Tsh - 15.7

[Journeytobabyj]

I have been trying to have a baby for 18 months but have had no luck. I have recently been diagnosed with subclinical hypothyroidism with a tsh of 15.7 and put on 25 levothyroxine. I have been doing my research and most people seem to have a much lower tsh and are on a higher dosage of levothyroxine. I feel like my doctor is failing me and medication should be started a lot higher if I want to have any chance of conceiving! What do you think?

[Aurealis]

it’s a low starting dose, I believe used especially for people with underlying conditions, a cautious starting dose. It would only be enough if your thyroid just needed a little bit of help. More likely, your body will recognise this thyroxin and downgrade natural production and so your need for thyroxin will increase not decrease. You’ll need an increase in dose then to get well.

[TiggerMe]

Good advice from Aurealis, you are certainly not sub clinical if you are over their stupid hallowed 10!

You might like to take a look at this book.... had a lot about fertility 🤗 you can get the gist by looking inside 😉

smile.amazon.co.uk/gp/produ...

Neal Barnard MD

[SlowDragon Administrator]

Welcome to the forum

With TSH over 10 you are not “sub clinical “ you are clinically hypothyroid

ESSENTIAL to test vitamin D, folate, ferritin and B12 plus thyroid antibodies

Have these been tested yet

If not, request they are done at next test

Standard starter dose levothyroxine is 50mcg

(unless over 65 or heart condition)

Which brand of levothyroxine have you started on

Many people find different brands are not interchangeable

Levothyroxine doesn’t “top up” failing thyroid, it replaces it

So starting on too small a dose can make symptoms worse

Bloods should be retested 6-8 weeks after each dose increase

Guidelines on eventual dose levothyroxine you are likely to be on is approx 1.6mcg per kilo of your weight per day

So unless very petite likely to need to be on at least 100mcg levothyroxine if not higher

Very important, especially before TTC that your vitamin levels are tested and improved to OPTIMAL levels

Both folate and B12 are Goldilocks vitamins…..you don’t want to low a levels (risk of neural tube hydrocephalus or spina bifida) or too much ….possible increased risk of autism

Before considering TTC thyroid and vitamin levels need to be optimal and stable 

verywellhealth.com/infertil...

aim of levothyroxine is to increase the dose slowly upwards in 25mcg steps until TSH is ALWAYS below 2. Most people when adequately treated will have TSH around or under one .

Most important results are always Ft3, followed by Ft4

Test thyroid levels early morning ideally just before 9am, and last dose levothyroxine 24 hours before test

Pregnancy guidelines 

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

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

See pages 7&8

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

Also here - dose increase in levothyroxine as soon as pregnancy test confirms conception 

cuh.nhs.uk/patient-informat...

thyroidpharmacist.com/artic...

Low ferritin, low thyroid levels and miscarriage 

preventmiscarriage.com/iron...

Low iron and hypothyroid 

endocrineweb.com/news/thyro...

[SlowDragon Administrator]

Starting levothyroxine - flow chart 

gps.northcentrallondonccg.n...

Even if we frequently don’t start on full replacement dose, especially if been hypothyroid some time……standard starter dose levothyroxine is 50mcg

most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near 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.

Also here 

cks.nice.org.uk/topics/hypo...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine: 

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months. 

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range. 

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[SeasideSusie Remembering]

Journeytobabyj

There are two ways of initiating treatment with Levothyroxine as outlined in the NICE guidelines:

cks.nice.org.uk/topics/hypo...

Initiation and titration

The dose of levothyroxine (LT4) should be individualized on the basis of clinical response and thyroid function test (TFT) results. Treatment must be monitored regularly to determine an adequate dose and to avoid both under- and over-treatment.

The NICE clinical guideline recommends:

Consider starting LT4 at a dosage of 1.6 micrograms per kilogram of bodyweight per day (rounded to the nearest 25 micrograms) for adults under 65 years of age with primary hypothyroidism and no history of cardiovascular disease.

Consider starting LT4 at a dosage of 25–50 micrograms per day with titration for adults aged 65 years and over, and adults with a history of cardiovascular disease.

