Follow up blood test. Should I increase the dose?

[MrsAlice]

Hi all

I posted a few months ago. I have hashimoto with TSH 1.15 back in October and borderline/low free T4 (and sky high anti thyroglpbuline antibodies). A very open minded endo agreed to start me on levothyroxone 25. 4 months on and the Tsh has gone up!!! 2.05 (0.35-5.50) and the T4 is barely in range at 9.5 (7-17). Any suggestions? We would like to try for another baby soon too and I know that this Tsh is not great.

I'm not seeing the endo until the end of April.

Thanks in advance!!!!

[Clutter]

MrsAlice,

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.2 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email [e-mail] if you would like a copy of the Pulse article to show your GP.

The TSH of women planning conception should be in the low-normal range 0.4 - 2.5. When pregnancy is confirmed dose is usually increased by 25-50mcg to ensure good foetal development. NICE also recommends that hypothyroid women planning pregnancy should be referred to en-docrinology. 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 to the ATA First Trimester TSH levels between 2.5 and 5.0 are associated with in-creased pregnancy loss

thyroid.org/patient-thyroid...

[MrsAlice in reply to Clutter]

Thanks for this clutter, just the information i needed. I'll up the levothyroxine to 50 myself whilst waiting to see the endo in April. I'm just surprised at how fast the TSH has gone up in only a few months and when on levothyroxine already?