Hello- can anyone help please. GP unsympathetic to treating TSH level of 6.7.

Trying to conceive and have heard that this level may be too high and I would benefit from bringing it down. Does anyone have a list of private doctors who would look more sympathetically at this? Live in Sheffield but willing to travel. Grateful for any help you may be able to give. Thanks.

[shaws Administrator]

Yes you would be very wise to seek a private appointment. In the USA you would be treated with a TSH of 3.

This is a link and someone who knows a good doctor in your area will send you a private message as we don't put names on the forum.

thyroiduk.org.uk/tuk/diagno...

[Hidden in reply to shaws]

Thank you for taking the trouble to reply. I will go onto the link you have sent.

Benjie

[ejh1]

Hi. You most likely need treating to get pregnant. Get an endo referral from your GP - you may have to go private for this. I was in a similar situation (TSH was 5.6 I think) and I couldn't concieve. I got referred privately to an endo who immediately started me on 75mcg thyroxine as a starting dose. 2 weeks later I conceived. I absolutely believe that the treatment was essential for me to conceive.

I've just replied to another recent question about pregnancy - you need a dose increase and may grow a big baby when you do finally get pregnant!

Good luck, and do keep pushing for that treatment. It will make all the difference to you.

Emma

[Hidden in reply to ejh1]

Thank you for replying.Happy to go private if I can get some help.

Benjie

[sporty333]

..... I was treated with a tsh of 6.2....

[nobodysdriving in reply to sporty333]

and I was treated with a TSH of 4.27 and not planning any more children either (been 'stitched up' LOL )

[Hidden in reply to nobodysdriving]

Thank you for replying. Hope I can get lucky too.

benjie.

[Hidden in reply to sporty333]

Thank you for yor reply.

benjie

[cloud1]

Hi,i have untreated hypo/hashimotos and am 3mths preg(which is a constant worry).But what i wanted to share was that i know that it was the natural progesterone cream that helped me become preg(as previously i seemed infertile).i was taking it to regulate my 3wk cycle periods and also for pms;as soon as i started on it my first period came at a more normal nr4wk cycle.Then the second month got preg.So even if u need thyroid meds too it may be worth considering this too.A g web for info a ndwhere i buy the cream is progesterone.co.uk.(wellspr... Serenity is the name of the prog. cream.)Goodluck.

[Hidden in reply to cloud1]

Thank you Cloud- that is encouraging.Thanks for the link will definately look into it. Good luck with your pregnancy.

[Muffy]

In pregnancy you need a TSH of below 2 and preferably around 1. High TSH can = infertility.

Google thyroid and pregnancy and take medical papers to your GP!

[Hidden in reply to Muffy]

Thanks Muffy- will be doing this and hope that GP responds. Trouble is so much of the evidence is not UK based which I think gives them a "get-out".

[Muffy]

You will find a fair amount re hypothyroidism and pregnancy from UK medical papers. I actually have a lot here, but we now have Windows 8 and I'm totally baffled as to where to find all my references.

Look up Clinical knowledge summaries, hypothyroidism management , preconception or conception.

Thyroxine dose adjustment during pregnancy.

San Diego Paper, (Obviously not UK) gghjournal.com/volume26/1/a...

Increased Miscarriage Rate in Thyroid Antibody-negative Women with TSH Levels between 2.5-5.0 in the First Trimester of Pregnancy

Home ? Pregnancy and Fertility ? Thyroid problems can be at the root of miscarriage and premature birth

Dr. John Briffa

May, Tue 10th, 2011Posted in : Pregnancy and Fertility, Women's Health By : Dr John Briffa 11 Comments

In conventional medicine it is my experience that we tend to struggle a bit with the diagnosis and management of certain conditions, and near the top of the list (again, in my experience) is low thyroid function (hypothyroidism). Conventional wisdom dictates that ‘normal’ levels of thyroid hormones mean normal thyroid function. The ‘screening’ test for thyroid function is to measure ‘thyroid stimulating hormone’ (TSH). Raised levels of this point to low thyroid function. However, there is evidence that TSH is not as utterly reliable as an indicator of thyroid function or marker of health, and I’ve written previously about some of the issues here, here and here.

