Pregnancy

[Cazzalouise]

I’m writing on behalf of my 35 yr old daughter. She has tested pregnant but has had a bleed. She is going for a scan on Saturday. She doesn’t have much hope. She rang her doctor told them she was pregnant and hypothyroid. They were disinterested. She quoted the nice guidelines to the dr who then got snotty. She says she should have been tested straight away and levo upped. We are all devastated for her and angry at the dismissive dr. She’s getting a private thyroid and private test on Saturday. None of these were offered to her. Any pregnancy advice please? Thankyou in advance

[SlowDragon Administrator]

What were her most recent thyroid and vitamin results

How much levothyroxine is she currently taking

Does she always get same brand of levothyroxine

Essential to test vitamins too, hopefully you have included those in testing

What vitamin supplements is she currently taking

Presumably she has Hashimoto’s?

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

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)

If/when also on T3, make sure to take last third or quarter of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

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 vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

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

monitormyhealth.org.uk/thyr...

If she is taking any vitamin supplement that contains biotin, this should be stopped a week before ALL blood tests

Pregnancy guidelines

thyroiduk.org/having-a-baby-2/

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

IMPORTANT See pages 7&8

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

[Cazzalouise in reply to SlowDragon]

She was on 100 levo off the bat. The doctor said it went by weight. I was surprised at this as I’m also hypo 56? and take 100

Levo. I think her levo is always the same.

She didn’t have vits done it’s all been such a shock. The private clinic charged her £120.00 just for basic test. I will relate this to her. I’m so angry she was dismissed by the doctor they knew she was trying for a baby. Her last dr test was last September and they said it was fine. Still not giving her printouts saying it’s not their policy. She’s so new to this

Thank you so much for your advice

[SlowDragon Administrator in reply to Cazzalouise]

We are legally entitled to printed copies of our blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

healthunlocked.com/thyroidu...

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

Strongly recommend getting vitamins tested asap

B12 and folate are critical for baby’s development

Iron and ferritin important too

vitamindtest.org.uk

[SlowDragon Administrator in reply to Cazzalouise]

guidelines on dose levothyroxine by weight

Even if we don’t start on full replacement dose, most people need to increase levothyroxine 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...

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[humanbean]

You may have to dig quite a bit to find out information that is useful to your daughter, but these are a few links that might be helpful :

See page 4 : gps.camdenccg.nhs.uk/cdn/se...

List of research papers on the subject of pregnancy in subclinical hypothyroidism :

library.wmuh.nhs.uk/wp/libr...

List of research papers on the subject of pregnancy in overt hypothyroidism :

library.wmuh.nhs.uk/wp/libr...

Reference ranges for Thyroid Function Tests including ranges for pregnancy which are shocking :

frontierpathology.nhs.uk/pu...

It really wasn't that long ago - a year ago and before? - since the TSH to be aimed for in early pregnancy was < 2.5. The NHS has obviously decided to save money and has raised that TSH to be actually HIGHER than the target TSH in healthy, non-pregnant adults, which is absolutely incredible and just mind-boggling. I cannot see how that can be justified under any circumstances, unless they want to increase the number of miscarriages and don't care about the health of any offspring produced from mothers with a high TSH.

I can guarantee the NHS will ignore this information...

healthline.com/health/mthfr...

And finally - but probably not that helpful :

patient.info/doctor/thyroid...

[Cazzalouise in reply to humanbean]

Thank you so much for your information. The NHS has badly let her down