Tsh of 3.4 and ttc

Hi all ,

I am hoping you can give me some answers as information online is a bit confusing to me.

Me and my husband have been trying to conceive for over a year . Reproductive wise everything is normal no issues found . However when i asked to see my blood tests from the gp,which came back as "normal" i found out that my TSH was at 3.4. Which is considered normal under the nhs guidelines

I discussed this with a private fertility consultant in the past when i was doing some initial scans and i remember him mentioning than when ttc or pregnant your tsh levels should be as close to 1 as possible and not over 2

I am now convinced that since everything else seems ok this is the reason that i am having trouble conceiving

My question is how can i make the gp take me seriously and prescribe something to reduce tsh levels ? I dont undeatand why does the nhs have a guideline of up to 4.5 when is widely accepted that is too high when ttc

Also is it likely that the private dertility consultant will be able to prescribe medication for this if the go refuses to do anything else

Any advice will be much appreciated

17 Replies

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  • Nicky883,

    Show your GP the extract below from Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee

    The serum TSH reference range in pregnancy is 0·4–2·5 mU/l in the first trimester and 0·4–3·0 mU/l in the second and third trimesters or should be based on the trimester-specific reference range for the population if available. These reference ranges should be achieved where possible with appropriate doses of L-T4 preconception and most importantly in the first trimester (1/++0). L-T4/L-T3 combination therapy is not recommended in pregnancy (1/+00).

    onlinelibrary.wiley.com/doi...

    NICE CKS says that when pregnancy is confirmed Levothyroxine dose should be increased by 30-50%

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

  • Thank you very much for replying. I have found the NICE guidelines and it does say that women that are planning to get pregnant should have a TSH below 2.5 .

    Since i have done the blood tests for fertility reasons in the first place i would expect them not to be classed as normal with a TSH of 3.4 .

    I have a telephone consultation with her on Monday since i couldn't get an appointment until the end of December . I will refer to the NICE guidelines so that she could hopefully take me seriously.

    If she doesn't is there a way i can go private for this to prescribe levothyroxine ?

  • Many doctors know little and make the assumption that if the results come within the 'normal' range then everything's fine. This may be helpful because miscarriages can occur.

    web.archive.org/web/2010103...

  • Nicky883,

    If your GP isn't helpful perhaps your fertility specialist will prescribe. You can see a private GP or endocrinologist to see whether they will prescribe Levothyroxine.

  • Thank you for your replies. I have contacted my gyno (in another country) he couldn't believe that the nhs considered 3.4 TSH normal when TTC. He advised that i should get a full thyroid blood test done. I have booked that privately tomorrow and i will take the results to my GP to see if she will take me seriously

  • Be careful about getting thyroid blood tests done privately. Doctors in the UK all work to the same guidelines whether they are NHS or private and in some cases are just as likely not to bother doing the Free T3 or the antibodies or whatever.

    Also, to get a full set of thyroid tests done you don't actually need a doctor to order them you can save a lot of money by ordering them yourself.

    You could use this link :

    bluehorizonmedicals.co.uk/T...

    You can order it as a microtainer (finger prick test) or vacutainer test (full blood sample from the arm like a nurse or doctor would do). If you ordered the vacutainer test you would need to get someone to take blood for you (a friend? colleague? anyone you know who is qualified?) or would have to pay someone to take it for you.

    The kit you require is sent through the post, you get your blood sample and then you return it through the post. The results are sent via email. Lots of us on this site use the above test.

    Some useful links :

    bluehorizonmedicals.co.uk/W...

    bluehorizonmedicals.co.uk/e...

    Once you have your results post them on here in a new post and we can interpret them for you. If any doctor tell you that finger prick tests are rubbish, ask him/her why the NHS does heel prick tests for congenital hypothyroidism on newborn babies if they are so useless.

    Another thing you may not know is that it is possible to treat yourself for underactive thyroid if you are prepared to buy thyroid hormones on the web. Ask on here for reliable sources for the hormones you need.

    The Thyroid Check Plus 11 that I linked to above tests for the following :

    TSH

    FT4

    FT3

    TT4

    Thyroid Peroxidase Antibodies

    Thyroglobulin Antibodies

    Ferritin

    Folate

    Vitamin B12 (NOT ACTIVE B12)

    C Reactive Protein

    Vitamin D (25-OH)

    All of these are relevant to feeling well and to getting the best thyroid health possible. Your thyroid health won't be as good as it could be if your vitamin B12 is very low, for example.

