Managing thyroid/adrenals for conception/pregnancy

[Calluna]

Hello everyone,

This is my first post and I'm hoping someone will be able to offer me some advice. Apologies in advance for the lengthy background info - I've been trying to address this for a while! Hoping some of you knowledgeable people will be able to help.

I've had hypothyroid symptoms since I was a teenager (I'm now 38). My GP thought my bloods were fine: TSH 3.27 (0.35-5), FT4 10.6 (7.0-20.0), FT3 not tested. I don't have elevated thyroid antibodies. As I am trying to conceive, my fertility consultant advised that TSH needed to be below 2.5 so GP agreed to give me thyroxine. I started on 25ug/day and felt AMAZING! Like someone had lifted a great weight out of my body and I could function normally for what seemed like the first time in my life. My blood results went to TSH 2.07 (0.27-4.2), FT4 17.0 (12.0-22.0), FT3 4.1 (3.1-6.8).

Unfortunately, I soon felt worse again and my next blood results were TSH 2.19, FT4 16.1, FT3 3.2 (ranges as previous set). I increased to 50ug/day and felt better. Bloods went to TSH 1.07, FT4 21.6, FT3 4.1 (ranges as previous set). Again, it didn't last. I felt worse and TSH went to 2.33 (0.35-5.0) (FT4 and FT3 not tested). We increased to 75ug/day. I didn't really notice any improvement. My bloods went to TSH 1.44 (0.27-4.2), FT4 18.7 (12.0-22.0), FT3 3.4 (3.1-6.8), reverseT3 21 (10-24), FT3/rT3 ratio 10.6 (>20).

So, I concluded thyroxine is not working for me. My T3 stays low, my reverse T3 is too high relative to my T3 and I still feel rubbish. I decided to see another doctor from the Thyroid UK list privately. Lots more testing and he finds low DHEA 0.20-0.22 (0.25-2.22), flat cortisol 8.30 (5.56-22.20), 6.10 (2.45-8.12), 2.00 (1.54-5.56), 1.00 (1.17-3.18) (I'd been exercising immediately prior to the second reading), low 24h-urine T3 569 (800-2500), ok 24h-urine T4 1410 (550-3160), low 24h-urine iodine 50 (100-199). Everything else was good (vitamin D, folate, B12, MCHC, HCT, homocysteine, methylmalonic acid). We didn't test my ferritin but this was lowish last time my GP checked it – 38 – and I’m taking iron supplements. My iodine was half the minimum it should be despite the fact that I was already supplementing with 100ug/day iodine (as well as taking 75ug/day thyroxine). Dr advised me to increase iodine to 500ug/day and start taking nutri-thyroid and nutri-adrenal, building up to 4 tablets of each per day (keeping thyroxine at 75ug/day). As soon as I started on the additional supplements I felt worse. Still very fatigued but also anxious and breathless, which was new. Dr advised to slow down with increasing the nutri-thyroid and nutri-adrenal but keep thyroxine the same. Next blood test was TSH 0.19, FT4 22.0, FT3 4.6 (ranges as previous set). I stopped thyroxine altogether for a few days and the breathlessness and anxiety went away but still fatigued. Dr advised to build thyroxine back up to 50ug/day rather than 75.

I'm currently taking 25ug/day thyroxine, 4 each of nutri-thyroid and nutri-adrenal and 440ug/day iodine. My blood pressure remains low (high 70s to low 90s over 50s to 60s), as does my temperature (high 34s to low 36s) and my pulse (50s). I definitely feel under-medicated at the moment but I don’t want to increase the thyroxine any further. I'm thinking that I clearly don’t convert T4 to T3 very well and I want to try NDT. I see lots of people saying they feel great on NDT with good FT3 levels but very low TSH and relatively low T4. My problem is that I want to get pregnant so, from what I understand, I need to keep TSH around 1 and FT4 in the upper part of the reference range for the baby, whilst also getting FT3 somewhere near mid-range so that I (hopefully!) feel ok. So I'm thinking I’ll need to keep taking some thyroxine alongside low dose NDT. My main question is, has anyone managed to mix the two and keep all the levels where they’re supposed to be for baby as well as keeping yourself feeling well?

I'm also considering taking supplemental DHEA and/or pregnenolone. Any other advice anyone can offer about whether you think I'm on the right track with how I want to proceed or any alternative suggestions you might have would be much appreciated.

[Hidden]

Just to pick on one thing from your story, your ferritin level is low. There's a study which shows it has to go over 60 before you feel better - the optimal may be 80 to 100 ish. Until you fix this problem you won't feel better and it will be hard to tell apart from the thyroid symptoms. If you have an absorption problem of some kind it may not fix easily.

Do you have any idea why your ferritin might be low? Vegetarian? Very heavy periods?

The thyroid needs iron. You need iron for energy.

And, very important, if you are about to get pregnant, you would be wise, and indeed, very, very important to get your iron levels up to a nice healthy level before you do so.

You are working incredibly hard to figure out your own health and spending a lot of time and money to do so, congratulations on your attitude. Others who have good understanding of thyroids and Levo will comment on that side, no doubt.

[Calluna]

Hi Aspmama,

Thanks for your reply. I've always had heavy periods. I was vegetarian and also vegan for many years but not for a long time now. I'm now on a mostly Paleo diet so quite the opposite and I supplement with 15mg iron per day. When it was first tested my ferritin was 18. I supplemented with 15mg per day and it went up to 38. I increased the iron to 30mg/day for a while to try to increase it further but then I cut it back to 15mg again because I was reading about zinc being important for conversion of T4 to T3 and I was concerned about too much iron possibly interfering with zinc absorption.

My haemoglobin level is always good and my MCHC was actually slightly above range. Do you know if there's any reason why these levels would be so good but ferritin low?

I'll get my ferritin tested again with my next set of blood tests to see where it is now and up my intake further if necessary (maybe with some additional zinc as well).

Thanks for the advice.

[Clutter in reply to Calluna]

Calluna, I couldn't tolerate Levothyroxine (T4) on it's own but adding T3 to it calmed the adverse effects I experienced and raised my FT3 from below range. If your doctor won't prescribe it PM me for sources and self medicate.

NICE recommends FT4 in pregnant women should be in the top 75% of range but the assumption is the patient will be on T4 only. FT4 is usually lower when patients are taking T3 or NDT. You may find more about optimal levels of FT4 and FT3 in pregnant women on USA sites where NDT use is common. hypothyroidmom.com

[Calluna]

Hi Clutter. Thanks - I'll PM you. I'll be speaking to my doc next week and I think he will prescribe but would be good to know just in case.

Hi Reallyfedup. I don't have any autoimmune conditions. My thyroid antibody tests were negative, as were all the other auto-antibodies I've been tested for (transglutaminase, various anti-phospholipid antibodies, various anti-nuclear antibodies). I did have chronic urticaria for a couple of years, which can be autoimmune in some cases, but I've managed to get rid of that.