<s>[INST] Hi. I have graves disease and 8 months ago had rai which successfully destroyed my thyroid. I am a few weeks pregnant and although my t4 is normal 16.6 my tsh is 5.75 - this is the lowest so far. I know about the probs with a high tsh and I will be monitored more later all going well. Is there a cause for concern at this moment. [/INST] Hello, and I hope I can help you today. I first want to reassure you that women can and do have healthy pregnancies with thyroid disease all the time. In the case of someone like you, whose thyroid has been essentially destroyed by RAI, your TSH will frequently be high. But as long as your free T4 is normal (which is the actual level of your circulating thyroid hormone) the baby will receive enough hormone for normal healthy development. So as long as your supplemental thyroid medication is at the correct level, your baby will be fine.  It is more important to monitor your thyroid hormone level by the T4 value, however, rather than the TSH. Your endocrinologist likely will check your level every month or two during the pregnancy as most women need more thyroid hormone as the away grows. So in summary, there is nothing to be concerned about right now, and under the right care you should absolutely be able to have a healthy pregnancy. I hope this answer was helpful and reassuring. Best wishes for the rest of the pregnancy,  </s>