Pregnant with low TSH and low T4 results

[thyroid-warrior]

I just got my test results back from last Friday through NHS.

There's no test results for T3 unfortunately, as it's not included.

I was on 100mcg T4 and 20mcg T3.

Test was done at 8.10am and fasted. And I didn't take T4 24 hours before and I took last dose of 5mcg T3 12 hours before.

I was very exhausted on the morning of the blood test due to not taking 24 hours before. I nearly wanted to take a cab to the clinic instead of taking a bus and walking. I had to get a 2 hour nap after the test and breakfast.

Previously I figured out my conversion from T4 to T3 was low hence I decided to get T3.

As such, I was very surprised at my TSH results. I'm due for a call with the GP later this afternoon. He doesn't know yet I'm taking T3.

14 March 2025

Se thyroid peroxidase Ab conc

134 KIU/L [Below 34]

Plasma TSH level

<0.01 mu/L [0.27-4.2] (-6.6%)

Serum free T4 level

15.1 [12.0-22.0] (31%)

I'm expecting some kind of discussion but wanted to get some advice hopefully beforehand.

On Friday morning, aside from fatigue, I noticed my wrist temperature went down to minus from the baseline. From my understanding, increase in progesterone levels should result in positive baseline increase for wrist temperature. I read up alot about pregnancy and thyroid dosage increase and decided to increase my dosage by 25mcg since Friday night (after blood test in the morning).

I woke up feeling very energized on Saturday morning. I was even up at 6.30am, feeling relaxed and was out and about the entire day. I even mustered some energy to do housework.

Since then, I've been feeling more energized and still normal despite the increase in T4. My wrist temperature every morning is on the positive side from baseline so I'm still feeling good.

I'm experiencing occasional cramps in the belly. But overall, I'm still feeling fine, aside from occasional fatigue (needing a nap) after walking about too much or after a long day.

Unfortunately I don't have T3 results.

The TSH results turned out much lower than I expected.

I was wondering if the GP would ask me to lower my FT3 dosage due to my TSH levels?

I mean the FT4 levels is too low, so maybe not? I wouldn't increase my T4 dosage as I've just increased by 25mcg myself.

But I was slightly concerned if the TSH level should be something I should worry about?

Thank you!

[greygoose]

Your TSH is low because you're taking T3. That's what T3 does, it lowers TSH. But that's ok. It's low because you don't need it.

However, your GP's reaction will depend on how clued up he is. Most of them are terrified of a low TSH because they don't really understand what it is, nor how it all works. But, if he suggests reducing anything, just refuse. Without an FT3 result you cannot know if you're over-medicated - although rather doubtful that you are. Just stick to your guns and say no.

[thyroid-warrior in reply to greygoose]

Thank you for your insights, greygoose ! Hugely appreciated, gave me another boost of confidence! Somehow the thought of speaking to the GP at 3pm might have raised my adrenaline earlier on, with heart rate going up to 105. I had to go for a short walk in the sun to calm my nervous energy. Two hours later, GP hasn't called yet and my heart rate has gone back down to 92 - which is more normal.

[greygoose in reply to thyroid-warrior]

Yes, I can understand your reaction. Not something to look forward to.

[thyroid-warrior in reply to greygoose]

I had the most hilarious phone conversation with the GP earlier.

He was concerned about the low TSH levels and told me that I appear to be overmedicated. 😅

He didn't seem to know about

- T3 dosage would suppress TSH.

- the increase in Beta HCG during pregnancy that could also suppress TSH

- NHS also recommended to increase T4 dosage (immediately) if pregnant for extra T4 needed for baby brain development.

Totally didn't mention how low the FT4 was and totally ignored when I mentioned about my symptoms and my history of how I raised my T4 dosage since October.

After I told him assertively (I had a script) about all the above, he said he would speak to the endocrinologist and just told me not to increase anymore. He sounded not as chirpy as before but he couldn't rebut any of what I said.

He also asked me how I knew all of that? 😅

I was maybe being slightly cheeky, I asked if he knew about (what I've just told him). Somewhere along those lines.

I also highlighted, I felt okay in general since my increase and I've been monitoring my heart rate. That was totally overlooked too.

When I had a miscarriage back in August, I didn't have any information - maybe my low thyroid levels could also be one of the reasons as it affected my hormonal levels. Unfortunately, there was zero checks back then and I had zero knowledge about optimal T4 to T3 conversions and never checked my T3 levels.

