Pregnant and Hashis - what support should I be getting?

[Alexandra987]

Hello,

I'm currently 6 weeks pregnant with my first baby which I'm thrilled about, I made sure my TSH was under 1 before we started trying and I'm keen to stay on top of my Hashi's during the pregnancy. I called my GP as soon as I had a positive test and they upped my dose from 75mg to 100mg a day. I'm going in for a blood test on Thursday (2 weeks on from increase) to check all is ok and have a phone call booked in with the Dr the week after to discuss results.

However where I live the GP does not manage your pregnancy, you are managed by the local midwife team. I just called them to book in my first midwife appointment and the first one they had available won't be until I'm 11 weeks... I told the receptionist about my thyroid issue but she said she wasn't medically trained so couldn't advise of push my appointment any sooner (though oddly did advise that I stop taking my medication if I was worried I was hurting the baby...unbelievable!)

Obviously I've not done this before so maybe this is all fine and standard but I was under the impression I would be referred to an endocrinologist before this point?

I'm just a little concerned and not quite sure if this is normal procedure of if I should be pushing for more?

[shaws Administrator]

Someone will be along soon who is more knowledgeable than me. Pregnancy is great but you might need more thyroid hormones as I believe baby relies on your dose for the first ten weeks till it's thyroid gland develops. In the meantime these are past posts:-

healthunlocked.com/search/p...

[humanbean]

Well, that receptionist needs to be shot, for a start. Imagine telling a hypothyroid woman to stop her medication if she was worried about her baby!?! If you felt energetic enough, I would suggest writing to the practice manager and asking him/her to warn the receptionists NOT to give out advice on things they know nothing about!

The NICE Clinical Knowledge Summaries say hypothyroid women should be referred to an endo.

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

Look for the section in the above link under Management, Scenario: Preconception or pregnant.

Note the sentence hidden at the bottom of that page :

Women with known thyroid dysfunction who are taking levothyroxine may need the dose increased by 30–50% from as early as 4–6 weeks gestation [De Groot et al, 2012].

The scientific reference used is this one :

academic.oup.com/jcem/artic...

You can get a PDF of the whole paper using a link above the word "Abstract".

You seem to be doing everything right regarding your thyroid hormones. Hope the pregnancy goes well, and you feel well too.

The only thing you might want to do is make sure your ferritin, vitamin b12, folate and vitamin D are optimal.

Low folate has been proven to increase the risk of neural tube defects.

Low B12 has been shown to increase the risk of hydrocephalus (in baby rats).

Low iron/ferritin will make you feel knackered. I don't know what other effects it has on babies.

Low vitamin D will weaken the baby's bones.

Good luck.

[Alexandra987]

Thanks both, I'll check out all of those links.

humanbean I'm feeling pretty tired but that seems to be standard at this stage. I'll ask for ferritin, vitamin b12, folate and vitamin D on Thursday as well, I'm supplementing folate and Vit D so hopefully those should be good. I couldn't believe the advice from the receptionist - I just about managed to stutter out that it would be very dangerous to stop but I don't think it registered with her.

[DoubleM]

You should be referred to an endo for your pregnancy and get regular blood tests. I'm hyperthyroid so was already seeing an endo. I had blood tests every 4-6 weeks throughout both my pregnancies (done by the midwife) and saw the endo 3-4 times (rather than every 6 months). I'm sure someone with hashis will comment as well. Wishing you a happy healthy pregnancy x

[Alexandra987]

Hi All,

I just wanted to say thank you for the advice, I picked up my results earlier this week and my TSH had risen from 0.99 to 3.87. They hadn't done T4 or T3 which was a little annoying. I immediately upped my dose from 100mg to 125mg, I wouldn't usually change my dose without consulting my DR first but as I couldn't speak to mine for another 2 days and I didn't see what other option there would be but to raise I thought it was worth it.

I managed to speak to my GP this afternoon who confirmed that I should raise to 125mg (I didn't mention that I already had...) and has also said she will phone my midwives to arrange a referral to an endocrinologist as she doesn't want me to wait until 11 weeks. I'm very pleased about this, I guess I'll get a referral letter at some point?

I have further blood tests booked in for 2 weeks time so feel a bit calmer now that it seems to be being handled.

Thanks once again for continued advice, I would have no idea about so many of these issues otherwise.