Thyroid UK
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Going to GP to ask what next? High TSH

Hi, I went to GP about a month ago to ask what next with trying for a next baby- weve been trying for over 2 years now and no sign, although we do have one child already so it has "worked" in the past. He did a load of blood tests. Bloods came back as TSH is bit high- it was around 5.7 with range 1-5.5 cut off I think. He said this may be the issue, but fertility clinic wont accept a referral until we get TSH to a normal level of between 1 and 2. I am supposed to have another blood test tomorrow to double check it wasn't a one off, so I signed up for the online view my records. Just looking at it today I can see I've had TSH tests several times in the last 18 months/2 years as investigations for other things- query ME at one point, I had very low Vitamin D crash at another point and also had glandular fever at another point- TSH was tested at each of these times. So I have felt unwell regularly for a while now and had no luck with trying to conceive. My TSH has been steadily rising- it was 2 in 2014 (whilst pregnant), then it went to 3 in Spring 2016, 3.7 in Autumn 2016 and now a year later it is 5.7. I don't know what the next bloods will show, but do I have enough "proof" already that TSH isn't where it should be? What should I be asking to happen next? Do I need treatment at this level? T4 has been tested each time too- it is always between 13 and 15.5, not showing any pattern of going up or down. Thank you for any advice.

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When you get your next blood test result, post both the one you've shown here and the new results on this forum and people will make helpful suggestions. You should also have thyroid antibodies TPO and TgAb tested because if you have antibodies, results can fluctuate so tests may vary. The fact that one TSH result has been above range indicates there's a problem with your thyroid.

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NICE guidelines were updated last year and state that TSH should be below 2 in pregnancy and regularly monitored. High TSH can lead to miscarriage and I have heard that the risk of autism is higher in the child.

Have you been given any levothyoxine?

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You should be started on Levothyroxine at 50mcg and then retest after 6-8 weeks

Also ask for thyroid antibodies to be tested as well as vitamin D, Folate, ferritin and B12

Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's

With Hashimoto's, until it's under control, our gut can be badly affected. Low stomach acid can lead to poor absorption of vitamins. Low vitamin levels stop thyroid hormones working.

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

Low stomach acid can be an issue

Lots of posts on here about how to improve with Apple cider vinegar or Betaine HCL

thyroidpharmacist.com/artic...

drmyhill.co.uk/wiki/hypochl...

scdlifestyle.com/2012/03/3-...

healthunlocked.com/thyroidu...

Other things to help heal gut lining

Bone broth

thyroidpharmacist.com/artic...

Probiotics

carolinasthyroidinstitute.c...

Importance of magnesium

hypothyroidmom.com/two-vita...

Have you remained on maintenance dose of vitamin D since low levels? If not it's likely very low again

Also glandular fever is strongly linked to Hashimoto's

hypothyroidmom.com/hashimot...

Read as much as possible about thyroid

The Thyroid Pharmacist website has masses of info about Hashimoto's plus her video series the Thyroid Secret has specific episode about pregnancy and conceiving

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Thank you very much for the replies- it's all new to me and you only get such a short time in with the gp it really helps to understand things before I go in to discuss results.

Yes I had antibodies blood test today- for the first time so nothing to compare to on that one. I'll update with results when I get it, they're usually very quick.

The last time I had these tests (around glandular fever time)- it came back as:

Serum vitamin B12 : 274 (ref 200-770) ng/l

Serum folate 4.8 (ref 4.6-18.7 ) ug/L

I haven't been on maintenance levels for vitamin D since I was phased off them- the last reading was 64 nmol but no reference range was given for that- it just says "adequate"

The only other odd thing I can see is total white blood cell count is just below th range- at 3.98 with range 4-1110 - is that familiar to anyone or just a coincidence?

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Oh I should say no I haven't had levothyroxine as yet.

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