I'm pregnant :) GP is taking no action regarding hypothyroidism?!?

So, I'm pregnant! Just...But pregnant all the same. This is my second pregnancy but my first with a diagnosed thyroid condition. I thought I would need to increase my dose as I read that the foetus takes its throxine from the mother until 12 weeks. I called the GP today who congratulated me and booked me in with the midwife for June. She said the Midwives would sort 'it' (meaning my thyroid) all out. That would make me around 6 weeks pregnant. Is this the expected course of action?

Last blood test was 2.5 months ago and TSH was 0.25. I was taking 150mg levo at that point but had hyperthyroid symptoms so began to alternate taking 125mg on one day then 150mg the next. Hyper symptoms went away but now I'm pregnant. I didn't confess to the GP that I'd lowered my dose. They have been really quite unpleasant and callous about the condition in the past and I just don't have the faith that they know what they are doing.

I suspected I was pregnant last week so stopped alternating and reverted back to just taking 150mg daily. Is this the right course of action? I'm very confused but my GP is worse than useless.

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  • Clarabelle,

    Congratulations on your 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].

    NICE states TSH should be kept low-normal range (0.4–2.0 mU/L) and an FT4 concentration in the upper reference range. 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.

    Your TSH is low (which is good.). Do you have a recent FT4 result ?

    Ask your GP to refer you to a specialist.

    .

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

  • Congratulations! Is the midwife he has booked you into attached to a hospital or seeing you in the surgery. If coming into the surgery that I would insist seeing her straight away as Clarabelleuk has said or if not I would pop down to the maternity unit and explain that the doctor had booked you in but has he mentioned your thyroid condition as you know you will need careful monitoring and that it has to start earlier than the usual meet the midwife appointment. It is worrying you and your partner has insisted you come down to see them! That should set things moving!

  • Congratulations!

    I was hypothyroid for 6 years prior to having my perfectly healthy baby.

    The GP told me the same info as you ie that midwife would do necessary referrals.

    I didn't see midwife till 13 weeks, even though I insisted on an earlier app due to my thyroid condition.

    She did refer me to an endo, who I saw at around 4 months. He increased my dose by 25mcg and as my TSH was stable, I remained on the same dose. I was tested every month, at my insistence.

    So I think one of the key things is optimal dosage at the time of conception and thereafter. I think we both were fine in that respect. My pregnancy was treated as high risk due to this condition and my age, 37.

    Hope this helps. Feel free to ask me anything.

    J

  • Congratulations on your pregnancy!

    I am currently on my 3rd pregnancy with an underactive thyroid. I take NDT (a mix of T4 and T3.) and extra T3. (Though, recently, my consultant has persuaded me to do a trial of Levo at the same time as taking these other things. I started in 50mcgs at 16wks, and moved up to 100mcgs at 17wks. I am currently 20wks.)

    Check out the website, hyperthyroidmom.com. It has lots of great articles, (I have included some thyroid/pregnancy articles at the bottom) and advice you can take to your GP. (You GP will know very little about the thyroid in pregnancy, so it is very important for you to get as knowledgeable as you can. If you are lucky, you will have one like mine, who is very open minded and willing to read the articles and go with my suggestions.) Buy the book she wrote on pregnancy-it’s amazing! “Your Healthy Pregnancy with Thyroid Disease”, by Dana Trentini & Mary Shoman.

    As you have just found out that you are pregnant, increase your Levo/thyroxinne (T4) by 30% . The demand increases as soon as 4-6 wks into pregnancy and we are trying to avoid miss carriage amongst other things. Then go to your GP and let them know you need blood tests every 4weeks until 20weeks. The results of these tests, will likely show that you need further increases. (Don’t increase without the blood tests to tell you how much you need.) Your blood tests need to include T3 results. If your GP won’t do this, get private testing done through “Blue Horizon.” As always, get copies of all your blood tests, and post on here for advice. Do not accept your GP telling you that you are “normal” or “within range” as very few of them know what is healthy for pregnancy. At 20 wks, the demands usually plateau and you will need tests/increases less often. (The book tells you how often.)

