Pregnancy concerns

[hashihol]

Hello again, you helpful community. Don't worry if you don't have time to respond, but I thought I'd try. I've read the hypo in pregnancy information on various websites. Clinical trials and studies I've read scare me as I see there's little research in this and endocrinologist monitoring is most urgent in the first trimester...

I'm just over 5 weeks pregnant. I had a blood test a couple of days after the positive test. The results are 28/03/11 TSH: 0.18 (0.27-4.20) fT4: 21.2 (10.20-24.50). I was on 150mcg Levothyroxine for 2 months previous to this and have remained on this dose.

I'd had a private Medichecks done previous to this on 8th March and the results for this were as follows: TSH: 0.08 (0.27-4.2) Free T4: 20.2 (12-22) Free T3: 5.20 (3.1-6.8).

I know there are only a couple of weeks between these results, but I got tested asap on positive pregnancy result. Originally the GP said I could increase my dose by 25mcg (to a total of 175mcg) as I told her everything I'd read from BTF about doing this, and I took 2 of these increased doses 48hrs apart. On receiving the blood test results, the GP contacted the endocrinologist at my request, and they told her that by taking the extra 25mcg I'd be overmedicated, so I should stop and continue with my original 150mcg.

The need for thyroid hormone increases rapidly in the first weeks of conception and I'm pretty scared because of the studies I've read where hypo women who aren't monitored carefully have a far higher incidence of miscarriage, babies born with birth defects and impaired intellectual and cognitive development. I've been told that I will referred to the maternity endocrinologist by the midwife when I have my first appointment which is not until May. The referral may take weeks and that will mean I won't see an endocrinologist until after the first trimester when it's already too late. I do see that right now my levels are very good, however the rapid increase in the need for thyroxine scares me. I miscarried last time and this time really wanted everything to be ok. I feel quite abandoned by the fact that I won't be referred until it's too late.

At present I have another blood test booked in with the GP for 4 weeks time. Should I just continue on the same dose hoping that it will be sufficient? Should I make a song and dance or possible try and see a private endocrinologist (money is tight though). Or should I increase the dose every other day with the 25mcg?

[radd]

hashihol,

A woman with untreated or mismanaged hypothyroidism is at greatest risk of a miscarriage during her first trimester but your levels are excellent.

However, up until about 12 weeks you will be supplying both baby’s and your own increased demand for thryroid hormones and usually one or several 25mcg Levo dose raises are necessary as levels begin to drop. Also oestrogen levels will raise with the corresponding TBG (thyroid binding globulin) that risks binding a small proportion of thyroid hormone.

Blood tests should be performed every four weeks during the first trimester, then at 16 and 28 weeks of gestation, or more frequent if needed. You are not waiting for the total cell saturation that the usual recommended six week blood test determines but an immediate TSH blood serum level of low-normal range (0.4–2.0 mU/L) and FT4 concentration in the upper reference range as stated by NICE.

As you already have these results you don’t need an immediate dose raise and certainly not 25mcg Levo every other day! but if you worried ask your GP to bring your next blood test forward a little as you need to be reassured so as not to worry.

Congratulations by the way 😊

[Serendipitious]

hashihol,

Congratulations! I was also wondering if you have Hashimoto’s? Your username suggests so.

I recommend reading up on these articles by Dr Izabella Wentz, known as The Thyroid Pharmacist. She also states that TSH should be no more than 2. You seem fine in this regard.

These two articles by her are about the thyroid and pregnancy and are invaluable:

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

All the best, take care.