We are undergoing fertility treatment due to premature ovarian failure, of which our first IVF cycle ended in miscarriage at 9 weeks.
I have Addison’s disease, so pushed to have further testing done and have just received a letter from the fertility clinic to my GP, saying my TSH is 3.1 and to start me on a dose of 25mg thyroxine.
Clearly I am going to follow their advice, as we are due to start a second IVF round imminently and I don’t want to unnecessarily risk another miscarriage.
My question is, is 3.1 remotely significant, if it weren’t for the fertility aspect (they want it down near 1 and my T4 in the mid to upper range)?
I presume such a low TSH wouldn’t result in any actual symptoms?
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Bramble83
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Many struggle to get pregnant and/or have a higher risk of miscarriage if TSH is above 2.5, so your doctor is right to start you on treatment.
You should be retested in 6 weeks to check your TSH is coming down, and dose may need to be increased. When you do get pregnant, your thyroxine dose should be increased by 50mcg as well.
Unfortunately everyone is different. 25mcg is quite a low starting dose, most people start on 50mcg, but 1 person might be fine on 25mcg, while another might need 150mcg. It's hard to know until you get yourself re-tested in 6 weeks.
Well you may feel fine, or you may be symptomatic, with a higher in range TSH, it's an individual thing, as are all aspects of thyroid health. But it isn't so much that the TSH itself is a problem, more what it implies in terms of your thyroid hormones and thyroid health. A rising, or higher in range TSH - a pituitary hormone - can indicate failing, or less than optimal thyroid function, and therefore the presence of falling or low thyroid hormones. Pregnancy is in any case, an overall thyroid drain for expectant mothers, not least because for a little over the first trimester, the foetus has no thyroid function of its own and is therefore wholly dependent on its mothers. The mother therefore needs to have optimal thyroid levels before becoming pregnant, for her own health; but also to supply her baby - the latter being very important because adequate thyroid hormones are critical to the baby's overall foetal development and especially to its brain development.
The CKS/NICE guidelines indicate the appropriate protocols for overt and subclinical hypothyroid women planning and achieving a pregnancy, and of particular importance is the underpinning reference material listed towards the end, should you wish to read further.
Yes, it could be too high, so your gp was right to start you on thyroxine and should be increased in a few weeks. Are your progesterone levels ok, as too low may also be a cause of miscarriage?
Thank you. My progesterone is always very low but through the IVF you’re on a very high dose of it, so thankfully that doesn’t matter for the IVF cycles.
Is there a link between thyroid and progesterone out of interest?
IVF is a very stressful process and to have the joy of a successful insemination and then miscarry must be torture. I’m so sorry for your loss.
As you are so going to try again I think I would get private blood tests to check all vitamin and mineral levels. Check your diet and also get a full thyroid check. I would tick all these boxes before I would start another round of IVF.
Thank you. They did do a full thyroid check and the TSH was the only thing they flagged, but I don’t have the other results. As it’s being done by the fertility clinic, not the GP they seem super stringent 😀
I had a medichecks done last year for all the vitamins etc and everything was okay except for ferritin and vit d, so I have been supplementing them for about a year now, so all should be okay.
Supplementing is no guarantee of raised levels. Its best to retest these things again after a few months plus to confirm that your supplementing is working. If your levels haven't raised successfully you may need a higher dose or more bioavailable form.
We tend to have deficiencies, particularly with htypothyroid, because the body isn't successfully absorbing vitamins from food. This means you may also struggle to absorb them from supplements.
In general having a deficiency bad enough that a doctor will point them out is a red flag that your other vitamins might not be optimal, so well worth confirming they are good.
I can only comment about my personal experience. Many failed ivfs and mc. I forced clinic to do Thyroid tests which came back just over 4. My antibodies were sky high. My fertility clinic refused ivf if I didn't drop below 1. GP said I should just go ahead as I was 'normal' under 5. I only had 2 frozen embryos left and knew it was my final chance so listened to clinic instead.
