Trying to conceive, high TSH. Please help

[Acadia0708]

Hi everyone - I have hashimotos, diagnosed 7-8 years ago. Currently on 50 and 75mg alternating days. Supplement with folate, b12, vit 3, selenium and multivitamin. We’ve been trying for a baby, unsuccessfully for a few months. Had bloods done 2 weeks ago - TSH was 4.6 and FT4 22 (upper end of the range). Did the tests again yesterday and came back with TSh 2.88 and FT4 21. GP says they’re perfect. But I know TSH needS to be below 2.5 to Conceive and not miscarry. Tempted to increase my own dose to 75 and see if I conceive, but that’s probably not right and mindful FT4 at upper range. Just desperate. Please help

[SlowDragon Administrator]

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially as you have Hashimoto’s

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Is this how you do your tests?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus ultra vitamin

medichecks.com/products/thy...

Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

Many Hashimoto’s patients are poor converters of Ft4 to ft3

Essential to test Ft3 and vitamins

Are you on strictly gluten free diet

[Acadia0708 in reply to SlowDragon]

Thank you, yes I’m on strictly gf diet and take levothyroxine apart away from food and drink. However I did take it before the test and not after. I tried to do the home finger tests a few times but I must be doing it wrong as the blood keeps getting haemolysed.

It’s just so frustrating that the GP / NHS would test for any of these things

[SlowDragon Administrator in reply to Acadia0708]

See/contact different GP and request 25mcg dose increase in levothyroxine and request vitamin D, folate, ferritin and B12 included in next blood test 6-8 weeks later

[SlowDragon Administrator in reply to Acadia0708]

Also ....guidelines by weight might help push for dose increase

Even if we frequently don’t start on full replacement dose, most people need to increase dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

gp-update.co.uk/Latest-Upda...

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Before considering TTC levels need to be stable

verywellhealth.com/infertil...

Pregnancy guidelines

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

gp-update.co.uk/files/docs/...

thyroiduk.org.uk/tuk/guidel...

Important See pages 7&8

btf-thyroid.org/Handlers/Do...