gorgeous--my husband refers to it as a resort!) Well, the midwives

consulted with an OB regarding my case and any potential complications and

were told that I'm too high risk for an out of hospital birth. I was crushed

and had to start over as far as choosing the person I want to deliver my

child. That led me to waffle between the two hospitals. I don't know what

it is that makes it imperative for a Graves' mother to deliver in a hospital.

I don't know what problems could arise, what I should expect or at least

prepare myself for, or what sort of emergency facilities I may need access

to. I was barely 5 weeks along when my endo started asking for the contact

info for my OB, perinatologist, and pediatrician! I'm horribly unprepared

and naive. I had no idea I would need all this. I had a very simplistic

picture of sharing a wonderful, spiritual birth experience with my husband,

without medical intervention and far from hospitals and nerve-wracking

equipment and monitors. I don't anticipate anything going wrong that would

require emergency facilities, but people keep telling me that " I should be

prepared " and " I have someone else to think about now, " which is incredibly

infuriating, like I'd actually put my own child in danger!

Anyway, thanks again for the congrats. Hopefully, I'll have a perfect,

uneventful pregnancy and won't have to worry about emergency facilities.

Merry Christmas,

Tori

In a message dated 12/16/2002 9:15:18 AM Pacific Standard Time,

csr@... writes:

> Tori,

>

> I don't think I actually posted it, but congratulations on your

> pregnancy!

>

> You seem to be worrying a lot about emergency facilities for the baby.

> Are you expecting some kind of problem that might require that? What do

> you think the baby will need? Is this from the Graves or is there some

> other problem?

>

> It is a shame you have to make the decision so early. Have you talked

> to any of the docs at either of the two hospitals you mentioned?

>

> -- in Fla.

[Guest guest]

kind of OT maybe.. but the beta blocker labetalol is routinely given

as a BP med in Australia during pregnancy.. i was on it with all

three of mine.. have you any references to where its not recommended?

thanks Grace

> Hi Tori,

> You might want to double check with your endo, but beta blockers

are not

> recommended in pregnancy. And with your blood pressure so low, you

should not

> even be using beta blockers.

> Many studies show that it's better to be on the hyper side rather

than the

> hypo side during pregnancy. Normally, most women become slightly

hyper in

> early pregnancy. this is a natural response caused by the hormone

hCG that

> helps ensure adequate thyroid hormone for the baby. Thyroid storm

is not

> related to pregnancy but it can occur in labor if levels are too

high. Best

> to you, Elaine

>

>

>

[Guest guest]

In a message dated 12/17/2002 1:08:06 AM Pacific Standard Time,

moonlytgirl@... writes:

> kind of OT maybe.. but the beta blocker labetalol is routinely given

> as a BP med in Australia during pregnancy.. i was on it with all

> three of mine.. have you any references to where its not recommended?

> thanks Grace

>

Hi Grace,

I'm curious about beta blockers in pregnancy too. I asked my pharmacist

about it and she made a face and said that beta blockers get about a 'C'

rating during pregnancy because they haven't really been studied that well,

although she didn't know of any birth defects or problems they're linked.

She said she'd probably try to minimize the dose she took while pregnant, but

there are some benefits that may outweigh the risks. My endo, GP, and every

OB I've talked to all say atenolol or propanolol are fine to take during

pregnancy. I wish I had a more definite answer.

Peace,

Tori

[Guest guest]

Hi Grace,

The Physician's Desk Reference or PDR states " that there are no adequate and

well-controlled studies in pregnant women. Latetalol HCL should be used

during pregnancy only if the potential benefit justifies the potential risk

to the fetus. "

Most toxicological studies using beta blockers have been done on propranolol,

and the studies I've done were all done using propranolol. The PDR for

propranolol states " that there are no well-controlled studies in pregnant

women. Intrauterine growth retardation has been reported in neonates whose

mothers received propranolol during pregnancy. Neonates whose mothers are

receiving propranolol at parturition have exhibited bradycardia, hypoglycemia

and respiratory depression. Adequate facitlities for monitoring these infants

at birth should be available. "

There is more information in Goodman & Gilman's Physiological Basis of

Therapeutics, but I've loaned my copy out. Many public libraries carry this

book as well as the PDR in their reference sections. Take care, Elaine

[Guest guest]