I find it fascinating that being undertreated seems to be a preferred state compared to being overtreated. 🤷‍♀️

[greygoose in reply to thyroid-warrior]

Oh yes, they don't give a hoot if you're under-medicated. But they're terrified of a low TSH. They seem to think that if your TSH goes one point below range your bones are going to crumble on the spot and your heart will explode. Yet a TSH over 10 is of no concern - yes, I did once have a doctor who told me my TSH of 11 was 'fine'. 'It's near enough', he said. That appointment did not end well.

[thyroid-warrior in reply to greygoose]

That makes me wonder what they learned in med school?

That a suboptimal-functioning person with high TSH is preferred over a normal functioning person with low TSH? 😅

[greygoose in reply to thyroid-warrior]

I think the answer to that is: not very much. And, to give him his due, after a long discussion, that doctor did admit I knew more about thyroid than he did! And I didn't know that much in those days.

[thyroid-warrior in reply to greygoose]

I give that doctor credit for admitting that! How did you gain your knowledge about your thyroid over the years given that there was minimal information? Was this when the internet came about?

I was diagnosed with hypothyroidism in 1988, this was pre-internet days. But because I was told by the doctor I would be fine and I was a child, so I never looked further into this myself after I grew up and never once attributed any of my symptoms to thyroid issues.

[greygoose in reply to thyroid-warrior]

Ah, I've written all about that in my profile.

I was diagnosed in 2000. So, yes, I had the advantage of internet.

[thyroid-warrior in reply to greygoose]

Oh wow, just read your profile! I'm very impressed by the navigation of your thyroid journey. You've been through alot!!! Sounds like different battlefields with the doctors you've seen over the years. I saw you seem to have thyroid symptoms at a young age.

I think I got lucky with my diagnosis - my neck appeared to be swollen from my mom's intense observation so I was on medication even before adolescence. From my experience reading through the forum, it feels like only an obvious symptom like a swollen neck would one be taken more seriously? If your hair is dropping out or if you are tired or feeling cold, that's taken less seriously?🤷‍♀️

[greygoose in reply to thyroid-warrior]

Very true. But I don't think my mother ever looked at me - only to remark on the weight I was putting on, anyway. She certainly didn't look at details like necks! And the doctors I saw never really looked at me, either. Too busy writing out a prescription for some placebo or other before I'd even told them what was wrong. Nobody ever felt my neck, or tested my reflexes or even did a blood test - I don't think I ever had a blood test until I was pregnant at 23! And thyroid wasn't what they were looking for.

[thyroid-warrior in reply to greygoose]

There's definitely huge potential for research into thyroid issues - and getting it right. Imagine the number of people who could properly contribute to the economy!

[greygoose in reply to thyroid-warrior]

Yes, it's definitely false economics to under-treat hypos. But you can't tell these people anything. They know it all! Pft

[janeroar]

Well done for doing your research and ensuring you get what you need for your baby and yourself. Just to be on the safe side I would get a private blood test done to check T3 and your vitamin levels (if you haven’t recently checked them)

[thyroid-warrior in reply to janeroar]

I did a check in January and intended to get another private test for TSH, T4 and T3 in April. But now I’m wondering if I should wait given, I’ve just increased my T4 too.

[Aj2690]

Morning!! Congrats, is it your first? I’m pregnant too with my first. Navigating the thyroid stuff along with pregnancy is already nerve wracking but it’s still early days for me. Have you noticed the fatigue get worse during the pregnancy?

[thyroid-warrior in reply to Aj2690]

Morning! Congrats! Yes it is my first. Definitely has been nerve wracking, with having to self advocate at the same time without the right medical support. Im just into the fifth week but starting to feel more fatigue than usual. Have you increased your T4 dosage upon pregnancy confirmation too?

[Aj2690 in reply to thyroid-warrior]

Wow me too, tomorrow will be the start of my 5th week. The doctors immediately upped my Levo dose from 75 to 100 when I told them I was pregnant. Absolutely shattered and sleeping by 8pm every night but the increased dose is causing me anxiety so I’m wide awake by 6am. You sleeping okay? I keep having the weirdest dreams.

[thyroid-warrior in reply to Aj2690]

Wow, did they upped your levo immediately without checking your thyroid levels?

The increased dosage gets me awake around 6.30am, today I was up early, second time, sleeping less than six hours. My first increase was on Friday night and Saturday I was hyperactive and walked around too much about 13k steps. That resulted in fatigue for the next 2 days.

