Pregnant - advice on TSH please

[Molliemoo1]

Hi all

I'm 7 weeks pregnant and looking for your advice.

I was prescribed 25mg by my doctor (reluctantly) before I was pregnant. When I got a positive pregnancy test I upped my dose to 50mg. My doctor didn't agree but said she couldn't stop me and referred me to an endocrinologist.

My last TSH, 2 weeks ago, was 2.1.

I saw the endo on Thursday. He said I definitely have Hashimoto’s and that during ttc and pregnancy, I should be on treatment and said that he thought the 50mg was sufficient.

I received a Medicheck test result this morning from a sample taken on Wednesday... See image.

My TSH is now 2.8. My hospital likes to see a TSH below 2.5 in pregnancy. It's now back holiday weekend and I'm panicking. I won't be able to speak to the endo until Tuesday at the earliest.

What would you do?

Would you increase dose yourself right away before being able to speak to the doctor?

I'm thinking either 75mg or 75/50mg on alternate days.

Or do I wait until I can speak to an endo?

Your thoughts would be appreciated.

[Molliemoo1]

*Bank holiday

[Molliemoo1]

If I increase my dose then I would have to tell the doctor that I did because it would affect future test results.

[Clutter]

Molliemoo,

I would increase to 75mcg until you can speak to endo.

________________________________________________________________________________________________

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.

[Molliemoo1 in reply to Clutter]

Hi Clutter ,i have already taken my 50mg dose of levothyroxine today. If I up by another 25, when would you suggest that I take it? Later tonight?

[Clutter in reply to Molliemoo1]

Molliemoo1,

You can take it any time you like as long as it is away from food and drink. Tomorrow you can take 75mcg in one dose.

_______________________________________________________________________________

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.

[Hidden]

Congratulations for making it to 7 weeks. I was told it takes about 2 weeks for it to make a difference to your TSH levels. I was on 25 mg and didn't up my dose until I was 7 weeks and I regret it as I feel it was too late. Good luck with whatever you decide.

[radd]

Mollie,

Your need for additional thyroid hormones are supporting your baby requirements during the first trimester until at about 12 weeks their thyroid begins to function on its own.

NICE guidelines clearly state thyroid hormone replacement should achieve a TSH of 0.4–2.0 mU/L and an FT4 concentration in the upper reference range but your TSH is too high and your T4 (& T3) too low.

Even considering the long half life of Levothyroxine if this were me I would immediately increase my meds to 75mcg a day and ring the endos secretary on tuesday for an appointment (or phone-call) with endo asap.

Optimal thyroid hormone replacement will help manage Hashi attacks and hopefully reduce thyroid antibodies which are an independent marker for an "at-risk" pregnancy. Your doctor sounds useless but 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.

.

NICE guidelines

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

.

Thyroid Antibodies in Pregnancy.

jama.jamanetwork.com/articl...

[jimh111]

The 2.5 recommendation is optimal, a little bit higher will make a tiny difference in risk. My message is don't worry. If it were me I would alternate tweet 50 and 75 and let your endo know when you see them. Say it was a bank holiday holiday and you thought this was the best option until you could set them.

[Molliemoo1]

Thanks all for your prompt advice. I'm definitely going to increase before I speak to endo. Just need to decide whether to do 50/75 on alternate days or straight up to 75.

I hate being in this position because I feel like every gp thinks I'm over paranoid about something that's not an issue. Why isn't there better awareness of this amongst doctors.

Thanks again, please keep your fingers crossed for me xxx

[Hidden in reply to Molliemoo1]

Have you had a 6 week scan where you can detect the heartbeat? I'm always given these scans now... I agree there needs to be more awareness .

[Molliemoo1 in reply to Hidden]

Yes we had a scan on Tuesday morning and saw the heartbeat and the baby was measuring right. Thought it was going to help me worry less but it hasn't.

[Hidden in reply to Molliemoo1]

That is a good sign. Going the way it should! So it was prob the thyroxine that you just needed. Take it easy. Good luck

[kayaktime]

Congratulations, Molliemoo! Lovely news. I would up dose to 75mcg now and inform doc when you can. I had to do exactly that within a week of BFP. Wishing you the very best of luck x

[misswinky34]

Mollimoo

Yeay for getting to 7 weeks 😊 As you know I increased to 150 from 100 and they've decided that I'm slightly over medicated tsh under .16 and t4 20.2 (from memory) they have knocked me down now to 125 and fast tracked me to see endo on Tuesday morning at the hospital. I would go up by 25 if I were you and contact endo like you said. Worse case scenario they knock you back down. Congrats on the scan! That's great 😊 Mines not till the end of June and I doubt I will relax much till then. 😕

[Molliemoo1 in reply to misswinky34]

Thanks. How are you feeling misswinky

[misswinky34 in reply to Molliemoo1]

So far so good thanks, I will feel better when I've seen endo, all this thyroid stuff so stressful isn't it 😔 Wish I could have had a scan. I will be nearly 14 weeks by the time I get one 🙏🙏 I remember with my eldest son the midwife managed to find the heartbeat with the Doppler at 10 weeks so I will settle for that 😊 I lovely little heartbeat be music to my ears 😊 Let us know how you get on with your endo xxx

[Molliemoo1 in reply to misswinky34]

My next scan is at 13.5 weeks. So long to wait. I might book a private scan for 9 weeks x

[misswinky34]

I would love a private scan. But I'm already doing two jobs to keep above float as it is, so that's not really an option for us. I'm just gonna keep saying little prayers and crossing all the fingers and toes. 😊 When I have read my maternity notes it says you often get extra growth scans when your referred to endo, so that would be awesome xxx

[Molliemoo1]

Hi all just wanted to say thanks for your help with this. I upped to 75mg straight away and the endo confirmed this was the right thing to do and has written to my GP. Phew... Was prepared for a battle!

Thanks again!