I’ve known for a long time that, in practice, it’s wise to assess individuals biochemically, but at the same time it’s crucial to take into account the clinical picture too. Failure to do this, in my view, can result in individuals suffering needlessly. And the symptoms of hypothyroidism are not just a minor inconvenience either. They can include: weight gain, fatigue, low mood and depression, mental lethargy, generalised swelling (known as ‘myxoedema’), sensitivity to cold, dry skin, dry hair, thinning of the hair and constipation. It’s unusual for hypothyroid individuals to exhibit all these symptoms, but it’s not uncommon for them to exhibit many of them.

In more recent times, I’ve become increasingly aware that it’s generally a good idea to check levels of ‘thyroid auto-antibodies’. These antibodies are made by the body in response to substances involved in thyroid function. The two most commonly tested antibodies when hypothyroidism is being suspected are anti thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG). I think it’s fair to say that most endocrinologists (hormone disorder specialists) would not treat a person with positive antibodies who also has a normal TSH level. However, I doubt that this is the best way, particularly having read this book. The book focuses on the most common form of hypothyoidism known as ‘Hashimoto’s Disease’. One may point made by the book as that standard blood tests are not to be relied upon. It also recommends management of the immune dysfunction that appears to be at the root of the disease. One key strategy here is to avoid gluten (in foods such as wheat, oats, rye and barley). For more details, see the book!

The relevance of thyroid antibodies was again highlighted this week on the publication of a study in the British Medical Journal [1]. In this review, the relationship between thyroid autoantibodies and miscarriage and preterm (premature) birth was assessed. Pre-term birth was defined, in this review, as birth occurring from between 24 and 37 weeks gestation.

Here’s a summary of the findings of this review:

1. Evidence from ‘cohort’ studies (generally recognised as the best type of ‘epidemiological’ evidence) showed that the presence of thyroid autoantibodies was associated with a 390 per cent increased risk of miscarriage (i.e. risk was almost 4 times that in individuals without antibodies).

2. Evidence from ‘case-control’ studies (generally regarded as inferior to cohort studies) risk of miscarriage was raised by 80 per cent in individuals with thyroid autoantibodies).

3. The presence of autoantibodies was associated with a more than doubling in risk of pre-term birth.

The authors of the review offer two potential explanations for how a positive antibody status might affect pregnancy:

Firstly, the presence of thyroid autoantibodies in women with normal thyroid function could be associated with a subtle deficiency in the availability of thyroid hormones (a fall in circulating free thyroid hormones within the reference range) or a lower capacity of the thyroid gland to adequately rise to the demand for augmented synthesis of thyroid hormones required in pregnancy. Given that minor perturbations in thyroxine concentrations within the normal range can lead to an association between thyroid autoantibodies and adverse pregnancy outcomes, trials have been conducted to evaluate the effects of supplementation with levothyroxine on pregnancy outcomes in women with normal thyroid function who tested positive for thyroid autoantibodies. Secondly, thyroid autoantibodies might be an indicator of an underlying enhanced global autoimmune state. This itself can have a direct adverse effect on placental or fetal development.

Notice here there is mention of treating those with positive antibodies with levothyroxine (the stand drug/hormone used to treat hypothyroidism). The review goes on to report on the results of these trials: overall, treatment with levothyroxine roughly halves the risk of miscarriage.

Of what use is all this information? If you or someone you know has had a miscarriage or pre-term delivery (or perhaps more than one) and is planning pregnancy (however far off this may be), I suggest having a full thyroid ‘work-up’ including levels of TSH, free T4 and free T3. I recommend, obviously, that thyroid autoantibodies be checked too.

If your doctor expresses scepticism regarding the need for these tests, show him or her the study I’m reporting here. Click this link for a full text version of it.

