Hypothyroid and fertility concerns

[HealthyEmski]

Hi all

i'm new here and would like some advice about my fluctuating TSH levels although my T4 seems to be raising. (My GP only tests for TSH and T4, not T3.).

Following fertility treatment last year I was put on 25 mg of Levothyroxine as my TSh was 2.7 (0.30-5.50ml/L) serum free T4 level T4 13.5 (9.00-25.00pmol/L). The fertility doctor advised that a TSH less than 2 was optimal and I felt better for a while then felt sweaty and tired. I had another blood test in Aug last year and my TSH was 3.4 (0.30-5.50ml/L and T4 was 12.8 (9.00-25.00pmol/L) . I spoke to my fertility dr who suggested the fertillity drugs can affect the thyroid so my Levothryoixine dose was increased to 50 mg.

Another test in Jan this year was

1.7 (0.30-5.50ml/L)

and T4 15.1(9.00-25.00pmol/L)

and i thought all was going well until about a month ago I stopped losing weight and my hair loss increased as did the brain fog.

My most recent test end of March confirmed what I was feeling:

TSH was 2.8 (0.30-5.50ml/L) yet T4 was 16 (9.00-25.00pmol/L). I also asked for a Vit D test which was 62 nmol/L ( 50.00-150nmol/L) as I've been concerned about low Vit D and effects on a baby.

My GP who has been away for a year left a message saying the results are normal so I know I'll need to have the conversation/struggle to increase my levothroxine.

Any insight would be appreciated.

thanks

[Jellyfish_1]

My endo advised me that a person trying to become pregnant should have tsh below 2.

[HealthyEmski in reply to Jellyfish_1]

Thanks, Jellyfish. Yes, that's what my private IVF doctor said. But my GP never mentioned a thing about TSH when I'd been trying to get pregnant naturally for months and my TSH was about 3.7 two years ago!

[mistydog]

NICE guidelines have been updated in the last year and women attempting to get pregnant or pregnant should be kept below 2.

Patient experience shows that a TSH below 1 is where people feel best and even at the very low end. Once diagnosed, the TSH should be ignored and the free T4 and free T3 should be monitored. It doesn't look as though your T3 has been checked. This should be in the top half of the range and the T4 should be in the top third. Don't accept normal from your doctor.

[HealthyEmski in reply to mistydog]

Thanks, Mistydog.

It's ironic that for years my very nice GP said there was nothing wrong with my thyroid levels even when I was trying to conceive. It was only when I started IVF privately that I've become educated about optimal thryoid health.

[mistydog]

One other thing. If your levels are fluctuating, you should ask for TgAb and TPO antibodies to be tested.

[Clutter]

HealthyEmski,

TSH of women planning conception should be low-normal 0.4 - 2.5. Levothyroxine dose is usually increased by 25-50mcg when pregnany is confirmed to ensure good foetal development.

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

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...

Vitamin D is optimal 75-100. I would supplement 2,500iu D3 daily and retest Jul/Aug.

[HealthyEmski in reply to Clutter]

Thanks, Clutter. I'm diligently upping my Vit D and other vitamins and minerals. I've always had anaemia problems but never known why. Hmm. Seems like the thyroid is at the base of it all.

[Eddie83]

You need to get FT3, TPO antibodies, TGB antibodies tested. Hashi's can cause progressive problems, you want to avoid that. T3 is what gives people that feeling of wellness, so if you aren't converting, T3 is essential. Are you on a nutritional supplement program?

[HealthyEmski in reply to Eddie83]

Thanks Eddie 83. I think I've been putting off the possibility of Hashi's because there's been so much else to think about but you're absolutely right : I need to think about my long-term health. Thanks

[HealthyEmski]

Thanks for all the comments and advice. I am on a nutritional programme and making sure my iron and Vit D and other minerals and vitamins are optimal. I am also planning to have a private test for FT3 and antibodies as my GP doesn't seem to do this. Thanks again.

[Roadrunnergreg]

Another reason for fluctuating levels that needs to increase levothyroxine is adrenal fatigue, the thyroid compensates for the adrenals, then after a while it cannot hence the increases. So need to check 9am cortisol levels

[HealthyEmski]

Thanks Roadrunnergreg. Everything is so connected. I'm going to get tested privately and include cortisol levels.