My partner and I are currently going through fertility treatment, I had my TSH tested which shows my levels are slightly elevated. At 4.2. The NHS threshold for treatment is 4.9, however the fertility clinic have prescribed thyroxin (50mg) and to be retested in 4-6 weeks, to get my TSH to 2.5 or below. We can then start the first cycle. If we don’t start in April, the IVF meds will expire (the clinic told me to order then before the TSH result came back!) so that’s another £1k down the drain…
So my question is, are my levels likely to change that much in 4 weeks? Is there anything I can do to ensure maximum absorption of thyroxin? Or any thing life style wise that could help?
To assure maximum absorption of levo, always take it on an empty stomach and wait one hour before eating or drinking anything other than water. Leave a gap of at least two hours away from any other medication or supplements. Are you taking any suppliments?
TSH is entirely unpredictable, it's impossible to say whether it will come down in that time. But you'll stand more chance of it dropping below 2.5 if you wait the full six weeks rather than four because that's the minimum time it takes for your dose to settle in and do what it's supposed to do and for you body to adapt.
I am taking pregnacare conception max, but I take it in the evenings after my main meal so it doesn’t interfere with the thyroxin.
I’m going to try and push back the test to 5 weeks, but I need to get the results back within time for the start of my next cycle to be in with a chance to start IVF meds.
Am I right in thinking if you have a blood test in the evening that TSH might be lower?
TSH is at its highest around midnight, then slowly drops to around 9 am, then drops sharply to its lowest around midday. Then starts to climb again. But, I'm not sure that arranging your blood draw to get the TSH you want is a good idea. Because it's not the TSH itself that is the problem. TSH is just an indicator to the thyroid hormone levels. TSH will not affect your conception or pregnancy, but low levels of FT4 and FT3 will. But, I'm really not sure that fully understand that. They put all the importance on the TSH, which doesn't actually do anything.
Has anyone tested your thyroid antibodies for autoimmune thyroid disease
very important vitamin levels are optimal
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG 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.
Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
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 that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Testing options and includes money off codes for private testing
TSH responds rapidly to thyroid hormone levels, except when it is suppressed or very high. By four weeks your hormone levels will have got within ten percent of their final levels. So, four weeks should be fine. You could do a private finger prick test after two weeks just to confirm your TSH is below 2.5 and for reassurance.
(The lateral-flow type simply check whether TSH is over or under the company's choice of top of TSH reference interval. They are anything between almost 100% useless and dangerous due to likelihood of misinterpretation/misunderstanding.)
I would do the Monitor my Health one as it is done by an NHS lab and will carry more weight with doctors. thyroiduk.org/testing/priva...
The cheapest TSH, fT3, fT4 is sufficient although you could include TPO antibodies if you really wanted but these might change during pregnancy anyway. I don't think antibody tests are much use except when hormone levels are erratic or symptoms don't resolve.
I wanted to share my experience with you. My underactive thyroid was discovered during the initial blood tests (TSH 4.6) when I contacted the GP about infertility. After the second blood test after 3 months (TSH 3.6) and a positive antibody test, I managed to convince my GP to give me levothyroxine. I had a positive pregnancy test days later. My TSH was tested after taking levothyroxine for a week and it had dropped to 2.2. I convinced them to up it to 75 after the positive pregnancy test using the British Thyroid Foundation webpages to back myself up. I now have two beautiful daughters and still feel like I won the lottery.
But back to your question. I think take the 4 week blood test and see how it goes. As others have said, it can be quite unpredictable. If I remember correctly, in Toni Wechsler’s Taking Charge of Fertility, she advises a healthy diet, a good daily multivitamin, at least 8 hours sleep and exercise (not running though, as this raises adrenaline) to help balance your hormones and states this can even help with thyroid problems. I think these are good rules to follow. I also took fish oil and probiotics. I went on to have good pregnancies and amazing births which I definitely associate with the healthy lifestyle I led.
I hope this helps you. I’m so sorry you’re going through this difficult time. Try not to worry about the expired meds. Frustrating but it is what it is. The doctors just want to maximise your chances of success. I wish you luck. 🍀 This could be a positive thing.
Thank you so much for sharing, and it’s wonderful to hear everything worked out for you. It’s giving me a glimmer of hope that my levels will have improved too! Thanks again
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