TSH level in early (weeks 4-5) of pregnancy?

[Qwerty11]

Evening all, people might remember me from questions I had in the autumn- I had been feeling awful for ages and had also been trying for baby for almost 2 yrs... I was eventually tested for TSH, found it was high and after a battle with all of the GPs at my surgery, a locum agreed I needed levothyroxine for hashimotos to have a chance of trying to conceive. ... My TSH came down quickly and I felt better within 2 weeks- it was a revelation! Now the hopefully good news- I tested positive for pregnancy last week.. had HCG for pregnancy confirmation and also TSH test done today. hCG has confirmed pregnancy! TSH has gone up slightly- from 2.6 to 2.9. T4 has not changed at all- exactly the same at 16.4 pmol. My GP (same one who doesn't agree with treating unless is reaches TSH 10) has said that is fine, I don't need to amend levo prescription. Is this correct? It may be but I have lost confidence in him now. Thank you once again for any advice.

[Clutter]

Congratulations, Qwerty11!

No, your GP should have increased dose by 25mcg-50mcg when pregnancy was confirmed to ensure good foetal development. See NICE recommendations cks.nice.org.uk/hypothyroid...

TSH of pregnant women should be in the low-normal range 0.4 - 2.5. The risks of miscarriage increase when TSH is >3.0.

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...

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

thyroid.org/patient-thyroid...

[Qwerty11 in reply to Clutter]

Thank you, I will go back tomorrow with print outs, (prepared for an argument I'm afraid- unfortunately it's the same gp on the rota again in the morning) at least I know what to 'ask' for now.

[Clutter in reply to Qwerty11]

Qwerty11,

Increase dose yourself and then if that GP won't increase dose you've got time to book an appointment with another GP and complain to the practice manager that your GP won't treat you according to NICE and BTA guidelines.

[Qwerty11 in reply to Clutter]

Will do. And I'll remember that phrase..."according to guidelines" Thanks... I'll update how it goes.

[Sisi10981 in reply to Clutter]

Hi. I am week 7 of pregnancy. Didn’t know tsh was important. It was high in my 5th week of pregnancy around 7. Now I increased my dose. Will do the test once again in a couple of days. I am afraid during that time, this would affect my baby’s brain development. Please advise

[Clutter in reply to Sisi10981]

Sisi10981,

How much did you increase dose? There's no point in retesting a couple of days after increasing dose. Wait 3-4 weeks.

I think your TSH may have been high because the baby was taking the hormone it needed which left you short. I doubt it will have affected your baby's development.

[Sisi10981 in reply to Clutter]

Thanks for ur reply. I used to take 100mcg and now I am taking 150mcg. It’s been now almost ten days since I increased my dose.

[Clutter in reply to Sisi10981]

Sisi10981,

That's a good increase. Retest in another 2-3 weeks.

[Sisi10981 in reply to Clutter]

Will do

Thnx

[humanbean]

If you look at the bottom of the page (bottom of the white bit) in the link that Clutter gave :

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

you'll see this :

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].

Print out the page and highlight that section to show to any doctor.

[Qwerty11 in reply to humanbean]

Thanks for highlighting key part- I thought I would be about 4 weeks ish but as my cycles have been v irregular im not certain- hcg levels were more like average for 5weeks + so I don't want to waste time arguing with stubborn GPs.

[Bexg]

Firstly congratulations!!

Please please make sure you see someone you really trust in pregnancy.... ask for Obs and Gynae ref and they will look after you.

I had a terrible first experience and went on to have 2 lovely pregnancies.

Your FT3 and FT4 need to be at the upper end of the spectrum. And you need to be closely monitored throughout and after birth too.

Good luck!

[SamanthaVictory]

Congratulations! This is so heartening to hear! I don't have the info to hand but I'm pretty sure I've read that if you're pregnant that even with sub-clinical hypothyroidism (i.e. TSH under 10) then you should be referred to an endo specialising in pregnancy. If I can find the info I'll update later - sorry it's so vague but I just wanted to make sure you felt you could stand your ground with your GP.