Hashimotos and first trimester?

[dizzyflossy]

Hi, I have finally gotten pregnant after almost 2 years trying. Ended up being gluten that was a barrier to my fertility - got pregnant within a month of going cold turkey and cutting it out.

I'm now 8 weeks pregnant and have had thyroid bloods done twice:

At the 4 week mark, TSH was 0.17. Can't remember exact T4, think it was 17. Dose was 125mcg daily of levothyroxine. I was exhibiting toxic symptoms and my GP wanted to drop my dose to 100mcg daily but I'm very sensitive to changes so we agreed on 125/100mcg alternate days.

At the 8 week mark, TSH was 0.28 and FT4 was 15.4. My GP said neither is where she wants them to be - TSH should be between 0.4-2 and FT4 should be in upper quartile, so about 20.

I'm seeing the midwife today but has anyone got any information as to specifically managing thyroid in hashimotos pregnancies?

I feel awful if it counts - currently signed off work with low BP/shortness of breath. All other blood tests (iron/liver/kidney) came back as normal.

Thanks for any information/advice.

[sootysgirl]

Mine wasn't checked throughout my last pregnancy (I always went by how I felt anyway) but I know that my tsh was around 0.03 at the very lowest! I'm currently running at 0.01 and still breastfeeding. I personally wouldn't mess with it in these early stages (hormone levels are so sensitive while pregnant), are you taking supplements at all? Maybe that could pick you up a bit? I would consider going back to 125 if GP says so but that's just my opinion... Good luck and congrats keep us posted xx

[Clutter]

Congratulations, Dizzyflossy

TSH is just under the low normal range aimed at for pregnant hypothyroid women. Your doctor shouldn't be dosing to target TSH unless it is too high. Decreasing your dose will make TSH rise but will cause FT4 to drop too. If you felt better on 125mcg daily this should be restored.

cks.nice.org.uk/hypothyroid...

[dizzyflossy in reply to Clutter]

Hi Clutter - thanks for this info. Just wanted to get it straight in my head... my GP wouldnt change my dose at all as she said she doesnt have the expertise (I'm now referred to an obstetrician and endocrinologist) but.... had she suggested a dose decrease I'd have disagreed because I'm not exhibiting toxic symptoms despite my TSH. However, do you know why my FT4 is not on the upper end of the range if my TSH is more than satisfactory? Should I be concerned? Or is it just that the baby is taking what he needs?

[Clutter in reply to dizzyflossy]

Dizzy, the foetus draws on the maternal thyroid hormone so is probably nicking your FT4. Not everyone's FT4 is top of the range even when they are optimally medicated though.

[CharlS28]

Can I ask how you found out it was gluten blocking your fertility? I have graves and been trying for almost a year, I got pregnant in April but had a very early miscarriage. I've always suspected I have an intolerance to gluten but never heard of it affecting fertility before.

[dizzyflossy]

Hi Charls28, thanks for your message. Given the autoimmunity component of my thyroid disease, and despite negative blood tests for coeliac, my GP said it would be worth giving it a go, cutting gluten out, before I ended up on the IVF route. If you Google "how gluten affects fertility", lots of links appear. I'd long had digestive symptoms that tallied with something being digestively-wrong, such as a strange but persistent radiating pain in my right groin, excessive stomach acid that ended in an oesophageal ulcer, and severe bouts of persistent constipation. I thought that I nothing to lose, and hey presto, it worked, within the first 4 weeks. I dont think anybody really knows how gluten affects fertility, but I gather from at least some of the information I read that when combined with thyroid issues (which can in their own right affect fertility), it can make it really hard to conceive as it somehow is involved with/worsens the autoimmune parts of the disease. Getting pregnant aside, the pain I suffered for months has resolved on its own, and before pregnancy hormones kicked in, so did the constipation! I guess it would depend on how you feel about trying a gluten free diet, but for me, it felt like I was "doing something" and being proactive, whilst the months rolled by, waiting for a fertility referral to the hospital. Happy to talk more, if you wish!