Ttc tsh 3.87

[Stary]

I had my first tft after commencing levothyroxine. Tsh is 3.87 (0.35-4.94) (seems a very odd refernce range compared to previous tests. I am due to start ivf sep/oct should i push for increasing dose?

I have no t4 result as not checked as tsh wnl....dr says normal but nice guidelines say different. So frustrating having to moan, nag or complain to get anything done or changed they (drs and receptionists) make me feel like an awful person but im only trying to do what best for my health potential baby and (bank balance!)

Previously tsh was 7ish so it has come down and t4 was just below reference range (dont have exact results on me atm)

Thanks

[Clutter]

Stary,

You need a dose increase. TSH of women planning pregnancy needs to be in the low-normal range 0.4 - 2.5. Dose is usually increased by 25-50mcg to ensure good foetal development. GP should also refer you to endocrinology.

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

Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee

13. 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...

[Stary in reply to Clutter]

Thanks for your reply. I have been increased to 50micrograms by gp. I know it is still a low dose. Fertility centre want my tsh to be between 2.2-2.5 before starting ivf (gp and fertility people seem to not communicate hence initially gp refusing to increase dose. Do you think I should ask to have it increased more quickly eg up to 75? I am aware they will increase lt4 by at least a third once/if I get pregnant so at some point expect to be hyperthyroid. Ive been waiting a year to start ivf and it just feels like it may be months more because of thyroid and finally we are ready to go (nhs self funded) and now we are waiting again- I know there is no point in starting until thyroid is sorted but feel everything is taking so long having a bigger jump may mean i can start in 6 weeks. Or is that a bad idea?

Thanks

[Clutter in reply to Stary]

Stary,

25mcg should be sufficient for now and TSH should be checked again in 6-8 weeks to make sure.

I should have said that "Dose is usually increased by 25-50mcg when pregnancy is confirmed to ensure good foetal development. GP should also refer you to endocrinology."