Pregnancy guidelines for monitoring of hypothyroidism

[Sarah_37]

Hello!

Just looking for some advice please...

I have just found out I am pregnant following a FET cycle (2 embryos transferred) and the clinic have said I should have my TFTs done ASAP so I will contact my GP tomorrow to push for a blood test but does anyone know what the guidelines are that the GPs should follow so I can arm myself if they refuse please?

TIA xxx

[Kiedy84]

Hi Sarah, are you already on any medication? I was advised by my consultant Endocrinologist to increase my dosage by 25mcg (as soon after positive home pregnancy test) he said not to wait for my GP and tests.

There is guidance on NICE website and BFT xx

[Sarah_37 in reply to Kiedy84]

Thank u, yes currently on 125mcg levothyroxine, unfortunately I’m not under a consultant and my GP is never very forthcoming with the treatment of it. Had a battle for them to increase my dose to get a suitable TSH for ivf xx

[Kiedy84 in reply to Sarah_37]

Hi Sarah, you need to be referred. Have they checked your thyroid antibodies before? xx

[Sarah_37 in reply to Kiedy84]

I don’t think so as they have never mentioned it but I will ask the question this morning thanks x

[Sarah_37]

Thank you that’s great, that was the magic number they wanted it at for ivf too. Not sure how often they should check it? Xx

[MaisieGray]

Here is the NICE/Clinical Knowledge Summary with which your GP should be familiar; and in particular where it states:

Pregnant

-Check TFTs immediately once pregnancy is confirmed.

-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.

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

[Sarah_37 in reply to MaisieGray]

Brilliant, thanks so much xx

[Eoperez]

Dosage needs to increase and they should refer you to an obstetrician that specialises in hypothyroidism. Make sure you go armed with info others have posted on here as my so called specialist reduced my dose once then tried to do it again and I had to battle with her not to, dread to think what could have happened if I'd listened to her. Good luck x

[Sarah_37 in reply to Eoperez]

Thank you, it’s such a shame that the condition seems to be so poorly managed everywhere, really frustrating. The consequences it can have are so worrying xx

[Tennisqueen27]

The GP will probably up your dose there and then, do a blood test and hopefully results will come back as normal. That's what happened to me when I was in your situation! Great news!

[Sarah_37 in reply to Tennisqueen27]

Thank u, will see how I get on this morning xx

[HEL123]

Sarah, congratulations on your pregnancy. Get referred asap, or you should be on hospital led care for your pregnancy, and they usually have an endocrinologist attached to the clinic who can advise. I needed an increase of 75mcg of thyroxine all the way up to 250mcg a day when i was pregnant with a single baby. In my experience GPs just don't have the knowledge about what proper levels should be when you are having a baby...

[Sarah_37 in reply to HEL123]

Thank u, at what stage was the first increase? I wasn’t diagnosed when I had my first child so this is all new to me xx

[HEL123 in reply to Sarah_37]

You should have an increase as soon as you know you are pregnant, as I believe that most of the impact of your thyroid happens during the first trimester. Presumably your doctors knew you were hoping to conceive beforehand given your circumstances so I would imagine your thyroid was under control so don't worry about it too much, just make sure you get some good advice as early as possible!

I've had 3 pregnancies with thyroid conditions - the first with hyperthyroid in remission, second with hypothyroid because I'd had a thyroidectomy, both under hospital led care with my endocrinologist. The third I was under the care of my GP, I had spoken to them repeatedly about upping my meds, as that is what happened the previous pregnancy, and was told time after time that my levels were 'fine'. Unfortunately due to entirely unrelated and uncommon reasons the pregnancy didn't work out. But afterwards I had to have genetic counselling with an obstetrics consultant who told me that my thyroid levels had been anything but 'fine' and would have had consequences for the baby, had he survived. I'm not sharing this to worry you in any way, as it's very early days, and mine were very unusual circumstances, but just to say, be persistent and get that referral!

[Sarah_37 in reply to HEL123]

Thank u that’s worth knowing x

[Bexta6060]

Firstly, congratulations!! As a fellow hypothyroid IVF'er im delighted for you.

You might also have to push to get regular bloods done throughout your pregnancy, as your levels will change. Im not sure what the protocol is in the Uk but I was able to get them every 6 weeks when in Australia. In the 1st Tri I pushed for every 4 weeks. Theres always the likes of Medichecks if the GP is dragging the chain xxx

[Sarah_37 in reply to Bexta6060]

Thank u and thanks for the advice, don’t think I will relax in this pregnancy esp after a previous mc xx

[TBB21]

Ditto above. Guidelines say you should be referred to an endocrinologist. Also, get TFTs every TWO WEEKS in first trimester. If GP grumbles, change docs. Too important to be polite about.

There’s a book called “Your healthy pregnancy with thyroid disease”. It’s American and not IVF-focused but it’s a start.

[Sarah_37 in reply to TBB21]

Thank u will have a look for that xx