Thyroid results - advice please

[9422x]

Hello,We've just gone through our second miscarriage in 4 months. The first was diagnosed as a pregnancy of unknown location at 7 weeks which passed naturally. With the second, a scan at 7 weeks showed an empty gestational sac that was only measuring 4mm.

I've not got any diagnosed thyroid issues but after the first loss, I had my thyroid tested due to family thyroid issues. The result was TSH 2.

I've just had my thyroid retested and the results were TSH 2.3 and free T4 12 pmol/l. I'm also being tested for blood clotting issues.

The thyroid results say they're in range on my NHS app but I was wondering if anyone could offer any further insight please? Is my free T4 low? Are they normal to sustain a pregnancy?

Thank you in advance x

[SlowDragon Administrator]

Welcome to the forum

Very sorry for your loss

Just testing TSH and Ft4 is inadequate

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

What vitamin supplements have you been taking

Where vitamins tested

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test 

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

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

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

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

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

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

monitormyhealth.org.uk/

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65 

(Doesn’t include thyroid antibodies) 

monitormyhealth.org.uk/full...

10% off code here 

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

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Only do private testing early Monday or Tuesday morning. 

Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

Link about thyroid blood tests

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

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

when you say blood clotting issue do you mean APS

APS and autoimmune thyroid disease may be connected

APS and pregnancy issues

tommys.org/pregnancy-inform...

enherts-tr.nhs.uk/content/u...

[PurpleNails Administrator]

Welcome you forumSorry for your losses.

Getting a full test might be a good idea.  Especially one with folate, ferritin B12 & Vitamin D.  

These are rarely tested & ideally should be optimal before conception.  

Often much easier to arrange own test to get complete picture in 1 go rather than “battle” with GP & specialist doctors over what & who should & test when.  

What is the range on your FT4?

Always add a range on a test results as they vary between labs. 

[9422x in reply to PurpleNails]

Thank you. The range was 7.8-21 and I had the blood taken about 7.30am. I've not had Vitamin D or folate tested but have been taken Vitamin D tablets and folic acid since last May

[PurpleNails Administrator in reply to 9422x]

FT4: 12 pmol/l (Range 7.8 - 21) is 31.82% through range.  That might be normal for you or it may be a sign thyroid struggling.  

FT3 is the more active hormone, some is produced from thyroid but most is converted from FT4.  You need FT3 levels tested & thyroid antibodies. 

What dose of vitamin D & Folic acid have you been taking?

[9422x in reply to PurpleNails]

That's interesting, thank you. Can this impact pregnancy?I've been taking 400mcg of folic acid and 10mcg (I think) of vitamin D

[PurpleNails Administrator in reply to 9422x]

10mcg vitamin D is very low level.  If you didn’t have an optimal levels it likely wouldn’t be any where near enough to be a supplementary level.  

10x can be brought over the counter as a daily dose, but it’s important to test & see where level are before trying high doses. 

 Folic acid recommended when TTC.  I’ve often read it’s recommended take a b-complex with Methylfolate a natural & more bioavailable version.   

[SlowDragon Administrator]

What’s the range on Ft4 result

Was test done early morning around 9am

[9422x in reply to SlowDragon]

The range was 7.8-21 and I had the blood taken about 7.30am

[SlowDragon Administrator in reply to 9422x]

so you need to get full thyroid including both thyroid antibodies and all four vitamins tested

FT4: 12 pmol/l (Range 7.8 - 21)

Ft4 31.82% through range

So thyroid possibly struggling

[Alanna012]

Very very sorry for your loss. The advice above is where you need to start, but beyond this (after thyroid and vitamin test results, these are priority) I would check your progesterone levels. Progesterone is vital to maintaining pregnancy and levels can become lower if thyroid hormone levels are low. But also worth checking even if levels seem good.

Your GP may be able to help with that or you may have to go private. Cerascreen do one, for around £70. However I can't exactly vouch for them as they lost my test and were very bad about it, only contacting me three months later after many requests. However it may just have been a one off bad experience. I know others have used them with no complaints.

I sincerely hope you receive some answers as to what is going on.

[mrsturnertobe]

Hello, I’m so sorry to hear your story. I wanted to give you a little bit of hope as I had two early miscarriages at around 7 weeks last year too. A similar situation to you that one was a PUL also. We had been ttc for over two years and tried IVF so all very heartbreaking…

After my 2nd I actually conceived naturally a month or two after and I’m now 18 weeks pregnant. All is looking good so far 🤞

I have Hashimotos disease and have been battling to keep my TSH in range for a while. It’s always been fairly low but not in the optimal range - during 2nd miscarriage it was 3 ish…

I’m not sure why this baby seems to be staying with us this time exactly but I was actually being over medicated and my level was 0.02 when I conceived this time. It slowly has crept up to 1.7 now as it rises in pregnancy. Are you on Levo? It might be worth considering asking for a higher dose but to be honest they probably won’t do it. So you could try some dietary changes which may help lower your antibodies which I found helped me to keep things stable. This is assuming you are autoimmune hypo?

I am completely gluten free now and have been for about 6 months. My endocrinologist confirmed this can help some people and it helped me!

How old are you? Now you’ve had two miscarriages you may be able to see the recurrent miscarriage clinic (if over 35) - worth asking your GP for a referral.

I saw them and this time I took progesterone supplements up to 16 weeks and I’m on low dose aspirin until 33 weeks. Apparently hypo people can have lower progesterone levels…

Get your self on a good prenatal vitamin so build up vitamin and folic acid stores. Pregnacare max has 50/50 folic acid and methylfolate which is the active form of folic acid - worth researching this in case you don’t absorb folic properly.

That’s all I can think of for now but I really wish you so much luck. Keep going, you will get there. Please feel free to contact me privately if you like x

[MJE1 in reply to mrsturnertobe]

Sorry to hear this. I’ve had similar experiences and loss. Most of what I would say is in the post above, but my IVf consultant told me that TSH should be below 2.5 x

[Alanna012 in reply to MJE1]

That is interesting indeed that your IVF consultant told you that regarding TSH.

Based on experience I'm pretty sure a GP wouldn't and maybe not even an NHS endocrinologist. It shows the difference in medical expertise between direct working experience and staying within supposed guidelines.