Palpitations and pregnant

Hi, am 45 and 7.5 wks pregnant. Was diagnosed as borderline thyroid in 2012/13 and also had v low iron (5) and low B12. Dr gave me supplements and 50mg levo. Took the levo for a couple of weeks on a couple of occasions and had to stop as heart was too racy. TSH seemed to normalise itself a little so I stopped taking levo and ferrous fumarate (was on 3 a day) and 2 b12 per day. Did have a miscarriage in 2011 but wasn't aware of any thyroid issue then (had not been tested either). Now found out am pregnant again. At blood test on 8 Dec (5 wks preg) TSH was 4.35. Iron was 12 and B12 around 300 (on pregnacare max). On 23 Dec TSH was 5.08. On 10 Dec I started on 50mg levo and dropped to 25mg after a week cos heart palpitations. Took 25mg for few days then after the result on 23 Dec, the private doc trying to help me prevent miscarriage again told me to up the levo to 75mg. Yest I went to A&E as had some bleeding (I actually think it could be rectal bleeding as constipated). They took my pulse and said it's too high at 89, range is 60-90. He told me to drop levo as 75 is too high. Am so confused. I want to support this pregnancy yet fear that I am unable to take the levo. What should I do? Drop back to 25mg daily? The private fertility doc has also put me on prednisolone, clexane, progesterone and suggested a baby aspirin daily. Have never taken so many drugs! Any advice appreciated. Wondering if I try and up my iron level by taking a ferrous fumarate daily (plus the pregnancare max where the iron level is low anyway) it might start to resolve itself again, but I understand pregnancy can take a real toll on tsh.

19 Replies

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  • Hello Rambler,

    I am sorry to hear of your previous miscarriage and send congratulations on this pregnancy.

    There is evidence of increased fatal loss, and psychomotor and IQ deficits, in infants born to mothers with undiagnosed or inadequately treated hypothyroidism (including subclinical hypothyroidism) [Casey et al, 2005].

    Two pregnancy-related hormones—human chorionic gonadotropin (hCG) and oestrogen cause increased thyroid hormone levels in the blood. Made by the placenta, hCG is similar to TSH and mildly stimulates the thyroid to produce more thyroid hormone. Increased oestrogen produces higher levels of thyroid-binding globulin, also known as thyroxine-binding globulin, a protein that transports thyroid hormone in the blood.

    Normal thyroid hormone level is critical to normal development of the baby’s brain and nervous system. During the first trimester, the fetus depends on the mother’s supply of thyroid hormone, which comes through the placenta. At around 12 weeks, the baby’s thyroid begins to function on its own.

    Thyroid Stimulating Hormone (TSH) should be kept LOW in all woman who are pregnant whether already medicating on thyroid hormone replacement or newly diagnosed whilst waiting for referral to a specialist. TSH & T4 levels should be monitored every four weeks and your Levo dose titrated during the first trimester, and then at 16 & 28 weeks of gestation.

    TSH should be kept in the low-normal range (0.4–2.0 mU/L) and an FT4 concentration in the upper reference range. Your TSH level is too high and it will be a balance finding a thyroid med dose you can tolerate that keeps TSH within NICE guidelines.

    Palpatations are a classic symptom of too low iron and B12 when medicating thyroid hormone replacement. It would be prudent to raise these levels before raising the thyroxine but of course being pregnant you don't have the time.

    If this were me I would email louise.warvill@thyroiduk.org.uk for a list of sympathetic endos/doctors that members have had positive experiences with

    and ring their secretaries asking if this is their specialised field as you need help and advice quickly.

    I wish you both well.

    Flower

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

    These recommendations are based on information from a consensus guideline produced by the Association for Clinical Biochemistry, the British Thyroid Association, and the British Thyroid Foundation [BTA et al, 2006]; expert opinion in a guideline produced by the Endocrine Society [Abalovich et al, 2007]; expert opinion in a learning module [Edwards and Vanderpump, 2007]; and the opinion of CKS expert reviewers. Some of the evidence to support these recommendations is based on observational studies.

    The recommendations on monitoring of thyroid function (TSH and FT4 levels) are based on expert opinion in guidelines [BTA et al, 2006].

    ……………………………………………………………………………………………………………………………...

    Disclaimer: I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

    ……………………………………………………………………………………………………………………………

  • Thanks Flower. I will email as you suggest. Trying to get my GP to listen is another battle in itself. I insisted on the blood test and I went in to ask for levo, she was reluctant and said 4.35 is 'normal', so I don't know how I will get her to refer me to a specialist, unless I try talk to the obstetric or midwife but the midwife appointment is not until 8 jan.

  • Rambler

    You need to sort this asap.