  • Thank you so much for the comprehensive reply i am so glad i have found this forum . I have booked a Full thyroid test in a private clinic which will test the following

    TSH

    T4

    T3

    And something about antibodies

    That would cost me 163 pounds i am thinking of cancelling now and going with what you have send . I am a bit worried of taking the test by myself though.

    I am on prenatal multivitamin and an extra vitamin D each day.

    The prenatal vitamin contains the following

    L-Arginine100mg--

    Inositol50 mg--

    N-Acetyl Cysteine50 mg--

    Betacarotene (Natural Source)3 mg--

    Vitamin D (as D3 600 IU)15 µg

    Vitamin E4 mg

    Vitamin C90 mg

    Thiamin (Vitamin B1)8 mg

    Riboflavin (Vitamin B2)5 mg

    Niacin (Vitamin B3)20 mg

    Vitamin B610 mg

    Folic Acid400 µg

    Vitamin B1220 µg

    Biotin150 µg

    Pantothenic Acid6 mg

    Magnesium60 mg

    Iron14 mg

    Zinc15 mg

    Copper1000 µg

    Selenium50 µg

    Iodine200 µg

  • £163 for those few tests is a lot of money.

    One thing to consider is that by paying for your own tests you can set the time when the blood sample is taken. TSH is always at its highest first thing in the morning (for blood tests in the real world anyway). I would suggest getting your blood sample at about 8am while fasting (except for water).

    Since you are already supplementing, I would definitely recommend stopping your supplements for a couple of days before testing.

    You may be able to get blood taken for private blood tests from your local NHS hospital (for a fee). They vary dramatically in cost, and some of them won't do it at all and get quite unpleasant when people ask.

    Lots of people on this forum have done the finger prick tests. If you ask for advice on here from people on how they did it successfully, then just think of how much money you could save!

  • Nicky883,

    Didn't your GP order the test showing your TSH is 3.4?

    Some doctors are reluctant to accept private blood results. It may be a waste of money if your GP won't accept them and wants to order her own blood tests. Why not wait until you've spoken to your GP on Monday?

  • Hi clutter ,

    Yes they ordered the tests for fertility one of the hormones tested was the TSH one.They have accepted other private tests so i would think they would accept this too. You are right i might have to wait until Monday to see if she orders any aditional test.

    After more than a year of Trying to conceive i have finally found a reason why and i am bit impatient to confirm it

  • Nicky883,

    If your GP ordered the TSH test she can see that according to BTA and NICE TSH 3.4 is too high for preconception and they recommend prescribing Levothyroxine to bring TSH into 0.4-2.5.

  • Thanks Clutter i can not find where in the NICE guidelines is that figure ? I haven't been diagnosed with hypothyroidism should i look under the infertility guidelines?

    When i called to get my results they told me that they are "normal" this is why i am nervous about asking for anything further

  • Nicky883,

    The range is taken from Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee I posted a link to it above.

    NICE CKS used to quote the range but is no longer since revisions made in April 2016.

    Your results are NOT normal for preconception. Quote the Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee to your GP.

  • Thank you . I think she is looking at the Infertility Guidelines which state the

    following

    nice.org.uk/guidance/cg156/...

    1.3.6 Thyroid function tests

    1.3.6.1 Women with possible fertility problems are no more likely than the general population to have thyroid disease and the routine measurement of thyroid function should not be offered. Estimation of thyroid function should be confined to women with symptoms of thyroid disease. [2004]

    I will look at the ones you have said above

  • Nicky883,

    Inability to conceive can be due to high TSH and high TSH also increases the risk of miscarriage which is why the British Thyroid Association recommended women attempting conception and newly pregnant should have lower thyroid levels than the general population.

  • Yes the Private consultant has told me that they look for a TSH as close to 1 as possible before starting any treatment . I am going to quote all this to the GP on Monday and i hope get prescription as soon as possible and there are no delays ! Is a telephone appointment so am not too convinced!

  • Nicky883,

    Put it in writing if your GP doesn't agree and ask to see another GP for a second opinion.

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