Hello I was diagnosed with an underactive thyroid in 2014.
I had my first baby in September 2017. My thyroxine was never increased during that pregnancy and I had a prem baby.
We are now wanting to try for another baby and I had my TSH checked today.
Results were:
TSH 4.15 mlU/L (range 0.27 - 4.2)
My optimum level is around 1.5.
I spoke to the doctor about my TSH levels and TTC as well as the fact my symptoms j have returned and they refuse to increase my dose (currently on 50mcg).
I don't know where to go from here and whether to start to TTC as I keep seeing levels about 2.5 but the doctor said that's when I get pregnant and not before and in in euthyroid range.
Thank you
Written by
Shannon1471
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If you have an underactive thyroid (hypothyroidism)
If you are planning a pregnancy you should speak to your GP to arrange thyroid blood tests and ideally aim for a Thyroid Stimulating Hormone (TSH) level of less than 2.5mU/l at the time of conception
A common problem for people who are hypothyroid is that their stomach acid is low and this reduces absorption of nutrients from food.
You will be healthier and so will any offspring you have if you could optimise your mineral and vitamin levels. It's not realistic to expect to optimise all of them. There are too many to test and treat all of them unless you have enormous piles of cash and are prepared to rattle your way through pregnancy (not a good idea I would guess), but the ones which are considered very important for anyone with hypothyroidism are :
Ferritin (iron stores) and serum iron
Vitamin B12
Folate
Vitamin D
You could do some research online on the effects of low nutrients on offspring by searching for something like :
Effects of low vitamin D during pregnancy
Effects of low vitamin B12 during pregnancy
Effects of low iron during pregnancy
...and so on...
There are lists of vitamins and minerals that would be worth looking into, even if it is just for curiosity :
If testing shows that you are low in some minerals and vitamins then it is worth asking on here for suggestions on what you could supplement. There are some that get discussed a lot and we can make some sensible suggestions about what supplements to avoid and which ones are worth looking into.
It is important to adequately manage hypothyroidism in pregnancy (BMJ 2007;335:300).
There is an increased rate of early and late obstetric complications with both overt and subclinical hypothyroidism, hence the rationale for treating all in this group.
Untreated hypothyroidism can also affect the neurodevelopment of the foetus.
Pregnancy can trigger the progression of subclinical hypothyroidism to overt hypothyroidism and can increase levothyroxine requirements.
Adequate treatment of hypothyroidism during pregnancy reduces complication rates.
Refer women with overt and subclinical hypothyroidism for shared obstetric care. Aim for TSH 0.4–2.5 mu/l.
Increase usual levothyroxine dose by 30% once pregnancy is confirmed.
Monitor TSH at least once each trimester.
If hypothyroidism is diagnosed during pregnancy, specialist assessment is advised to aim to correct TSH as quickly as possible.
Essential to test vitamin D, folate, ferritin and B12
Folate and B12 especially must be optimal BEFORE TTC
Add results and ranges if you have them
IMPORTANT See pages 7&8 too re when to increase dose of levothyroxine once pregnancy is confirmed
Recommend getting FULL Thyroid and vitamin testing
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 if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test vitamin levels
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)
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
guidelines by weight might help push for dose increase
Even if we 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
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.
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.
RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.
That is a ridiculously low dose. Another doctor who seems to be unaware that once people are diagnosed as hypo, that the aim is a TSH of 1 or lower with both Frees, FT4 and FT3, in the upper part of the ranges.
T4 is inactive and should convert to T3 as it is T3 which is needed in our millions of T3 receptor cells - the brain and heart have the most.
You have no thyroid and your TSH is over 4 and your only taking 50mg and he won’t raise it ..... thats absolutely disgusting medical treatment by your doctor ... switch doctors or get endo!
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