change of plans

[KittensEatLettuce]

hello - I've had hashimoto's for about 9 years, but have recently started working with a new Endo. He's been great and I have been really excited about improving my health.

Over the last 2 months I've started T3, and now take methylated b12 and folate (in addition to the vit d and other supplements I was already taking). My DNA results support difficulties in converting T4 to T3, and MTHFR mutations. I've been gluten free for over a year, but now low carb high fat diet which Endo advised, along with a gut support program.

I was feeling better for a month or so, started to feel like there was colour in the world. And my anxiety was way down. The last few weeks though, I've started getting a bit more anxious, and constipation being an issue. I thought it was maybe the diet.

Anyway, this morning, I've found out I'm probably pregnant. Was trying before, but stopped to concentrate on my health. I guess it's worked?! Explains the change in symptoms.

I'm a bit worried about what I should still / shouldn't take - and generally, what I should be aware of. I'm asking the endo for advice, but with it being the weekend, it's going to be a while before I hear anything.

Would really appreciate any advice as I'm panicking I'm going to do the wrong thing!

I know advice would be easier if I can provide test results - but I'm trying to get the latest from my GP who aren't being very helpful. Even the website they use is down. I feel like it's conspiring against me! Today I've ordered a new test from blue horizon so I can get all results at this point. I'm hoping I can post these soon.

I'm on 75 T4 (levo) and 15 T3.

(Sorry for writing so much)

[Clutter]

Congratulations, KittensEatLettuce.

The TSH of women planning conception should be in the low-normal range 0.4 - 2.5. When pregnancy is confirmed Levothyroxine dose is usually increased by 25-50mcg to ensure good foetal development.

NICE recommends that hypothyroid women planning pregnancy should be referred to endocrinology. cks.nice.org.uk/hypothyroid... NHS endos will probably try to persuade you to stop taking Liothyronine during pregnancy.

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 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...

[Scazzoh]

This is taken from the NICE guidelines on treating pregnant women who are hypothyroid:

'Refer to an endocrinology specialist all women with overt or subclinical hypothyroidism who are:

Planning a pregnancy

Check thyroid function tests (TFTs) before conception if possible.

If TFTs are not within the euthyroid range, advise delaying conception, until stabilised on levothyroxine (LT4) treatment — discuss with an endocrinologist if there is any uncertainty about initiation of treatment or what dose to prescribe while waiting for review.

Check that the woman understands that her dose of LT4 must be adjusted as early as possible in pregnancy to reduce the chance of obstetric and neonatal complications.

Advise the woman to seek medical advice immediately if pregnancy is suspected or a menstrual period is missed.

Pregnant

Check TFTs immediately once pregnancy is confirmed.

Discuss urgently with an endocrinologist regarding initiation of, or changes to, dosage of LT4 and TFT monitoring while waiting for review — trimester-specific TFT reference ranges may vary locally.'

The second paragraph applies to you. As you already have an excellent Endocrinologist, I suggest you show this extract to your GP and ask them to get in touch with the Endo as a matter of urgency, to discuss test results and treatment. Tell your Endo this is what you are going to do. Your GP is not allowed to sit on the fence here. There is too much at risk.

[KittensEatLettuce]

Thank you!

Previously my GP was really slow at increasing my dose, I had to fight and then did end up losing the pregnancy. Of course, that could have been unrelated, but I want to make sure to tick every box this time, just in case.

Do you have any information / opinions on diet (not sure if people on here also following low carb high fat?) and the other supplements? I'm really worried I'll be told to come off the T3 - but not sure whether I should follow that advice or fight. My endo's really good, he's private so hopefully I can ask him to keep monitoring me if I can't get NHS help. Obviously would rather not pay out, but think health is more important at the moment!

[Nanaedake in reply to KittensEatLettuce]

I'm not pregnant - no chance - but I follow a low carb high fat diet and feel better for it as I eat more nutritious food and don't fill up with carbs. I expect so long as you eat nutritious food in pregancy and eat 'healthy' carbs like vegetables it's got to be good for health and nutrition which should support a healthy pregnancy. It's good you took folate and B12 leading up to pregnancy because folate is really important for fetal development. You'll probably have the most healthy baby ever with all the care you've taken.

If constipation is a problem, it won't do any harm to eat up to 5 prunes a day. They are good for bone development and as they are a natural food they won't do any harm.

[KittensEatLettuce in reply to Nanaedake]

Thanks for this info!

[KittensEatLettuce]

Good news, thyroid looking OK at TSH: 0.4, T3 4.7 (think ref 3.1-6.8) and T4 10.3 (ref 12-22). Waiting for vit d and others, think they're OK though. Consultant just wants to increase my vit D a little.

[KittensEatLettuce in reply to KittensEatLettuce]

I'm taking 1000 (iu/mg?) folate, and currently about 5000 iu vit d, upping to 6000. Can't remember the b12, but it's a jarrows one (high dose)

[humanbean]

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

Buried at the bottom of the above page is this sentence which is easily missed :

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].

Bearing in mind that it takes a while for a foetus to grow a thyroid it will be reliant on your thyroid hormones. So the earlier your dose is raised the better, I would think.

Edit : I forgot to say... Congratulations.

[KittensEatLettuce in reply to humanbean]

Thank you! On both counts 😊