In Malta recently I suggested that someone have her antibodies checked as I suspected hypothyroidism. The lab refused to do the test. Why? Because the TSH was normal. The problem, as I see it, is that people who work in labs generally haven’t seen enough patients, and don’t appreciate just how limited in value the TSH test is in practice.

References:

1. Thangaratinam S, et al. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ 2011; 342:d261

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From ENDO 2010 The Endocrine Society Annual Meeting, San Diego, June 19-22, 2010

Studies over the last two decades have demonstrated an increased miscarriage rate in euthyroid women who are thyroid antibody positive. Similarly, women with overt hypothyroidism have an increased rate of spontaneous pregnancy loss. The impact on pregnancy loss with thyroid-stimulating hormone (TSH) levels between 2.5-5.0 in thyroid antibody negative women is unknown. The present abstract is a component of a larger study in southern Italy in which 4562 women were screened for TSH and thyroid peroxidase (TPO) in the first trimester of pregnancy. Women were randomly assigned to a universal screening (US) group or a case finding (CF) group and stratified as high risk or low risk for thyroid disease. All women in the US group and high-risk women in the CF group had TSH and thyroid peroxidase antibody performed immediately. Women in the CF low-risk group had their sera assayed postpartum. Antibody-positive women with a TSH >2.5 were treated with levothyroxine. The results on pregnancy outcome are in press.1 The present study evaluated the miscarriage rate in thyroid antibody negative pregnant women with TSH levels between 2.5-5.0 as compared to thyroid antibody-negative women with TSH levels <2.5. None of these women were treated with levothyroxine. In the first trimester of pregnancy 4123 women were TPO negative with a TSH of <5.0 (mean time of screening was 8.8 weeks). The rate of spontaneous pregnancy loss was 6.1% (39/642) in women with a TSH between 2.5-5.0 and 3.6% (127/3481) in women with a TSH <2.5 (p=0.006).

This study demonstrated a significant increase in the rate of spontaneous pregnancy loss in antibody-negative women who have first trimester TSH levels between 2.5-5.0 as compared to antibody-negative women with first trimester TSH levels <2.5. These data provide further evidence that the normal range for women in the first trimester of pregnancy is <2.5. Future studies are needed to evaluate the impact on the miscarriage rate of levothyroxine treatment in antibody-negative women with TSH between 2.5-5.0 in the first trimester of pregnancy.

Negro R, Schwartz A, Gismondi R, et al. George Washington University, Washington, DC, USA; University of Illinois-Chicago, Chicago, Illinois, USA; Casa di Cura "Salus" Brindisi, Italy; "V Fazzi" Hospital, Lecce, Italy

Editor's Comment

These data implied that in pregnancy "compensated hypothyroidism" in thyroid antibody-negative euthyroid women may not be well compensated. Approximately 1-2% of pregnant women receive levothyroxine treatment for overt hypothyroidism. This condition, which commonly has an autoimmune cause, is defined as a low plasma free thyroxine (T4) concentration and a raised plasma TSH concentration. Another 2.5% of pregnant women have subclinical (compensated) hypothyroidism, which is defined as a raised plasma TSH concentration with a normal free T4 concentration.2 It has been suggested that in hypothyroid women anticipating pregnancy (with serum TSH in the lower quartile of normal range) pre-conception adjustment of levothyroxine doses may result in adequate maternal thyroid function.3 This procedure seems safe and inexpensive; it may be a worthwhile treatment, not only to prevent miscarriage but also in view of the well-known potential effects of even marginal maternal hypothyroid function on the subsequent IQ of the progeny.The data also suggest a role for universal screening in all newly pregnant women with testing for serum TPO antibodies and TSH levels.4

Fima Lifshitz, MD

References - (linked to Pubmed Links)

1.Negro R, Schwartz A, Gismondi R. et al. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinolo Metab, in press.

2.Hypothyroidism in the pregnant woman. Drug Ther Bull. 2006;44:53-6.

