Hi my name is Lauren, I am 32 years old and I am aiming to get pregnant while I still can. What is the recommended cut-off levels for thyroid hormones/TSH when aiming for/when in pregnancy? GP currently reluctant to increase. I take 175mcg levothyroxine and I was diagnosed hypothyroid 8 years ago when I was 24. Fertility hormones were all over the place and at the moment they have stabilised. Thanks in advance.
December 2017
TSH 5.44 (0.2 - 4.2)
FT4 14.6 (12 - 22)
FT3 3.3 (3.1 - 6.8)
Thyroid Peroxidase antibodies 874 (<34)
Thyroglobulin antibodies 255.6 (<115)
Ferritin 21 (15 - 150)
Folate 2.3 (2.5 - 19.5)
Vitamin B12 144 (180 - 900)
Vitamin D total 31.1 (25 - 50 deficiency)
GP says I am on a high enough dose and doesn't think I take it every day
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LaurenC85
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Your TSH level should be below 2. Is there a reason that your GP is reluctant to increase your dose. Could you post your TSH, FT4 and FT3 levels. The body usually needs an increase during pregnancy, maybe you cd speak to an endo or find nhs medical papers and guidelines so that you could show them to your gp.
If you have Hashimoto's, it affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone 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
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor please email Dionne: tukadmin@thyroiduk.org
Your doctor is incompetent if he doesn't know that the aim of taking levothyroxine is to get the TSH level below 1.
Please find another doctor and get your TSH level lower before you put yourself through the heartbreak of either having difficulty getting or staying pregnant.
It is very important to have your T3, T4 and TSH levels optimal during pregnancy for the health of the baby.
In fact you should be referred to a specialist endocrinologist according to NICE Guidelines if you are trying to get pregnant.
Sorry just wanted to add that I don't mean to scare you - plenty of ladies have successful pregnancies with hypothyroidism but you just need to get a doctor who has a clue - and to get your TSH level down.
Once you are pregnant you need to be monitored and might possibly need to increase your dosage.
Lauren, right now your folate and B12 are dangerously too low for you to have a pregnancy. There is risk of spina bifida, heart defects, and cleft palate with such low levels. Your ferritin is also too low.
You need to see a doctor who understands what's going on. The doctor you are seeing right now is not competent to help you.
You are not absorbing the thyroxine properly and you need to be checked for Coeliac disease.
My daughter was diagnosed as hypo about two years before her pregnancy. She is now seven months pregnant and all is well so far. She, like you, was concerned about whether she would be able to have a baby and about a year and a half ago she consulted a Dr Vanderpump at the Physicians Clinic in London. He was recommended to her by her GP who, as luck would have it, went to a talk he gave about hypo and pregnancy the night before my daughter consulted her about her concerns.
Dr Vanderpump advised my daughter to target under 0.5mU/L TSH levels in the lead up to getting pregnant (she now thinks it is doubtful she ever reached that as hers has never been below 2 when measured). The endocrinology department at University College London Hospital said in a letter to my daughter recently that the ideal preconception TSH values are 0.4 - 2.5mU/L so the GP letting you be 5.44 without increased medication seems wrong and contrary to NHS advice.
As soon as my daughter became pregnant the endos at UCLH increased her thyroxin and they test TSH her every two months. The trimester specific TSH reference ranges cited by the NHS are:
1st trimester: upper limit of 2.5mU/L
2nd trimester: upper limit of 3mU/L
3rd trimester: upper limit of 3.5mU/L
Hope this is helpful. Good luck with your future plans.
Another thought.... Given how low your T3 is and how high a dose you are on, I wonder if you are unable to absorb the thyroxin from your blood into your cells. Your ferritin, B12 and folate are all quite low and I also wonder if you need to pay some attention to your gut health as you may not be absorbing all the vits from the food you eat - I'm assuming your diet is good when I say this. Ferritin, for example, needs to be at least 70 for the thyroxin to be converted to a useable form in your body. It might be an idea to read up on this. Good luck. x
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