Just a quick one from me. I have hypothyroidism and have been on 50mcg Levothyroxine since Jan. I am on my second cycle and requested they check my thyroid again and TSH is currently 2.9 which is above the 0.4-2.5 mUi it should be when TTC.
The doctor today prescribed me to increase my meds and take 75mcg. I asked whether I can have another test just before transfer and she said they wouldn’t recommend as it’s unlikely to have made a difference by that point (currently I think around 9-10 days away from transfer). Just wanted to get perspective if anyone had done something similar and checked their thyroid before transfer itself and were able to see a difference? Or if increasing dosage now will support and help my transfer?
Thank you xxxx
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PenguinBlue
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Bloods should be retested 6-8 weeks after EACH dose increase
Do you know if you have autoimmune thyroid disease?
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 NOW
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)
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
Levothyroxine doesn’t “top up” failing thyroid, it replaces it. Hence why it’s important to be on high enough replacement dose
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, or near 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.
Hi slow dragon, thank you so much for all your information - my clinic has definitely not given me any of this. My free t4 level was also tested and is at 21.2pmol/L
I’m definitely going to look into getting a full blood work done with my GP.
Was this test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test?
Poor conversion of levothyroxine (Ft4) common if vitamins are low
Hi thanks for the quick replies! I wasn’t told to not eat beforehand so I had eaten around 45 mins after taking levithyroxine that morning (and had my blood test around 2 hours after eating)
I am currently taking prenatal vitamins - Vit B12 (800% NRV), folic acid (200% NRV) and Vitamin D (400% NRV) all included
Hi PenguinBlue - just wanted to let you know I’ve had two separate endocrinologists tell me that my TSH should be around 1 or below if TTC. Your dose increase would have had some sort of impact in 10’days I would have thought but it’s usually a few weeks to see the full effect. Can you delay your transfer a few days at all? Good luck, sending you lots of baby dust xx
Hi Arlie, thanks for letting me know - it’s interesting my doctors are so unconcerned with my thyroid - they think it’s just slightly elevated.
Unfortunately like human bean says below, I cannot postpone my treatment as I am on a fresh cycle but will definitely bring it up with them if this fails.
Thank you for your input and luck, I definitely need it xxx
No problem and apologies if I’ve made you worried. I’ve not been through ivf so don’t know the detail around timings. There are a few other ladies on the fertility forum that have posted but generally there doesn’t seem to be enough info and even fertility specialists don’t seem to be very clues up. Your tsh isn’t super high in the grand scheme of things so hopefully you will be fine one other thing to note is that during pregnancy levo should be increased by 25mcg automatically as baby doesn’t make its own until second on third trimester I think so also worth bearing in mind and lining up gp to do that. It’s in the thyroid /pregnancy guidelines somewhere if you need a reference X
Hi Arlie, no problem, it’s good to get input and information as I am not very knowledgable on thyroid issues
Yes I did read that medication should be increased 25mcg after positive test so will definitely let my clinic know if I am lucky to get to that stage.
Yes I hope that as my TSH isn’t much higher than the expected norm I’ll be okay with alternating my dose in the lead up to the transfer as my doctors have requested.
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one other thing to note is that during pregnancy levo should be increased by 25mcg automatically as baby doesn’t make its own until second on third trimester I think so also worth bearing in mind and lining up gp to do that. It’s in the thyroid /pregnancy guidelines somewhere if you need a reference X
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