### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi, I am pregnant 17wks and almost 35years old. I have not taken my thyroid meds in a year. I have graves disease, treated by radioiodine therapy when I was 21. Three years ago, I started to get full body cataplexy drops, expecially after climbing stairs or elevations. Hospitalizations many times ruled out many cardiac and sleep study concerns. It was found that any slight decrease in my postassium level caused the hospitalizations after comparing notes for every visit. The doctor experimented and left me on IV potassium for a week and my levels would not go past 4.0 to make me hyperkalemic at any point, but did not make me feel better. Once the symptoms stopped, I would get released. Finally, they diagnosed me with hypokalemic periodic paralysis and potassium supplement nor potassium sparing diaretic would suffice. It actually made it worse. Ultimately, after discovering that sipping Pedialyte slowly all through the day kept me out of the emergency room, they put me on time released low dose potassium capsules 4x a day (10meq) as well as noting my thyroid levels had finally thrown me into hypothyroid after all these years since therapy. A year ago my TSH w T4 reflex was 1.80 and today it is 13.6. My potassium levels have been fine and I do take B12 monthly injections since I was 20 for pernicious anemia diagnosed by spinal tap a year before the Graves disease. I will see my endocrinologist this week but I am worried that the OB referred me to a maternal/fetal medicine specialist. They are getting familiar with electrolyte imbalances and taking the proper chromosome testing for my age and I await results. I am concerned about possibly getting paralysis attacks and falling while pregnant. It has not happened since I got pregnant, even though I feel awfull and stay in bed or on the couch. I am assuming the thyroid levels contribute to this worse feeling of my life because of my own neglect. I thought thyroid medicines made my heart race and made me have paralysis attacks more often, so I stopped to prove I dont have them as often when not taking Synthroid or Levothryroxine. The only other abnormality any specialist came up with during hospitalizations was a nuerologist noted strange brain waves during the test they make you hyperventilate to go to sleep (I did not sleep, only paralyzed myself) and he noted a small sclerosis on my hippocampus that was missed from a different hospital. I have not followed up with the nuerologist in fear because he had no answer for what causes it. Is it possible that tweaking my thyroid levels with treatment can cause the electrolyte issues to suddenly reappear and make it unsafe to be unattended or exert myself as before, noted by my frequent hospital visits of the past? My second fear is how much worse can it get until I deliver if I do not treat my thyroid? So in short I ponder: Obey doctor and suffer possible hypokalemic paralysis attacks/cataplexy body drops and treat as they come, or can the consequence of not treating my thyroid be more harmful to myself and the baby? I am not sure how bad a thyroid can get over another 20 weeks to guess which suffering of myself is worse, by for the baby, I am not sure how either symptoms can affect him.

### output:

Hi. I can understand the concern you have regarding your baby. The most concerning for me at this point would be the report of a high TSH, since you were off thyroxine supplements, because hypothyroidism during pregnancy is known to affect the fetus and its development including neurological development. So I think a visit to your Endocrinologist should be done as soon as possible, and this needs to be corrected. Otherwise, you will need to check and monitor your potassium levels and take supplements as required. You must already must have been informed about avoiding high carboy Chat Doctor.  Hypokalemic periodic paralysis is a condition known to be associated with hyperthyroidism. So take care and get your thyroid status corrected. Thank you.