TSH and pregnancy

Hi, does anyone know anything about guidelines for TSH levels in pregnancy? I've never been diagnosed with a thyroid problem before but my midwife is concerned about my TSH levels.

They were 2.8 in the first trimester which the midwife said was borderline and should be treated but GP refused saying anything below 5 was normal.

They're now 3.6 in the second trimester which again a different midwife says is borderline and should be treated and is sending me back to GP. should I push for medication or are these levels ok without a confirmed thyroid issue?

I have some symptoms, both now and prior to pregnancy, such as IBS, dry skin and restless legs but would such a borderline result even cause symptoms? Should I push for them to check T3/4 levels too? I'm just a bit worried as I've read that thyroid problems can increase the risk of stillbirth and developmental issues but from what I've read I can't work out if there's really even a problem or not.

Many thanks for any help.

14 Replies

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  • The risks of minor increases in TSH are marginal. The guidelines refer to patients already diagnosed with primary hypothyroidism (a failing thyroid gland), presumably because their impaired thyroid is unable to respond to fluctuations in demand. Refer your GP to the NICE guidelines and see if that will do the trick.

  • Thanks for the reply. That's really where I'm confused. Are the midwives confused and looking at guidelines meant for women already diagnosed or are there also guidelines for all pregnant women? I don't want to worry about something if it's just a mistake but there seems to be conflicting information on the internet stating that levels should be below 3 for ALL pregnant women, it actually even says this on the results that the lab have sent back.

  • Hi, Congraulations on your pregnancy!

    OK, a few things here. Firstly, yes, absolutely push for FT3 and T4 to be checked. If your GP is not helpful, please find another GP!! Many of us had to do this.

    Yes, you could totally have those symptoms at that TSH level! It is very personal and different for everyone, this is why doctors should focus on patients' symptoms rather than lab test results! You need to find a GP that listens to you and works with you rather than fobs off your concerns.

    By the second trimester (after about 12-13 weeks) the baby has its own thyroid and produces its own thyroid hormones, however, treating your hypothyroidism and symptoms would be definitely beneficial to both of you!

    I hope this helps, tag me if I can be of any further help!

    Best wishes for the rest if your pregnancy, take care x

  • Would be good idea to check thyroid antibody levels too.

    Also ask him to check levels of vitamin D, B12, folate and ferritin.

  • Thanks for all your replies. I can see this is a complicated issue and get the impression many doctors don't know very much about it! I suppose I'll just have to see what my GP says this time and if he dismisses it, try and get to the bottom of why my midwives think it's a problem.

  • It is supremely important that you as the mother do not become thyroid hormone deficient during pregnancy. The foetus will take everything it needs from you during its growth and if your own thyroid is insufficient, then you yourself will suffer the most in becoming hypothyroid. TSH levels in late pregnancy should be about 1.5 - yours seems to show your thyroid is under stress. In the USA where this situation has been carefully discussed, there is no hesitation in temporarily giving T4 to pregnant mothers if the TSH is indicating the need. This could be stopped after birth. However there are a surprising number of women who have temporary thyroid problems after birth so a close watch on your FT4 and TSH is warranted from now up to and beyond giving birth until things settle down.

  • NICE CKS recommend that women attempting to conceive and newly pregnant should have TSH in the low-normal range 0.4-2.0 with FT4 in the upper range

  • For your doctor's information there's a good site on TUK (Lothian Guidance for Treatment in Pregnancy) -admin could let you know of it in full to access

  • Link to what Diogenes mentioned: thyroiduk.org.uk/tuk/guidel...

  • Thanks for all your help and link! Have appt. tomorrow so will try to convince him a more comprehensive blood test would be useful.

  • Just a note to say Diogenes is a clinical scientist who has carried out a great deal of research on the thyroid.

  • The general guidance is that for patients diagnosed with hypothyroidism is TSH should be kept below 2.5 during the first trimester and below 3.0 from then on. This is optimal care and if you are a little above then the risk is very minimal. Also, this is for patients with a thyroid that is known to be failing. In these cases the patient's thyroid isn't able to respond if the demand for thyroid hormone increases. They have a malfunctioning thyroid and it will not respond well to further stimulation. The above is an explanation which might explain the difference in opinion between your midwives and doctor. It is a subtle difference and I wouldn't criticise either, although the midwives are giving the better advice.

    I would ask for some levothyroxine just to be on the safe side but I do believe (I am not a doctor) the risk is very minimal. Also, you have symptoms which may be thyroid related, so why take the risk of feeling pretty bad during and after the pregnancy. Levothyroxine is incredibly safe, much safer than asperin or paracetamol. I would press for the levothyroxine rather than more detailed blood tests as they will only introduce a delay and lead the doctor to pay more attention to the numbers than you. Detailed blood tests can come later.

  • This link may also give you info to give your GP when next you see him/her. Its from the Journal of Clinical Endocrinology and Metabolism. You'll only be able to get the abstract but that tells you what you need. It is:

    Increased Pregnancy Loss Rate in Thyroid Antibody Negative Women with TSH Levels between 2.5 and 5.0 in the First Trimester of Pregnancy

    Roberto Negro, Alan Schwartz, Riccardo Gismondi, Andrea Tinelli, Tiziana Mangieri, and Alex Stagnaro-Green

    Address all correspondence and requests for reprints to: Dr. Roberto Negro, Division of Endocrinology, V. Fazzi Hospital, 73100 Lecce, Italy. E-mail: dr.negro@libero.it.

    DOI: dx.doi.org/10.1210/jc.2010-...

    - See more at: press.endocrine.org/doi/abs...

  • Thanks to all. Doctor has agreed to 25 mg with blood test in 4 weeks. Hoping it's just a pregnancy issue and not a long-term problem.

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