Advice ...again

[Peachy4130]

Hello again & sorry for always popping back for yet more advice!

I do try to talk to my GP but I find I got little support and the advice I get here really is invaluable!

I have it’s had my levels tests due to pregnancy and got my results today as follows:

TSH: 1.96 (ranges are 0.4-4 or during pregnancy 0.01-3.4)

T4: 20.8 (ranges are 12-22 or during pregnancy 10-18)

My GP won’t test for T3 & has said in these results that they are “Normal No Action”

When I queried he said my midwife (who is yet to see me) will make any recommended changes.

I’m using the pregnancy ranges as a guide and to me it seems that my TSH is in range but the T4 is out of range.

Am I reading this correctly?

Also, is it common to have TSH in range and T4 out of range? And does that signify anything specific?

I wonder if I should be going to see the Dr again, but I don’t know how to get them to adjust my medicine to get me in line with the ranges. I have previously taken printout as advised on the forum and the Dr response was that they weren’t relevant.

I’m rather worried and confused (early pregnancy hormones are not helping either!)

Thank you again to anyone who can shed light or advice!

I really appreciate it!!

[shaws Administrator]

Did you leave 24 hours between last dose of T4 before the test and take it afterwards?

Doctors should really not make newly pregnant women worried and should try to reassure them.

[Peachy4130 in reply to shaws]

Thank you for replying!

I had just over 24hrs before last dose and it was a morning appointment so I didn’t eat before hand either.

Ironically the Dr at my GP surgery who is excellent with thyroid conditions & explaining results & treatments is on maternity leave.

Thank you again for replying!

[shaws Administrator in reply to Peachy4130]

These are two excerpts from the link:-

Conclusions:

Management of thyroid diseases during pregnancy requires special considerations because pregnancy induces major changes in thyroid function, and maternal thyroid disease can have adverse effectson the pregnancyand the fetus.Care requires coordination among several healthcare professionals. Avoiding maternal (and fetal) hypo-thyroidism is of major importance because of potential damage to fetal

neural development, an increased incidence of miscarriage, and preterm

delivery.

*****

1.1.2. If hypothyroidism has been diagnosed before prenancy, we recommend adjustment of the preconception T4 dose to reach a TSH level not higher than 2.5 U/ml before pregnancy. USPSTF recommendation level is I; evidence ispoor (QEEE).

1.1.3. The T4 dose usually needs to be incremented by 4–6 wk gestation and may require a 30–50% increase in dosage.

USPSTF recommendation level is A; evidence is good (GRADE QQQQ).

1.1.4. If overt hypothyroidism is diagnosed during pregnancy, thyroid function tests should be normalized as rapidly as possible. The T4 dosage should be titrated to rapidlyreach and thereafter maintain serum TSH concentrations of less than 2.5 U/ml in the first trimester (or 3 U/ml in the second and third trimesters) or to trimester-specific normal TSH ranges. Thyroid function tests should be remeasured within 30–40 d. USPSTF recommendation level is A; evidence is good (GRADE 1 QQQQ).

This is a tinyurl as the link was too long:-

tinyurl.com/y8s34gea

It must be very confusing for those who are pregnant not to have a shorter/simpler idea of what the T4/T3 or FT4/3 should be.

[shaws Administrator]

Yes, your T4 is over range. These are the up-to-date links about pregnancy.

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

[Peachy4130 in reply to shaws]

Thank you I can’t tell you how helpful that is and I really appreciate you taking the time to respond.

I’m going to see a GP tomorrow and ask again if they will reconsider my situation with this in mind.

I wonder if I need to insist that they contact the endocrinologist at the hospital to ensure that I get the proper care.

Thank you so much

[shaws Administrator in reply to Peachy4130]

There's no harm in asking and you may be referred. As you probably realise on this forum it is mainly those who've not recovered due to guidelines and doctors not really understanding much except the TSH and T4 are to be in range so many are left floundering.