I was directed here from the Fertility UK forum. We’ve had 1 round of IVF/ICSI which we were referred for due to my partner’s low sperm count.
Our first embryo transfer was not successful. We have a frozen embryo, but the clinic advised I get my Vit D and thyroid levels tested before transfer by my GP. The fertility clinic advised these show a Vit D deficiency and underactive thyroid. The results were:
Vit D 27nmol/L (clinic advised needs to be above 50)
Serum free T4 level 14.0pmol/L (range 10.0-22.0)
Serum TSH level 5.0mu/L (range 0.3-4.2) The clinic have advised this needs to be below 2.5.
I have started Vit D supplements (75 micrograms) and been prescribed alternating 75mcg and 50mcg levothyroxine.
The GP were very reluctant to give me an appointment to discuss the results let alone prescribe and I had to get a letter from my clinic. I was also advised by the pharmacist I should have been given an exemption certificate from the GP.
This hasn’t instilled confidence, so I am just looking for some advice on how to go about getting an exemption certificate and how often should I be getting tested and should I be asking for anything other than T4 and TSH tested? Also, any advice on diet or anything else I can do to help with TSH levels is much appreciated.
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Tiger37
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I'm sure one of the experts on here will be along shortly to advise, but I just wanted to share in your frustration of not being told about the exemption certificate!
I paid for loads of prescriptions for thyroid meds up until I happened to collect from a different pharmacy and they said I shouldn't be paying for it!
If you ask at the GP reception about it they should give you a form to fill in and it should get signed off pretty fast!
Your GP should at the very least be following the NICE guidelines: How should I manage a woman who is preconception or pregnant?cks.nice.org.uk/topics/hypo...
'how often should I be getting tested'
Usually, we say wait 6-8 weeks before re-testing. But given your individual situation, you may want to follow the 3-4 weeks suggested in this section of the NICE guideline:
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.
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.
For adults aged 50 years and over, with cardiovascular disease, or severe hypothyroidism — initially 25 micrograms once daily; adjusted in steps of 25 micrograms every 4 weeks, adjusted according to response; maintenance 50–200 micrograms once daily.
'should I be asking for anything other than T4 and TSH tested? '
At this stage in your treatment, TSH and FT4 are sufficient. But if they haven't already been done, you could ask for thyroid antibodies to be tested to determine whether or not your hyothyroidsism is autoimmune.
Also, any advice on diet or anything else I can do to help with TSH levels is much appreciated.
There's nothing you can do diet-wise to help with thyroid things - apart from avoiding soy. But, it's not about the TSH, anyway.
TSH - Thyroid Stimulating Hormone. It's a message from the pituitary to the thyroid to tell it to make more thyroid hormone. So, when thyroid hormones are low, the TSH is high, and vice versa. And that's about all the TSH does. It doesn't cause symptoms and doesn't have any effect on fertility or anything else.
However, since the TSH test was invented, the medical community decided that that was all they need to test because it told them 'all they needed to know'! How very wrong they were! It's not always a reliable indicator of thyroid status and, in any case, does not differentiate between the T4 and the T3. So, you could be a very poor converter but the TSH won't tell you that.
So, what you need to conceive and carry a pregnancy to term is good levels of FT4 and FT3. And they are assuming that if your TSH goes below 2.5, your FT4/3 will be good. But, as I said, that's not necessarily so.
At the moment, your FT4 is only 33.33% through the range. It needs to come up to about 75%. So, that's what you need to be looking at, not the TSH. And, as your pituitary looks like it might be a bit sluggish, your TSH will probably be below range by the time your FT4 gets up there. But that's OK, because the TSH isn't doing anything much. And don't let anyone tell you otherwise!
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Trying to conceive with Subclinical hypothyroidism 
Not so subclinical hypothyroidism
subclinical hypothyroidism but all the symptoms
Could be be hypothyroid/subclinical?
Recently diagnosed subclinical hypothyroidism
