Pregnancy and hypothyroid

[CCheale]

Hi Everyone. It's been awhile since I posted. My partner and I just found out we are pregnant at 4wks. I will be 6wks on Sunday. I spoke to my GP straight away and he put an urgent request into the endocrinology clinic. Unfortunately, by the end of the week I hadn't heard any information. I then spoke to another GP at my surgery who ordered my labs and reassured me my levels are where they would expect for this stage of pregnancy and to wait for my antenatal clinic appointment. I just got the letter for my appointment with the consultant and am not scheduled to see them until March 20th! That puts me at 12 weeks. Should I be pushing to have my bloods tested sooner than that or is it standard to test every 8-10wks in pregnancy? Feeling very anxious as we have been trying for a baby for nearly a year and want to eliminate any risks I possibly can. I have called my GP, midwife, and Endocrinology many times over the last 2 weeks and no one seems to be taking this very seriously. Perhaps I am overreacting? Feeling tired of the run around and looking for some solid advice on what to expect as I enter this very uncertain stage. Thanks in advance!

[SlowDragon Administrator]

Insist the GP or Nurse do full blood tests on Monday as per NICE guidelines

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

You need folate and B12 tested too for baby's healthy development.

And vitamin D and ferritin too

Clutter will be along to advise

[CCheale in reply to SlowDragon]

Thank you SlowDragon. I had my thyroid levels tested a week ago (right before 5wks) and levels came back normal for pregnancy. TSH on lower end (slightly suppressed) and T4 around midrange. I see midwife on Thursday. Haven't had any tests done for folate and B12 or vitamin D or ferritin. I am on a prenatal for all those though and I take 3000IU of vitamin D.

[SlowDragon Administrator in reply to CCheale]

So you should be OK on vitamins

NHS should test FT3, but probably won't

You might want to reassure yourself with full private testing

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

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, lowest FT4 and most consistent results

[MidnightBlue]

As far as I remember the nice guidelines are to increase your thyroxine dose by 50% as soon as you are pregnant. I will google to check.

[MidnightBlue in reply to MidnightBlue]

Link to nice guidelines here cks.nice.org.uk/hypothyroid... It does say you may need to increase 30-50% from 4 weeks. Gps must follow the nice guidance.

[Clutter]

Congratulations, CCheale.

Low TSH and mid-range T4 is good but NICE recommends increasing dose by 30-50% as soon as pregnancy is confirmed to ensure good foetal development. I would increase dose by 25mcg as the foetus is entirely dependent on maternal hormone until weeks 12-14.

The TSH of women during the first trimester should be in the low-normal range 0.4 - 2.5. NICE also recommends that hypothyroid women planning pregnancy should be referred to endocrinology but it's not unusual to wait until week 12 before most women get an appointment. cks.nice.org.uk/hypothyroid...

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

[misswinky34]

You need an increase as soon as your sure your pregnant. I had this wait with mine and self medicated an extra 25mcg and when I finally saw endo they said I did the right thing. Its so important! Don't feel. Bad about nagging them, your carrying precious cargo, keep at them, get the increase. ❤️

[Saggyuk]

Yes you definitely need an increase asap - I had 50mcg increase by 5 weeks without even doing blood tests and they tested shortly after to make sure good levels - which were perfect.

It is categorically stated in the NICE guidelines that an increase of 25-50mcg is required by weeks 4-6 so print off and start repeating this to them and say you will make an official complaint if this is not actioned and your tsh rises!

Officially, you are required to keep your tsh under 2 whilst pregnant but to be honest 1 or just below is better.

THis is really important so make sure you get into the refuse to take no for an answer mood.

I had my bloods taken every month thereafter and had additional scans.