What weird dream do you have? I can’t remember any unusual dreams so far…

[Aj2690 in reply to thyroid-warrior]

Yeah, then they did a “full MOT” - their words, which I’m waiting on at the moment. Only thing I’m annoyed about was I let the young doctor persuade me that doing the bloods AFTER taking my meds was fine and shouldn’t effect the result 😬

You manage to stay up past midnight? That’s amazing! I can barely keep my eyes open after 8pm. Apparently the first trimester is the toughest though, especially for us so fingers crossed it’ll get a little easier. Oh my dreams have been super odd and just so vivid, probably the anxiety.

[thyroid-warrior in reply to Aj2690]

I tried to do the 24 hours before taking the blood test and that resulted in rather low T4 levels. I’m curious about your results, in particular the TSH during pregnancy. What does your full MoT consist of? Is this initiated from your GP?

There is no MOT on my side unfortunately, I’m waiting for the referral to the antenatal care.

I wanted to start on a new routine of sleeping before midnight but it’s not quite working yet… I had the odd nap in the afternoon/evening a handful of times. I’m also feeling the anxiety more, I didn’t feel as though I properly rested last night. Not sure if it’s due to the increased dosage or adrenaline from yesterday.

[Aj2690 in reply to thyroid-warrior]

Might give them a call actually as they should be ready. I’ll keep you posted. So from what I gathered it was TSH, iron, vit D and some others that I can’t remember. My Vit D is alwayssss low so I’m hoping they give me some big supplements. They suggested the MOT to be fair, I lucked out with a young female doc on my last appt rather than the miserable middle aged man I sometimes get.

Everyone’s different to be fair, fortunately I’ve always been a morning person so I just find going to bed early quite easy. Have you spoken to your doctor about propanolol (is that how you spell it?), it’s been a life saver for when I have anxious periods, it’s just a beta blocker. Maybe enquire next time you see them or with your midwife. You take as and when you need it and it just reduces the physical symptoms of anxiety. Might be helpful 🙂

[thyroid-warrior in reply to Aj2690]

Good luck! I wish there was a standard protocol of how women with hypothyroidism were treated, so I don’t have to overthink too much. I’m hoping the antenatal department would be more helpful, fingers crossed.

I’ve heard about beta blockers, not the particular brand. I might wait to speak to the antenatal person, not quite sure i wanted to speak to the GP yet. He wasn’t exactly convinced about my 125mg when he got off the phone yesterday. And I didn’t (dare) ask for an increase in prescription yet (plus I was having anxiety/adrenaline) when speaking to him.

[Aj2690 in reply to thyroid-warrior]

Yes exactly, why is everyone treated so differently, I suspect because they don’t have a clue what’s best. I imagine the antenatal team will be much more thorough, it even says online that as standard our meds should go up 30% when pregnant so it’s strange that hasn’t happened. Hope everything goes well anyway and you start feeling better soon 💓

[thyroid-warrior in reply to Aj2690]

Yes, I saw that online beforehand but my GP never once mentioned it on our first call🤷‍♀️ I was waiting for him to bring it up…

Thank you very much! My anxiety went down finally a few hours ago. Feel more normal and calm now.

I hope everything goes well for you too and you’ll be able to sleep better soon💖

[jgelliss in reply to Aj2690]

Congratulations. It's a very exciting time. It's very possible that your Dr raised your dose a bit much for you. You might start off by dosing with 88mcg T4 for starters. Does your Dr monitor your Nutrients too? Enjoy your wonderful and Exciting Months a head.

[Insomania]

Is the GP prescribing your T3? If yes, it’s concerning that it’s not being monitored.

Can you get a private test to get your FT3? I do the Randox which are £31 for at-home.

[thyroid-warrior in reply to Insomania]

No I got a private prescription, the endocrinologist said they could support me if I got myself T3 but I’m not sure what support they would offer. She’s not an advocate of T3. Apparently they don’t support initiating T3 as there’s no enough conclusive evidence that it’s effective 😅

I’m planning on testing T3 levels myself soon if I don’t hear back from the GP and endocrinologist. The gp is getting in touch with the endocrinologist to discuss my suppressed TSH…

[Insomania in reply to thyroid-warrior]

Very poor that the endo sent you elsewhere to get T3! Let’s see if they support you.

Is the private prescriber good?

[thyroid-warrior in reply to Insomania]

The only good thing I had out from the conversation was the endo was very clear that under their organization, they don't support initiating (and testing) T3 despite the symptoms.

This is my first time getting, I think it's good cos I got my supply for now