To be honest it took 2 years to drop my TSH down to this level. I would recommend not having TEVA brand and only keeping to 1 brand of tablets rather than combining 2 if possible. It took me a long time to realise that my brands were not working or doing the job of lowering TSH. Wishing you all the best. xx
I started on 25mg it did nothing. I increased 25mg every 6-8 weeks and it made very little difference. When I got to 100mg I had Thyroid checked at clinic and they said it was jumping upwards if anything. I was given a 'mash of brands' from Gardines the chemist though to be honest. 25mg of this brand, 50mg of that, another 25 of something else. When I complained that it looked like a 'thrown together bag every 6 wks' I was told 'you get what we're given. It's the same ingredients and the brand doesn't matter'. My other half suggested I pick up my prescription personally and take it to Boots the chemist - a drive away. They gave me a different brand altogether in gold boxes (Actavis I think) and I haven't looked back. My TSH started to come down. It was the push to 150mg that made the difference. I'm still on that doseage. Don't take TEVA or 2 diff brands would be my recommendation. My ivf clinic told me it would take 6-8wks of being on levo for my TSH to drop and start ivf, but 2yrs later and I almost gave up. Maybe start with 50mg if you can... it may save you 6-8wks waiting on 25mg. Wishing you all the best. It did finally work for me, but watching bloods dip and dive every test would send me in tears. Just my experience xx
Hi Bramble, I only realised I had Hashimotos because I was Ttc and it wasn’t happening, I had tests which picked up that my thyroid was starting to fail, my t4 was in range but right at the lower end and my tsh was 5.6. I actually felt totally fine, I eat a good diet and do lots of exercise and didn’t really have any symptoms at all except that I was struggling to fall pregnant. I was put on levothyroxine initially just 50mg, then 100mg and finally 125mg which brought my tsh below 1 and my t4 in the upper range and I immediately fell pregnant. My baby is now 6 weeks old.
Along the way I spoke to other doctors who were quite happy when my tsh hit 2.2 but my own GP advised we get it below 1. It was only when it fell to that level that I actually got pregnant.
In terms of health and feeling well I’ve felt no different on or off the meds but my GP did say that as my thyroid was still holding out (my t4 was still in range) this wasn’t uncommon. But all I do know is that it wasn’t until my t4 was in the upper range and my tsh suppressed that the pregnancy magic happened.
Thanks so much for sharing this! I know when we first started this whole fertility process my TSH was 2.5 even then, but my GP was okay with that. It seems the fertility clinic is much more stringent.
Because I have Addison’s disease, it’s very hard to know whether or not i’m symptomatic! The only thing I have noticed in the last 6 months is suddenly I cannot lose weight!!! I’ve always been slim (not naturally but because I try very hard to stay that way) and it’s always been a case of 6 weeks of diet and exercise before holiday and i’d easily drop half a stone.
This last 6 months, I’ve tried twice to lose weight before a holiday, both times doing 1200 calories a day and running 4 times a week (5-10km each time) and to my utter bewilderment, didn’t lose a pound, which was very odd for me!
Do you think 25mg is a high enough initial dose? Is there any harm in starting at 50mg? I have free reign to do what I want with my prescriptions from my endo, because of my Addisons (you have to self dose your steroids), so could easily start with 50mg if I wanted.
Congratulations on the birth of your little one- lovely to hear it worked out for you 😀
No problem. When I was first diagnosed I was at a loss and felt very impatient and scanned the internet for advice and help. This group was helpful and I ended up having private blood tests to ensure all my vitamin levels were all ok, which they were. I even went gluten free for a period (Made no difference to me), basically anything to help me fall pregnant.
I think as your tsh is not all that high and 25 is probably ok and I think they like to slowly introduce the levo into your system. It sounds like as you are now with a good consultant who is on board with the sub 1 optimal that’s half the battle. For me to reduce my tsh from near 6 to sub one it took 6 months, at one stage i was on 150mg and was over medicated, so reduced down. You may find you respond well to the meds and that 25 is all you need.
I hear you on the weight loss. I’m 40 so not sure how much is age related but am worried the baby weight will never go!
Best of luck to you, I really hope that getting your tsh in good shape will put you in a good place regarding your ivf. Being diagnosed is half the battle and I really think for so many people trying to conceive this is a massively undiagnosed issue, GPs often accept anything below 4 as normal but I know for me that it was impossible to fall pregnant when the levels were that high it was only when they fell below one it worked. I had a miscarriage, very early one and nothing to do with Hashimotos and fell pregnant the following month after. I now have a lovely baby boy so there’s lots of hope.
What is also significant is the time of day you bloods were drawn. My daughter had bloods drawn in the afternoon 4.1 first thing in the morning 8.9 very big difference. She too miscarried, is now on 150mcg Levo and 31 weeks with a baby girl... good luck
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