3.Rotondi M, Mazziotti G, Sorvillo F, et al. Effects of increased thyroxine dosage pre-conception on thyroid function during early pregnancy. Eur J Endocrinol. 2004;151:695-700.

4.Alexander EK. Here's to you, Baby! A step forward in support of universal screening of function during pregnancy. J Clin Endorinol Metab. 2010;95:1575-1577.

[Muffy]

Sorry, seem to have got the Dr. Briffa piece muddled with the San Diego one, cut the latter carries on after Dr Briffa.

Dr. Gordon Skinner in Birmingham/Glasgow has treated a lot of patients with thyroid medication who have then successfully conceived. Obviously that would need a referral and fees as he is private only.

Anyway, I wish you well.

[Hidden in reply to Muffy]

Thank you so much Muffy for taking the time and trouble with this. Having another TSH and T4 test done so will see what that throws up. The info you have sent is very helpful.

Many thanks again.

Benjie

[Muffy]

It's a pleasure. infertility and miscarriage are often caused by high TSH. Maybe you could even see another GP who is more enlightened on the subject.

[Hidden in reply to Muffy]

Hi, will wait for new test results then go from there. I feel I have more info now to challenge GP if she remains unsympathetic and also the possibility to see someone else.

Thanks again for your interest.

Benjie.

[Muffy]

May well be worth a referral to Dr. Gordon Skinner

22 Alcester Road

Moseley

birmingham

B13 8BE

Tel/fax [phone]

He is a Virologist with an interest in thyroid disease. He has put his career on the line to treat extremely ill patients The GMC hound him and yet he still goes on. The GMC said they have never had a doctor up before them who has had so much support from his patients. At the review hearing last year, I think there were nearly 2,000 testimonials for him.

If you decide to go to him, get your GP to refer you (private only and I think it has now gone up to £220 1st apt). This was the first rise in price since 2003. Follow up appointments are half that and last for half an hour or more, depending how long you need. He will never rush you out of the consulting room.

Once Dr. Skinner has your referral letter, he will contact you to make an appointment.

I'm sure others have given you names of doctors as well, so whoever you finally decide to go to, I really hope it will help.

[Muffy]

May well be worth a referral to Dr. Gordon Skinner

22 Alcester Road

Moseley

birmingham

B13 8BE

Tel/fax [phone]

He is a Virologist with an interest in thyroid disease. He has put his career on the line to treat extremely ill patients The GMC hound him and yet he still goes on. The GMC said they have never had a doctor up before them who has had so much support from his patients. At the review hearing last year, I think there were nearly 2,000 testimonials for him.

If you decide to go to him, get your GP to refer you (private only and I think it has now gone up to £220 1st apt). This was the first rise in price since 2003. Follow up appointments are half that and last for half an hour or more, depending how long you need. He will never rush you out of the consulting room.

Once Dr. Skinner has your referral letter, he will contact you to make an appointment.

I'm sure others have given you names of doctors as well, so whoever you finally decide to go to, I really hope it will help.

[Muffy]

May well be worth a referral to Dr. Gordon Skinner

22 Alcester Road

Moseley

birmingham

B13 8BE

Tel/fax [phone]

He is a Virologist with an interest in thyroid disease. He has put his career on the line to treat extremely ill patients The GMC hound him and yet he still goes on. The GMC said they have never had a doctor up before them who has had so much support from his patients. At the review hearing last year, I think there were nearly 2,000 testimonials for him.

If you decide to go to him, get your GP to refer you (private only and I think it has now gone up to £220 1st apt). This was the first rise in price since 2003. Follow up appointments are half that and last for half an hour or more, depending how long you need. He will never rush you out of the consulting room.

Once Dr. Skinner has your referral letter, he will contact you to make an appointment.

I'm sure others have given you names of doctors as well, so whoever you finally decide to go to, I really hope it will help.

[Hidden in reply to Muffy]

Thanks- he is on the list that I was sent by Thyroid org. Also not too far from where I live.

Benjie