High TSH and TPO of >1000 advice please

[Viki456]

Hi I am new and my GP has left me a voicemail saying my TPO is >1000 (<34) and I have TSH of 7.2 (0.2 - 4.2)

Trying to conceive thanks for advice for what I need to do next

[Nanaedake]

Make an appointment with your GP and you need levothyroxine if not already taking it or a dose increase to bring your TSH level to around 1. If starting treatment you might need to start on a small dose around 50mcg and then retest every 6 weeks and adjust dose until TSH is around 1. If already taking levothyroxine then increase dose and retest in 6 weeks and repeat until TSH is around 1.

You should also get your vitamin levels tested, particularly B12 and folate as all can be low in people with thyroid disease and it's important to be sufficient when you concieve.

Ask GP to test

vitamin D

folate

B12

ferritin

[SlowDragon Administrator]

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

Essential to test vitamin D, folate, ferritin and B12. Always get actual results and ranges. Post results when you have them, members can advise

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...

GP should start you on 50mcgs of Levothyroxine. Retesting after 6-8 weeks. Dose increased until TSH is at least below 2 (recommended by NICe if TTC)

Read as much as possible about Hashimoto's.

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH and most consistent results

Link about antibodies

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

[humanbean]

I think you need to delay trying to conceive until you get your thyroid medication and blood tests optimised. Also, there is a strong likelihood that you have very low nutrients. The ones that are commonly mentioned on this forum are vitamin B12, vitamin D, folate and iron/ferritin. You should ask your doctor to test the first three things I mentioned plus a full iron panel, and (if you can swing it) a full blood count as well. Ask for a copy of the results and post the numbers and the reference ranges on a new post and ask us for feedback.

Having low thyroid hormones reduces your risk of conceiving, and increases your risk of miscarriage if you do get pregnant.

I'll leave it to you to research the risks of low vitamin B12, folate, iron and vitamin D on the unborn child. Your levels may be fine, but you really do need to find out. Not treating low levels is just not worth the risk in my opinion.

Another thing you could do is research low vitamin A which is also common in hypothyroid people. If you decided to supplement this you would have to do it only before you conceived, not while you were pregnant. You shouldn't take beta-carotene, you would need to take "proper" vitamin A (retinols) - people with thyroid dysfunction can't convert beta-carotene into "real" vitamin A very well. I supplement occasionally and I take the active vitamin A. But I am cautious with my dose and I'm not trying to get pregnant.

For more info on different types of vitamin A :

articles.mercola.com/sites/...

[humanbean in reply to humanbean]

I forgot to mention. You should find the following link helpful :

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

Click on the various words, tabs and links on the left hand side of the page and look for any reference to pregnancy or pre-conception. Since the page is written by NICE your doctor(s) should take it seriously.

[humanbean in reply to humanbean]

Notice the sentence buried at the bottom of the page that I just linked :

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].



[Clutter]

Viki456,

Tell your GP you are planning to conceive and ask for Levothyroxine to be prescribed in accordance with the following information.

The TSH of women planning conception should be in the low-normal range 0.4 - 2.5. When pregnancy is confirmed dose is usually increased by 25-50mcg to ensure good foetal develop-ment. NICE also recommends that hypothyroid women planning pregnancy should be referred to endocrinology. cks.nice.org.uk/hypothyroid...

Management of primary hypothyroidism: statement by the British Thyroid Association Execu-tive 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 refer-ence 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 tri-mester (1/++0). L-T4/L-T3 combination therapy is not recommended in pregnancy (1/+00).

onlinelibrary.wiley.com/doi...

According the ATA First Trimester TSH levels between 2.5 and 5.0 are associated with increased pregnancy loss

thyroid.org/patient-thyroid...