Advice for Hypo-pregnancy

[Rosie11]

Hi all,

This is my first post on here! I’ve just found out that I’m pregnant- somehow- despite being told this wouldn’t be possible without medication due to lack of cycle, wondering if anyone has any advice on diet etc? Also, I was considering going on levothyroxine before I found out, due to symptoms such as hair loss and poor concentration. Now I’m not sure whether I should?

T4 was 5.4 in October and the TSH was a normal level- though I don’t have the number to hand.

Thanks in advance!

[shaws Administrator]

This is a list of clinical symptoms. Often we aren't diagnosed if the TSH hasn't reached 10 in the UK. In other countries we'd be diagnosed if it was 3+.

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

If you are hypo it is very important that you are treated properly, for instance your dose is increased immediately (I know you aren't on any at present).

Ask GP to test TSH, T4, T3, Free T4, Free T3 and thyroid antibodies. Or you can get all of these through one of our recommended labs which do home pin-prick tests. I will give a link just in case you want to go that route:

All tests for thyroid hormones have to be at the very earliest possible, fasting (you can drink water) and if you were taking thyroid hormones (which have to be taken when we get up with one full glass of water and don't eat for an hour as food interferes with the uptake). Some prefer a bedtime dose but you last have to have eaten about 3 hours previously as our digestive system is usually slow as hypo slows everything down, i.e. pulse, temp etc.

thyroiduk.org.uk/tuk/testin...

If pregnant it is important that you are properly medicated as dose is immediately increased if pregnant and am aware that you haven't, as yet been diagnosed.

Blue Horizon of Medichecks are the labs.

If you are diagnosed and having a blood test next a.m. you have to allow a gap of 24 hours between last dose and test and take after blood test. Otherwise the results will be skewed and you may not get the increase you need.

Always get a print-out of your results with the ranges (ranges are important for comments to be made) for your own records and you can post if you have a query.

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

If you've not had B12, Vit D, iron, ferritin and folate, ask GP to do these at the same time as thyroid hormones if you don't do these privately. If you are in the UK, the doctor may not do all of the ones above, and FT4 and FT3 are important.

[Rosie11 in reply to shaws]

Hi,

Thanks for your message.

I have been diagnosed, but they said it was borderline at the moment- I disagreed- and so it would be my decision whether I chose to medicate or not. I had hoped that through diet I could improve, as I had in the past- 2 years ago, I had a reading of 13 for t4 with no symptoms, and managed to get it down to 4 just by diet change. This time they told me I’d have to wait another 3 months for the next blood test and so I’ve been waiting to request the additional tests (I’ve been out of the country for the last month so private was not an option) will have to see whether this will be possible or not on 10th January.

My concern is more about potential side effects. And dietary changes that I should make specifically for pregnancy when hypothyroid.

Thanks, Rosie

[shaws Administrator in reply to Rosie11]

I am not sure what you mean by:-

"I had a reading of 13 for t4 with no symptoms, and managed to get it down to 4 just by diet"

Do you mean TSH? Normally we are diagnosed when the TSH rises above range.

This is a rough idea of T4:-

T4 16.4 (11-23)

The aim is to get T4 towards the upper part of the range.

The aim is a TSH of 1 or lower. Many doctors think to get TSH somewhere in the range is fine also, but it isn't.

[Rosie11 in reply to shaws]

Sorry, yes I meant TSH

[shaws Administrator in reply to Rosie11]

Write a not for your GP and say that you are pregnant and believe you should be prescribed levo to try to alleviate you having a miscarriage as in other countries we will be given levothyroxine if TSH is above 3. I know that they may not prescribe until TSH is 10 in UK, but if you are quite near the top of the range which is about 5 she should prescribe, Also tick off your symptoms and tell her you'd like to get a Full Thyroid Blood test, enclosing the interpretation in the link below.

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

You can say you've had advice from the NHS Choices for info on dysfunctions of the thyroid gland (Thyroiduk.org.uk) and highlight the third column on the following:

thyroiduk.org.uk/tuk/testin...

Put a copy of your ticked symptoms and a copy of the interpretation and pop in the letter box for her to read, hopefully, on Tuesday.

[Rosie11 in reply to shaws]

Thanks for your help! I’ll try and see someone face to face on Tuesday with the above in mind. Fingers crossed

Rosie

[shaws Administrator in reply to Rosie11]

That's good.

[SlowDragon Administrator]

Congratulations on your pregnancy

So are you on any thyroid medication at all?

Essential to get tested ASAP. TSH normally rises soon after conception.

Also get vitamin D, folate, ferritin and B12 tested.

That FT4 looks extremely low, but need ranges to be certain

[Rosie11 in reply to SlowDragon]

Hi, thanks! It was quite the surprise!

I’m not currently on anything. The soonest appointment that I could get is the 10th of January, when I’ll be asking for the extra blood tests etc- will try and arrange a blood test for the 12th. Do you think this is too long to wait?

Thanks, Rosie

[SlowDragon Administrator in reply to Rosie11]

Yes, make urgent on the day appointment on Tuesday

[Rosie11 in reply to SlowDragon]

Thanks! Will see what I can get!

[Clutter]

Welcome to the forum, Rosie11 and Congratulations.

Make an emergency appointment to see a GP on Tuesday. The TSH of newly pregnant women should be in the low-normal range 0.4 - 2.5 to ensure good foetal development. Having TSH >3.0 increases the risk of miscarriage.

NICE advises referral of pregnant hypothyroid women to endocrinology but it is important that your GP initiates 50mcg-100mcg Levothyroxine while you wait for referral.

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

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

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...

[Rosie11 in reply to Clutter]

Thank you for your help! I’ve spoken to my Work and will try and get an appointment on Tuesday

[SlowDragon Administrator]

A TSH in the past of 13 was definitely hypothyroid

The fact you improved it to 4 with diet, suggests you have Hashimoto's also called autoimmune thyroid disease.

Did you change to gluten free diet?

Ask GP to test thyroid antibodies too plus vitamins

Make sure to get test done as early as possible in morning and fasting. This shows highest TSH

[Rosie11 in reply to SlowDragon]

Hi, yes, they were quite alarmed when I had this result but I was still quite young and naive and didn’t realise the seriousness of it, and as I wasn’t experiencing any symptoms, they said that I could try and improve the results myself.

I didn’t go gluten free, I ate more fish, rice and cut down on carbs.

Thanks for your help! Hopefully I can see someone on Tuesday

[Rosie11]

Hi all, went to the doctor’s to try and get an appointment yesterday. They sent me away with the promise of a prescription but no appointment, doctor called half an hour later- have started on 25mcg to be increased gradually, and been referred urgently to endocrinologist and booked in to see midwife.

Thanks for your help,

Rosie