Referral to Endo for fertility?

[ShelboBaggins76]

Hi I'm new here and recently requested my thyroid to be tested following a recent miscarriage and struggles TTC.

My GP was reluctant to retest me as he said that my TSH result of 3.2 last year was within normal range even though I've since found out that this isn't optimal for fertility and should be lower than 2 and ideally closer to 1. He requested TSH, FT3, FT4 is and antibodies to be tested but the lab didn't test FT3/FT4 which I had a feeling they wouldn't so I had private test via Medichecks on Monday. My results are attached.

I've had a lot of hypo symptoms for a while - tiredness, feeling foggy, weight gain, thinning hair, my goitre looks enlarged (or maybe that's just due to weight gain?), always cold, low BBT and more recently pins and needles/wrist pain. My mum has an auto immune thyroid disease (Grave's) so I had always wondered whether I was pre-disposed to having thyroid issues too.

I've not been to my GP yet with my Medichecks results although the TSH he did he said was 2.1 and negative antibodies and his comment was all in normal range. I'm wanting to be referred to an endo privately via my Bupa insurance if possible and need a GP to refer me, I thought I'd bypass my NHS GP and have a virtual consultation with a Nuffield GP which is offered through my employer, she wasn't particularly helpful either despite me describing my symptoms and mentioning trying to conceive and also said as my bloods were within normal ranges she wouldn't refer me.

I think my FT4 and FT3 being in the lower range of 'normal' indicate mild hypo, I wouldn't ordinarily be concerned about this except that I am currently trying to conceive and likely to progress to IVF in a few months and as I will have to self-fund this I want to ensure that there isn't anything which is going to hinder IVF success which is why I wanted to be referred to an endo. I have booked an appointment with my GP tomorrow morning to battle it out with him to get a referral letter for Bupa.

Is anyone able to offer some advice to help me fight my corner, am I right about being mildly hypo?

[Clutter]

Welcome to the forum, ShelboBaggins76.

Your thyroid results are all within range so they don't indicate 'mild hypo'. TSH >2 indicates thyroid is struggling and FT4 is low in range but FT3 isn't low for someone not on thyroid medication.

However, as you are trying to conceive your GP should prescribe Levothyroxine to raise FT4 and reduce TSH. 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 endocrinology. 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...

Email [e-mail] for a list of member recommended endos. Check with BUPA that the endo is on their approved list and ask your GP for a referral letter.

Thyroid antibodies are negative for autoimmune thyroiditis (Hashimoto's).

[ShelboBaggins76 in reply to Clutter]

Thanks for your response Clutter, do you think I'm warranted asking my GP for referral to an endo or should I should just push my GP to start me off on Levothyroxine and monitor my levels? I think my concern about approaching my GP for the latter was that he might not do anything if he believes my levels are within normal range and an endo might be knowledgeable about this from a reproductive endocrinology stance (although I'm aware that might not necessarily be the case!).

I am also planning to do my IVF cycle overseas (due to costs) so I won't necessarily have the clinic advise my GP to prescribe Levo if they think my TSH is too high as a UK clinic might do.

[Clutter in reply to ShelboBaggins76]

ShelboBaggins76,

I'd show your GP the links I posted above and ask him to start you on Levothyroxine. TSH >2.5 can make it hard to conceive andif you are able to conceive increases the risks of miscarriage and post-partum psychosis.

A referral to NHS endocrinology can take months so ask your GP for a referral letter and use BUPA. A UK Fertility clinic will want TSH <2.5 before starting IVF.

[ShelboBaggins76 in reply to Clutter]

Thanks again Clutter!

I think I printed off a small tree's worth of info to present to him, but it was pretty pointless as all he did was refer to my blood levels being within normal range. Thankfully as I asked for referral to a private endocrinologist he was OK doing this and said he'd do a referral letter. I called BUPA this morning and got an appointment with an endo for tomorrow (I was lucky as he's on holiday after this so I wouldn't have been able to get an appointment for another 2 weeks) and it feels like I needn't have bothered going to GP anyway as I wasn't even asked about referral letter!!

Now I'm just hoping that the endo will treat me to get my levels within optimal range, fingers crossed!

Thanks for your help and advice to far, much appreciated!

[Clutter in reply to ShelboBaggins76]

ShelboBaggins76,

Your thyroid levels are NOT within normal range for a woman planning conception according to the BTA and your GP should be following their guidance.

Good luck with the private endo.

[shaws]

Welcome to our forum and you are right to query the best way for you to become pregnancy and have a successful pregnancy. I shall give you a list of clinical symptoms:-

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

When you have blood tests for thyroid hormones, the following is a procedure which should give you optimum results:-

It must be the earliest possible appointment, fasting, and if you were taking thyroid hormones you'd allow a 24 hour gap between last dose and test and take afterwards. This helps keep the TSH at its highest (that's all doctors seem to notice) and it drops throughout the day which could mean remaining undiagnosed.

We have two private labs which will do all of the tests GP wont and ask for:

TSH, T4, T3, Free T4, Free T3 and thyroid antibodies.

Always get a print-out of your results, with the ranges as labs differ and it makes it easier for members to respond.

GP should test B12, Vit D, iron, ferritin and folate as deficiencies also cause clinical symptoms.

Put your results on a new post for comments, with the ranges.

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

Blue Horizon and Medichecks do home pin-prick tests or can arrange for blood draw, following the procedure above, and make sure you are well-hydrated a couple of days before and arms are warm (if drawing blood yourself i.e. pin-prick).