I was wondering if you could help me as I’m not sure my GP fully understands thyroid issues and I won’t be able to see a private endocrinologist until next week.
Today I am 8 weeks pregnant through IVF.
Last week when just under 7 weeks pregnant I had a full thyroid & prolactin blood test.
These are the results:
TSH: 1.6
T4: 17.1
T3: 4.6
Prolactin: 2000
Does anyone know if these numbers seem normal for 7 weeks pregnant?
I am on 75mcg levothyroxine daily and 2.5 Bromocriptine as this was prescribed for previously when not pregnant, for having high prolactin.
The fertility clinic said to stop bromocriptine when I got a positive pregnancy test, but my GP says to stay on it until I see the midwife in a weeks time - does bromocriptine harm anything in early pregnancy??
😊 thanks in advance if anyone can advise if my numbers seem normal and about bromocriptine in early pregnancy!
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Beanybeanz
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No they haven’t tested me for any of the things you’ve mentioned!
And again, I asked about increasing levothyroxine and the GP said to wait for my midwife appointment at nearly 9 weeks (I suspect two previous early miscarriages have been because of dodgy thyroid levels)
I ended up increasing it myself after reading the British Thyroid Association recommendation to increase it as soon as you get a positive test by 25mcg. Ive ended up taking an extra half a tablet 3 x per week which is the only reason it’s 1.6 - if I hadn’t in sure it’d be above the 2.5 limit it should be.
Oh and when I asked the fertility clinic they basically said they’d done their bit and it’s now all in the hands of the GP! Hence me coming on here to see if anyone else could give advice as I don’t seem to be getting answers I can trust
Congratulations on your pregnancy, I hope you are feeling well.
I am also navigating pregnancy and thyroid issues so lots of love and solidarity.
Have you increased your dose since you have confirmed pregnancy? If not give your GP a call and ask to, I have had to do this both pregnancies and GPs don't seem to know. I think its 25% increase that's recommended and then test again (but check this). The midwives will probably take over checking your bloods regularly once your booked in.
When you are having a blood test for thyroid hormones, always get the earliest possible appointment. It is a fasting test (you can drink water) and if you're taking thyroid hormones you'd miss this dose and take after the blood test.
You take thyroid hormones on an empty stomach (usually when we get up) with one full glass of water and wait an hour before eating). Food can interfere with the uptake.of the hormones
The information on the likely increased demands for LT4 treatment during pregnancy are based on the Endocrine Society guideline [De Groot et al, 2012], the ETA guidelines [Lazarus et al, 2014], the ATA guidelines [Alexander, 2017], and expert opinion in a review article [Chaker, 2017].
Women with known thyroid dysfunction who are taking LT4 may need the dose increased by 30–50% to maintain euthyroidism from as early as 4–6 weeks' gestation, for optimal fetal growth and development, with the need for regular TFT monitoring [De Groot et al, 2012].
Women with overt hypothyroidism taking LT4 pre-pregnancy may need an increase in LT4 by 25–50%, depending on the aetiology of hypothyroidism and the pre-pregnancy TSH level [Lazarus et al, 2014].
The ATA guidelines note that one option is to increase the daily dose of LT4 by approximately 25–30% as soon as pregnancy is suspected. In women with overt hypothyroidism, the increased requirement for LT4 occurs as early as 4–6 weeks' gestation. Such requirements gradually increase through 16–20 weeks of pregnancy and plateau thereafter until the time of delivery. It notes that pregnant women with hypothyroidism, subclinical hypothyroidism, or those at risk of hypothyroidism need frequent monitoring of TFTs, particularly during the first half of pregnancy when there is increased demand for T4 [Alexander, 2017].
The ATA guidelines also note that treatment of subclinical hypothyroidism in pregnancy with LT4 may reduce the risk of adverse pregnancy outcomes in some women, particularly those with positive thyroid peroxidase antibodies (TPOAbs) [Alexander, 2017]. This contrasts with a meta-analysis of 18 studies at low-to-moderate risk of bias (n = 3995 women), which found a lack of evidence regarding the effect of LT4 replacement therapy in pregnant women with subclinical hypothyroidism [Maraka, 2016].
In your shoes I would increase Levo dose by 25mcg immediately, I wouldn't ask for permission.
I would also take the advice of the fertility clinic over any suggestions from a GP.
You don't have time to muck about. Your baby is growing all the time and can't wait for a week for the convenience of a doctor or a midwife.
The references given for the above advice from NICE are as follows :
1) De Groot, L., Abalovich, M., Alexander EK, Amino, N., et al. (2012) Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism 97(8), 2543-2565.
2) Lazarus, J., Brown, R., Daumerie, C. and et al. (2014) 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. European Thyroid Journal 3(2), 76-94.
3) Alexander, E.K., Pearce, E.N., Brent, G.A. et al. (2017) Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 27(3), 315-389.
You need to get your vitamin B12, folate, vitamin D, ferritin, and iron measured to be sure that your levels are close to optimal, and supplement if they are not. Ideally, optimising nutrients should have been done before you got pregnant.
Having said that, it would be a good idea to research the effects of supplementing the various nutrients during pregnancy that I've mentioned before you actually do it, just in case there are any warnings about it.
It goes without saying that you need to eat a nutrient dense diet during pregnancy, including sufficient protein and fat, and keeping the sugar down to a minimum.
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