    Print off the NICE guidelines (link given in my above post) and offer to GP. Also advise of previous miscarriage.

    Flower

  • Oops .. sorry link not working ! !

    Try this one Rambler

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

    Flo

  • Thanks! Have emailed Louise and also called my GP, they said GP will call me tomorrow. I assume I need GP to refer me to the specialist?

  • The Thyroiduk office will not open until the 5th January, so Louise wont be back until then. :)

  • The doctor in A and E had no right to bumble in and make pronouncements about your thyroid treatment based on such little evidence. A pulse of 89 in a and e is nothing to even comment on. A and e is a stressful situation, and my pulse would be much higher than that! It looks to me that your tsh is too high, nice guidelines for pregnancy are TSH of 2 I think (will look for the link in a minute). If it were me, I would prioritise getting the TSh down. Palpitations are unpleasant, but are they harmful? ( I don't know). It might just be your body getting used to the medicine. It could also be that you are reacting to the fillers, you could try a different brand of levo.

  • Thanks. I did feel as though I was about to have a heart attack in A&E and you're right, I think most of it was stress related! Will try up the iron by taking 1 ff per day, and maybe try alternate 25/50 per day until the palpitations / shortness of breath settles down.

  • Definitely you need to keep your iron levels up throughout the pregnancy for your sake and the baby's. Also, has your D level been tested? If you are going to breast feed, keep your iron and D levels up while breastfeeding because otherwise levels in milk will be low.

    Research cord-clamping, if you have not already looked at this. if I were going through it again I would ask the cord to be left to pulsate for the full period before being clamped. This is your right and you will be given it under new guidelines if you ask. The cord delivers a final transfusion of iron rich and stem cell rich blood from the placenta into the baby after birth. I would think that it would be especially important if the mother has been low in iron during pregnancy.

    There is no definite evidence yet, but it may be (animal research) that early cord clamping is associated with ADHD.

    Good that you are onto all this so early in the pregnancy.

  • Thanks and yes I did get vitamin D checked but the result wasn't ready when I picked up the main results. I think when it was checked last (over a year ago) it was around 70. Will call the surgery and get the result. I thought too much iron may not be good during pregnancy so I'm taking 1 ferrous fumarate a day on top of the pregnancare max, although the private doc said 2 a day may be ok, any views?

  • Nutrient deficiencies rarely go alone. I am sure you are already taking folate. Here is a link to the vitamin D council on this vitamindcouncil.org/further...

    They are a pressure group advocating D, but they give full links to research and a range of recommendations. If you have a D test (they are cheaply available on the internet) and prove deficient then you can supplement at a high level. Look at the referenced studies, they are very interesting.

    Deficiencies in B vitaminas and iron in pregnancy have been associated with a higher risk of autism so it is great that you are looking at nutrients so early on -

    Personally I would ask for an iodine test too. Whether you would get it is another thing.

  • In your case you do not need to worry about taking too much iron, you are low in iron. Too little iron is dangerous.

  • Thanks. Just had a look at the site about vitamin D, I am of Indian origin so likely to be deficient. My mothers level is around 10 and my father is v low on iron too, so could be hereditary. I have some D3 supplements and can look at taking those too...

  • Sorry but personally I do not agree with all those drugs nor do I agree with your private doc

    your hypothyroidism should have been properly treated and the long term issues faced long before you thought about pregnancy

  • Reallyfedup, this is not her fault, I'm sure you didn't mean to imply that.

  • I am not implying its the OPs fault

    Its her doctors fault for not diagnosing /treating etc correctly

    all of which gives no thought as to the unborn child or what its health might be

    with 4 out of 6 grandchildren all severe Hashimotos despite my good genes imagine how strong my husbands views are on the lack of proper genetic counselling

  • I hate taking drugs myself. My hypo was diagnosed after a blood test (about 3 weeks later) by a phone call from the receptionist telling me to collect a prescription of levo that I would have to take for life and a print out from the internet for me to read up on it, that's it ! No monitoring, I had to self monitor by booking myself in for regular blood tests etc and then another GP at the surgery commented that I never needed the levo in the first place after all (as things normalised themselves).

  • ncbi.nlm.nih.gov/pmc/articl...

    possibly of interest

  • Thanks all. So I called my GP and left message to be referred to endo. GP left me a voicemail today asking me to put in writing why I want an endo referral so she can understand and deal with my request. She said 'is it only for the thyroid'. Can someone pls give me some guidance on suggested wording to send to my GP for the endo referral. In lay terms, I feel that the GP has been rather unhelpful throughout, not realising the importance of the thyroid tests esp in pregnancy, I in the one that keeps having to push so how do I justify this referral to her pls?

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