Hi Grace,

The Physician's Desk Reference or PDR states " that there are no adequate and

well-controlled studies in pregnant women. Latetalol HCL should be used

during pregnancy only if the potential benefit justifies the potential risk

to the fetus. "

Most toxicological studies using beta blockers have been done on propranolol,

and the studies I've done were all done using propranolol. The PDR for

propranolol states " that there are no well-controlled studies in pregnant

women. Intrauterine growth retardation has been reported in neonates whose

mothers received propranolol during pregnancy. Neonates whose mothers are

receiving propranolol at parturition have exhibited bradycardia, hypoglycemia

and respiratory depression. Adequate facitlities for monitoring these infants

at birth should be available. "

There is more information in Goodman & Gilman's Physiological Basis of

Therapeutics, but I've loaned my copy out. Many public libraries carry this

book as well as the PDR in their reference sections. Take care, Elaine

[Guest guest]

Tori,

I'm glad to hear there isn't something terrible here for sure! I admit

I had an image of you as the midwife/home birth type. But then, that is

what I am too... Is it different because you are on ATD's? I was

told that I would need to have blood work done periodically to see if my

Synthroid needed adjusting, but other than that it sounded like it would

be a fairly normal pregnancy. I've heard rumors that RAI may increase

the rate of miscarraige, but haven't seen any numbers, and I would

expect that if it does exsist it is an early pregnancy thing. I haven't

heard of any problems with delivery, or with the baby, assuming hormone

levels have been kept in a healthy range during the pregnancy. I have a

friend who has Hashi's who had a midwife-delivered homebirth, and is

planning on another. What makes for such a huge difference?

I admit, I haven't looked into details about pregnancy, but my doctor,

endocrinologist, and the rad med doctor all are really laid back about

the idea.

--

[Guest guest]

Hi Tori, is right, why not have both? Or, you could get a doula!

Though the nurses at Evergreen are WONDERFUL, a doula would cover you if for

some reason you got a nurse you didn't love. Plus no matter how loving a

husband is, he just can't anticipate all your wants like a doula could and

she would do the running around for you getting what you want and need.

Their are even doulas that come home with you for the first few days to get

you started.

Pam B.

[Guest guest]

In a message dated 12/17/2002 10:01:41 AM Pacific Standard Time,

daisyelaine@... writes:

> Intrauterine growth retardation has been reported in neonates whose

> mothers received propranolol during pregnancy. Neonates whose mothers are

> receiving propranolol at parturition have exhibited bradycardia,

> hypoglycemia

> and respiratory depression. Adequate facitlities for monitoring these

> infants

> at birth should be available. "

>

I'm floored! Why do doctors prescribe beta blockers so freely during

pregnancy without even mentioning the risks involved?!? Elaine, if you

hadn't posted this info, I doubt I would've come across it.

Should I begin to wean myself off atenolol as soon as possible? I'm

currently on 100mg/day.

Thanks for the info,

Tori

[Guest guest]

In a message dated 12/17/2002 10:01:41 AM Pacific Standard Time,

daisyelaine@... writes:

> Intrauterine growth retardation has been reported in neonates whose

> mothers received propranolol during pregnancy. Neonates whose mothers are

> receiving propranolol at parturition have exhibited bradycardia,

> hypoglycemia

> and respiratory depression. Adequate facitlities for monitoring these

> infants

> at birth should be available. "

>

I'm floored! Why do doctors prescribe beta blockers so freely during

pregnancy without even mentioning the risks involved?!? Elaine, if you

hadn't posted this info, I doubt I would've come across it.

Should I begin to wean myself off atenolol as soon as possible? I'm

currently on 100mg/day.

Thanks for the info,

Tori

[Guest guest]

grooooooowwwlll

my sons had every single one of those reported side effects.. ook for

my sanity im going to decide that aussie drs didnt know this 9-7 yrs

ago.. or id have to choke someone..

sigh.. just makes me more sure they dont know half what they make out

they do..

can i ask if the beta blockers actually work to lowering thyroid

function? like can they make you hypo? given that i was 20 weeks in

hospital on soy products and in a low iodine area and on these beta

blockers.. and my son has craniostenosis.. a symptom of being low,

from what ive read..makes me wonder..

thanks so much for the info.. Grace

> Hi Grace,

> The Physician's Desk Reference or PDR states " that there are no

adequate and

> well-controlled studies in pregnant women. Latetalol HCL should be

used

> during pregnancy only if the potential benefit justifies the

potential risk

> to the fetus. "