The British National Formulary (BNF) recommends:

For adults aged 18–49 years — initially 50–100 micrograms once daily; adjusted in steps of 25–50 micrograms every 3–4 weeks, adjusted according to response; maintenance 100–200 micrograms once daily.

The "dose by weight" is not for everyone and starting too high can be counter productive for some people. Many are best with a lowish starter dose and gradual titration. The 25mcg starter dose is generally for children, the over 60s and those with a heart condition. There is no reason why your GP could not have started you on 50mcg then retested in 6 weeks and titrated by 25mcg every 6-8 weeks thereafter (testing each time to check levels).

Perhaps discuss with your GP about increasing your dose to 50mcg now and then following the titration method outlined above.

For successful conception and pregnancy a TSH of below 2.5 is recommended so you might want to read up on this. ThyroidUK has some information which you can use as a starting point:

thyroiduk.org/having-a-baby/

For future reference regarding tests, and information about how to take your Levo:

Always advised here, when having thyroid tests:

* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day.

In fact, 9am is the perfect time, see first graph here, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm:

healthunlocked.com/thyroidu...

If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.

* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw. If taking NDT or T3 then last dose should be 8-12 hours before blood draw, split dose and adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

Also, take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours.

We need optimal nutrient levels for any thyroid hormone to work properly so ask your GP to test

Vit D

B12

Folate

Ferritin

Many of us use private tests as we can't always get these done with our GP. We have a list of recommended private labs.

[tattybogle]

Hi there . yes on NHS , 50mcg is the usual staring dose (unless over 65 or with heart issues). starting on 25mcg is an extremely cautious approach so ask GP why they are being so cautious in your case .. but whatever.. they shouldn't leave you on 25mcg for very long . a few weeks at most .. not months and months.

Assuming your TSH 15.7 was before you started taking Levo ? and you have not had a repeat blood test yet on 25mcg .

Blood tests should be done no sooner than 6weeks after a dose change / increase .. TSH is very slow to settle to it's new level when we change something . so testing TSH earlier than that can give a false impression of the effect of that dose . Most people will end up on somewhere between 75mc - 150mcg .. but it's very individual and hard to predict what dose someone will do best on . (as a very rough 'guestimate' ~ bodyweight (Kg ) x 1.6mcg Levo per day can be expected in theory .. but in practice that does not apply to everyone , not by a long shot )

Treating thyroid does take quite a lot of time .it takes several months (not several weeks) to find the best dose for you and become stable ... the dose is usually increased 25mcg at a time and there is no short cut to allowing time for the body's cells to recover. All the body's cells/ organs have not had quite enough thyroid hormone for a long time by the the time you end up with TSH @15, and it takes a while for them to function together again properly, even once you are on the best dose for your needs.

Getting pregnant while still trying to find the right dose is not a good idea.. the baby needs enough T4 from you in the very early day's / weeks after conception in order to develop properly ,( until it grows a thyroid of it's own ). Fortunately, nature seems to know this ,and this is presumably why we generally have great difficulty getting pregnant if we are hypothyroid , and why there are more miscarriages.

But follow the advice on here . prioritise yourself for now , allow yourself time to get well enough to have a successful pregnancy , (and be well enough to enjoy the baby when it comes ) .... probably, within a year you will be ok ... maybe shorter . but don't rush it .. you have to fix this first , and unfortunately with hypothyroidism . everything is an exercise in patience .

[helvella Administrator Thyroid UK]

It is also said that you need to have adequate thyroid hormone levels for some time before getting pregnant. Not just enough treatment, for just long enough.

Those on levothyroxine are often advised - and there are many written sources - to add 25 micrograms to their dose the moment they think they are pregnant, Insufficient is bad for development as well well as the mother.

[Journeytobabyj]

Thank you for all of your replies. It sounds like pregnancy won't be happening any time soon.

[mistydog in reply to Journeytobabyj]

Please cease trying and focus on getting the thyroid right, I don't want you to go through possible multiple miscarriage because that's often the result until thyroid is optimised. Good luck

[shaws Administrator]

The following link might be helpful:-

healthunlocked.com/thyroidu...

[3450]

75 is good to start, and reduced by 25

if needed after retest in 6 weeks.

You need to focus on T3 levels and

ignore your uneducated doctor.

They prefer to keep you in the region

of under 10, which is not optimum.