Hypothyroidism and Pregnancy

[Thyroid2]

Hello, may I ask what the guidelines are regarding hypothyroidism during pregnancy? My TSH is 0.05, should I have a 25mcg increase in levothyroxine?

[PurpleNails Administrator]

Welcome to forum

Congratulations on your pregnancy.

Please can you tell us a little more?

What is your current replacement dose?

Usually when confirmed pregnant it’s recommended to increase dose by 25mcg and monitor levels more closely.

How long have you been hypothyroid & is your pregnancy recent?

Is your TSH always low? Often GP view low TSH as over replaced & like to reduce replacement.

Are your FT4 & FT3 tested? It’s it these which are important most feel well when FT4 is in top 3rd of range and FT3 is in top 50%.

Some information

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

[Thyroid2 in reply to PurpleNails]

My current dose is 125mcg 5 x week and 150mcg 2 x week. My FT4 and FT3 has not been tested. Would my dosage increase at the point of pregnancy if my TSH is 0.05?

[PurpleNails Administrator in reply to Thyroid2]

Depends on the GP. Some understand adequate FT4 & FT3 can result in low TSH but if FT4 & FT3 haven’t been tested how does GP know?

I recommend you test FT4 & FT3.

Many arrange private test to gain a full picture. As NHS rarely test FT3 and key nutrients.

Medichecks thyroid advanced is a good option.

List of companies offering different options, some packages include thyroid function, key nutrients and thyroid Antibodies. Others basic function only. some also have discount codes available.

thyroiduk.org/help-and-supp...

You order test online the kits arrives via post sample taken by finger prick (extra fee for private venous draw). Complete test early in week (to avoid weekend delays) & track sample back by post - results available online quite quickly.

Ideally test just before 09.00. fast overnight, delay dose until after. Remember to leave off biotin 3-5 days before.

[Thyroid2 in reply to PurpleNails]

Thank you PurpleNails.

In regards to blood tests, how often should my bloods be taken during pregnancy? Also, at what point are you referred to an endocrinologist?

[HealthStarDust]

Quite frankly, there simply is not enough information and research on hypothyroidism in pregnancy. Many sources suggest increase by 25-30% of your dose, others suggest add 25mcg, some endocrinologists would wait to increase if your TSH is 2.5, others would say increase immediately to keep your levels (and your wellness) where it is.

I’m afraid there are no easy answers. After you’ve done your own research, then make a decision on what’s best for you. Being both under and over medicated at any time, but especially in pregnancy, is never a good idea. However, as many know, the right dose is not as easy as taking a while 25mcg or 50mcg etc. Lots require tweaking.

Congratulations on your pregnancy and may it go well.

[Thyroid2 in reply to HealthStarDust]

Thank you HealthStarDust,

I have read that dosages should be increase by between 30-50% during pregnancy. Should my levothyroxine dosage be increased at the beginning, if my TSH is 0.05?

[HealthStarDust in reply to Thyroid2]

Hello.

Only you can decide this. While we all have our experiences including many with pregnancies, including me (feel free to read my profile) and many endocrinologists have their experiences with their patients, I’m sure even then patients experiences varies on how they reacted to their increased if increased immediately from conception.

With a healthy pregnancy, the TSH *should* begin to rise as the demand on your thyroid from the pregnancy will increase.

At a starting point, you have to ring your GP to arrange your TFTs (including FT4 -side note, they always do TSH and FT4 in pregnancy so I’d ask to have your FT3 tested which considering your low TSH they may easily agree to, if not just tell them it’s for your peace of mind) now that you’ve conceived, they will and should speak to the local endocrinologist on increasing dose or decreasing dose. You can also ask the GP to speak local endocrinologist in case the GP decides to skip this part. Hopefully, you’ll have a good GP and endocrinologist.

During pregnancy you can expect to have your TSH and FT4 tested at conception, again in 6/8 weeks, at booking appointment (these can vary) and various times after that. You can also expect to have it more frequently if you are experiencing symptoms. If you are not under endocrinologist, you will be referred to an antenatal endocrinologist at booking appointment (possibly sooner by GP depending on the area of where you live).

Also, on here, the forum that is, it is often mentioned that TSH is meaningless without FT4 and FT3, and even then not everyone thinks the TSH has a crucial role in hypothyroidism. So, in pregnancy, all we have are pregnancy specific ranges that are dependent on the area you live in, and not concrete advise in any official guidance on increasing dose within the NHS.

If you begin to have any hypothyroidism symptoms including those that mimic pregnancy symptoms, I would not hesitate to increase your dose by a small margin supported by blood tests if possible. As I said, there’s just not enough research on pregnancy and hypothyroidism. And, only you can make this decision.

If you’ve had a pregnancy before while hypothyroid, use that experience to guide your judgement.

I am sorry, there are no definitive answers. If only?!

Wishing you the very best on your pregnancy.

[SlowDragon Administrator]

congratulations

important to test vitamin D, folate, B12 and ferritin levels too

[Thyroid2 in reply to SlowDragon]

Thank you for your advice SlowDragon. Why does ferritin levels need checking during pregnancy?

[SlowDragon Administrator in reply to Thyroid2]

Low ferritin, low thyroid levels and miscarriage

preventmiscarriage.com/iron...

Low iron and hypothyroid

endocrineweb.com/news/thyro...

.

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...

Folate and B12 and Neural tube defects and autism

healthunlocked.com/thyroidu...

NICE guidelines that if hypothyroid or subclinical you should see endocrinologist BEFORE TTC

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

[Thyroid2 in reply to SlowDragon]

Thank you SlowDragon for the wide range of very useful websites. They are very informative. I would not have found such a good range of websites via my own internet search, I really appreciate your help. Thank you.

[HealthStarDust]

Hello. How did you get on with it? Was an increase advised?

Hope things are going OK for you.