> Most toxicological studies using beta blockers have been done on

propranolol,

> and the studies I've done were all done using propranolol. The PDR

for

> propranolol states " that there are no well-controlled studies in

pregnant

> women. Intrauterine growth retardation has been reported in

neonates whose

> mothers received propranolol during pregnancy. Neonates whose

mothers are

> receiving propranolol at parturition have exhibited bradycardia,

hypoglycemia

> and respiratory depression. Adequate facitlities for monitoring

these infants

> at birth should be available. "

>

> There is more information in Goodman & Gilman's Physiological Basis

of

> Therapeutics, but I've loaned my copy out. Many public libraries

carry this

> book as well as the PDR in their reference sections. Take care,

Elaine

>

>

>

[Guest guest]

Tori.. i was on 600 a day in broken doses..so might have made a huge

difference.. plus aldomet plus hydralazine.. double check with your

specialist before altering anything and dont panic

hugs love and prayers, Grace

> In a message dated 12/17/2002 10:01:41 AM Pacific Standard Time,

> daisyelaine@a... writes:

>

> > Intrauterine growth retardation has been reported in neonates

whose

> > mothers received propranolol during pregnancy. Neonates whose

mothers are

> > receiving propranolol at parturition have exhibited bradycardia,

> > hypoglycemia

> > and respiratory depression. Adequate facitlities for monitoring

these

> > infants

> > at birth should be available. "

> >

>

> I'm floored! Why do doctors prescribe beta blockers so freely

during

> pregnancy without even mentioning the risks involved?!? Elaine, if

you

> hadn't posted this info, I doubt I would've come across it.

>

> Should I begin to wean myself off atenolol as soon as possible?

I'm

> currently on 100mg/day.

>

> Thanks for the info,

> Tori

>

>

>

[Guest guest]

Tori.. i was on 600 a day in broken doses..so might have made a huge

difference.. plus aldomet plus hydralazine.. double check with your

specialist before altering anything and dont panic

hugs love and prayers, Grace

> In a message dated 12/17/2002 10:01:41 AM Pacific Standard Time,

> daisyelaine@a... writes:

>

> > Intrauterine growth retardation has been reported in neonates

whose

> > mothers received propranolol during pregnancy. Neonates whose

mothers are

> > receiving propranolol at parturition have exhibited bradycardia,

> > hypoglycemia

> > and respiratory depression. Adequate facitlities for monitoring

these

> > infants

> > at birth should be available. "

> >

>

> I'm floored! Why do doctors prescribe beta blockers so freely

during

> pregnancy without even mentioning the risks involved?!? Elaine, if

you

> hadn't posted this info, I doubt I would've come across it.

>

> Should I begin to wean myself off atenolol as soon as possible?

I'm

> currently on 100mg/day.

>

> Thanks for the info,

> Tori

>

>

>

[Guest guest]

Tori.. i was on 600 a day in broken doses..so might have made a huge

difference.. plus aldomet plus hydralazine.. double check with your

specialist before altering anything and dont panic

hugs love and prayers, Grace

> In a message dated 12/17/2002 10:01:41 AM Pacific Standard Time,

> daisyelaine@a... writes:

>

> > Intrauterine growth retardation has been reported in neonates

whose

> > mothers received propranolol during pregnancy. Neonates whose

mothers are

> > receiving propranolol at parturition have exhibited bradycardia,

> > hypoglycemia

> > and respiratory depression. Adequate facitlities for monitoring

these

> > infants

> > at birth should be available. "

> >

>

> I'm floored! Why do doctors prescribe beta blockers so freely

during

> pregnancy without even mentioning the risks involved?!? Elaine, if

you

> hadn't posted this info, I doubt I would've come across it.

>

> Should I begin to wean myself off atenolol as soon as possible?

I'm

> currently on 100mg/day.

>

> Thanks for the info,

> Tori

>

>

>

[Guest guest]

Hi Grace,

Beta blockers don't lower thyroid hormone levels the way ATDs do, but

propranolol inhibits the conversion of T4 into T3. This can cause T4 levels

to rise while T3 drops.

I know they have known about the safety of beta blockers in pregnancy since

at least 1988 since that's when I first started researching them. Take care,

Elaine