    Your midwife or GP should refer you to a consultant. Unfortunately, it is unlikely you will see this consultant early enough. In my current pregnancy, I didn't get to see the consultant until 16 wks. (I am now 20 wks.) That's why it is important for you to take control in the early period.

    The book I mentioned above, gives this advice about the TSH levels you need to have to have a healthy pregnancy. This is really helpful to take to your doctor.

    First trimester: less than 2.5 with a range of 0.1-2.5

    Second trimester: 0.2-3.0

    Third trimester: 0.3-3.0.

    TSH should be monitored every 4 weeks during the first 20 weeks of gestation, then once again between 26 and 32 weeks

    Keep an eye on your B12 levels, as pregnancy places a high demand on these and people with an underactive thyroid are usually deficient to begin with. (You can’t overdose on B12, anything you don’t need you will pee out. A bit of a waste of money, but not dangerous!)

    Some articles, you may like to read:

    thyroid.org/professionals/e...

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

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

    hypothyroidmom.com/what-eve...

    dl.dropboxusercontent.com/u...

    thyroiduk.org.uk/tuk/about_...

    thyroid-info.com/articles/p...

    healthunlocked.com/thyroidu...

    2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum

    online.liebertpub.com/doi/p...

  • Congrats on your pregnancy!

    You need to take control of your own illness whilst pregnant. Per the posters above you should insist on monthly testing - a full thyroid panel not just Tsh.

    This didn't happen in my first pregnancy and I ended up with pre eclampsia which is a known risk factor of hypothyroidism.

    You may also consider going GLuten free to help keep your anti bodies down but plenty of links above so you can research this.

    In the meantime insist on your GP doing a blood test. Print out and Take these guidelines which are agreed by the nhs as being the correct protocol to follow thyroiduk.org.uk/tuk/guidel...

    Increasing your thyroxine by 25mcg as soon as you know you are pregnant is the accepted protocol.

    Tsh, ft4 and ft3 should also be measured monthly and monitored to stay within the parameters set out in that document.

    Be insistent. The risk factors for the pregnancy and the child are not to be ignored (miscarriage, pre eclampsia, hypertension, placenta abrupttion and autism, ADHD, developmental delays in the child.)

    Good luck. You are armed with the info & have the right to see a specialist. If your GP doesn't take you seriously self refer to the ante natal unit & requst the endo clinic.

  • Hi Wano, you would be better to start a fresh question as folks have moved on from here.

    Jo xx

  • Hi everyone. Thanks for your replies. I went back to the GP and said I wasnt happy with their planned course of action. I insisted on a blood test and on seeing the midwife early. I see her next week. My TSH was 0.19 they wouldn't do any other test than TSH and thyroid antibodies. I'll discuss it further with the midwife and if she isn't receptive I'll go to the maternity ward. I gave birth there before and the care was impeccable.

    Interestingly, when I phoned for the results I was advised by the reveptionist that the doctor had requested my bloods be redone in 3 months. To me, that just shows how little he understands and that he shouldn't really be involved going forward.

    In other news, I feel so much healthier than my last pregnancy at this point. I was hypo then but nobody knew. I feel very fortunate that I went through a whole pregnancy unaware that anything was wrong with my thyroid and my son is 100% healthy.

    I know I was hypo because I was an expat for some years and received medical treatment abroad. Once my thyroid news broke over here (2016) I pursued old blood tests from abroad (2012) and they showed my TSH at 2.5. So things were going wrong then and I felt ill. I just assumed it was the high pollution in China that made me feel lack lustre all the time.

    I found pregnancy really hard last time so hopefully being medicated will make it easier this time.

    Thanks for all your help and guidance.

    Love to all :)

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