Urgent pregnancy advice

[Jhenderson]

I’m pregnant through my first ivf cycle. Went to the doctor as I thought I needed to increase my levothyroxine.

He took my blood to test and said to call back on Friday. I’m not sure if the pregnancy will have put extra demand on my body yet at I’m only 3 week 3 days, the joys of ivf you find out super early! So my blood work won’t so my bodies need for extra meds. I have to retest in 4 weeks if bloods come back fine.

He googled what to do while I was there with him! And said testing now and again in 4 weeks is standard practice. Last time I was pregnant they put my dose up by 25mg straight away without testing.

I googled when I got home and the British thyroid society and they said to increase straight away!

What should I do? I don’t want to miscarry again.

[Rachael_]

I am litterally in the same boat and i sware that this is probably the reason why I misscarried... i have recently been for bloods before starting on my frozen cycle and they are fine im to carry on with the same dose as i have been... when i asked my nurse at the clinic the other day about this she said oh its ok as your doctor will automatically know that your pregnant and he will carry on with monitoring my levels... I automatically thought when i ended the call well the clinic wont notify my gp untill they have proof that the pregnancy is viable so what happens in the gap from then to that ..... i to am worrying that again once i get a positive what do i do .... Xx

[Huzat in reply to Rachael_]

Don’t assume anything, don’t take your GP’s word without serious questioning their knowledge of thyroid hormones in pregnancy. The guidelines state

‘Discuss urgently with an endocrinologist regarding initiation of, or changes to, dosage of LT4 and TFT monitoring while waiting for review — trimester-specific TFT reference ranges may vary locally.’

[Jhenderson in reply to Huzat]

You’re right. I’m shocked and frankly concerned with the inconsistency of care at my Doctors practice. Imagine if it was a vulnerable woman or a women who lacked the level of education to engage with her health and followed the Doctors advice without question. I’ve written a letter of complaint. Not to get the doctor in question into trouble. There clearly is a training need here my case has identified and needs to be rectified immediately with thyroid conditions in women being so common!

[Jhenderson in reply to Rachael_]

Hi Rachael. Sorry to hear about your loss. If your fet is successful and you get a positive pregnancy you are to go to the doctors to increase your dose. I’ve been back in touch with the Doctors and spoke to differently doctor and he confirmed that the dose should be increased straight away and has issued me a prescription of 25mg of levothyroxine on top of my 100mg I already take. I have to have bloods done about in four weeks and he said I may have to increase it again. Good luck. Xx

[Rachael_ in reply to Jhenderson]

Really thankyou i spoke to my clinic like i mentioned about this and they reasured me my doctor would keep an eye on it i was pregnant for almost 2 weeks after i did the test and the doctor didn’t contact me in regards to my thyroid... after the miscarriage i had my levels checked and all appeared ok.. i will deffinetly though be taking ur advice thankyou Xx

[trelemorele]

Do what you believe is best for you.

You have two options:

Go with recommendations or your GP.

[Jhenderson in reply to trelemorele]

I need a new prescription as I only have 100mg tablets so it’s not as easy as just taking another pill

[SeasideSusie Remembering in reply to Jhenderson]

You can split your tablet with a pill cutter or craft knife. I have quartered a T3 tablet which is very similar in size to my 100mcg tablet of Levo. Or halve the tablet and take 100mcg one day, 150mcg the next.

[Huzat]

These are the nice guidelines

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

‘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].’

[Jhenderson in reply to Huzat]

Thank you!!

[Jhenderson in reply to Jhenderson]

‘May’ need to change dose is that after bloods have been taken do you think? There is a two week lag time when taking levothyroxine if I wait for another 4 weeks could it be already too late?

[humanbean]

According to this link :

academic.oup.com/jcem/artic...

Title : Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline

1.2.3. If hypothyroidism has been diagnosed before pregnancy, we recommend adjustment of the preconception T4 dose to reach before pregnancy a TSH level not higher than 2.5 mIU/liter. USPSTF recommendation level: C; evidence, poor (2|⊕○○○).

1.2.4. The T4 dose usually needs to be incremented by 4 to 6 wk gestation and may require a 30% or more increase in dosage. USPSTF recommendation level: A; evidence, good (1|⊕⊕⊕⊕).

Read the full Summary of Recommendations.

Just above the Abstract you'll see a link to "PDF" - click on that and you can then print out the paper without all the blurb round the edges. The printer icon on my PC is near the top right of the screen when I'm viewing PDF files. You can also download the PDF and print it from your own gadget.

[humanbean in reply to humanbean]

Your IVF Clinic should be able to help you get through to your GP. Give them a call and ask what they would recommend.

[helvella in reply to humanbean]

It would be rather good if the IVF clinic had already sent information - to GP and patient - advising of the appropriate handling once pregnancy is established. Isn't this blindingly obvious to them?

The GP could even have given the patient a prescription for the dose increment in advance so she has it ready and waiting.

The idea that people have to join forums (even this very forum) in order to get the support they need at this vulnerable time is awful. It also raises very serious questions over the understanding of GPs in all pregnancies.

[humanbean in reply to helvella]

I absolutely 100% agree, helvella. The lack of foresight in both the IVF Clinic and any GPs involved via their patients is absolutely scandalous.

[Jhenderson]

That’s an American journal not sure if American Guide lines are the same as what the nhs recommends x

[Huzat]

The link quoted by humanbean are also included as references in the Nice guidelines so valid. If your blood test comes back fine you should then be given the 30/50% increase. GP should discuss/refer to Endo.