When to increase levothyroxine in early pregnancy?

[bananafone5]

I've just found out I'm pregnant - not quite 4 weeks yet, so early days, but having read up on it before I'm pretty sure the dosage of levothyroxine for my hypothyroidism will have to go up.

Obviously I would ask my doctor, but I've had to change GP surgery due to a move, and I couldn't get my registration appointment until I'm nearly six weeks pregnant. I read one scientific paper that suggested this was when they would start to increase it anyway, but I was wondering what other people with underactive thyroid have been advised?

Thanks :)

[YouGetNOTHING]

I developed an underactive thyroid during pregnancy and the dose went up and remained at the new level with each subsequent pregnancy. I didn't have to dose increased until I'd had the first blood test which as I recall is not with your booking appointment. Mine was reviewed by a consultant obstetrician who specialised in thyroid and pregnancy. They may refer you to a consultant if you already have an under active thyroid.

But they definitely won't increase it until they have done a blood test.

[HazleNutt]

I increased as soon as I got a BFP, based on this study www.ncbi.nlm.nih.gov/pubmed/15254282

[curiousjess]

I had a thyroidectomy so don't have a thyroid, but was told to increase my dose the moment I found out I was pregnant. I went from 150mg/day to 200mg/day and had a bloody test at 4 weeks then I've routinely had them monthly since and I'm 28 weeks now. My dosage hasn't changed since day one. I think the guidelines are that you need to increase the dosage by 50mg/day to produce enough for the baby.

[curiousjess]

I just ready the study above, and my increase was pretty much 30%. I advise you book in to see a doctor ASAP, even if it is at a walk in centre or something as its very important that thyroid levels are within range.

[Tootsiepops]

My endocrinologist told me to put it up straight away and not bother waiting for my gp to do anything about it as most don't really understand thyroid disorders.

[Theboxtrollsareallowed]

My GP put it straight up as per NiCE guidelines from 125 to 150 (I was 5 weeks pregnant) & this was confirmed with bloods - it stayed at 150 until 16 weeks then came back to 125 & has stayed there - since 8 weeks I have had 4 weekly bloods & 4 weekly consultant appointments to discuss it.

[shmuf]

I also had a thyroidectomy and pregnancy sends me totally out of whack,so far pregnant with dc3 and each time have had to triple my dose and end up taking crazy amounts (talking 300a day...!).anyway,i tend to get bloods done as soon as i get bfp and dr ups my dose slowly with blood tests every 4 weeks

[bananafone5]

After reading all your advice, I've managed to get a much earlier appointment after telling the new GP about my circumstances. Though my blood tests have been stable and healthy for the last couple of years, I've had significant problems previously, so it'll at least put my mind at rest. I also remember the original endocrinologist I saw recommending a referral if I ever got pregnant (that seemed very far off at the time!!), so will ask for one straight away.

Thanks everybody, that was really helpful :)

[YouGetNOTHING]

Ha! It seems that mine was put up very late then

[Maxbenji]

Mine was put up after seeing the consultant at the hospital at about week 15, and its steadily gone up with blood tests every 3 weeks and stayed stable now (27 weeks) and not having another test until September...

[IfYouWereARiverIdLearnToFloat]

Throwing in a completely different experience to everyone else but I have Graves' disease - had a thyroidectomy 20 years ago & have been hypothyroid ever since & on thyroxine 200mcg normally. In Graves the hcg hormone in pregnancy can stimulate your thyroid to produce more thyroxine so my dose had to be brought down straight away - I'd had bloods checked a week after conception not knowing I was pregnant at the time & my free T4 had shot up. Endocrinologist sees me every 4 weeks & now at 20 weeks my free T4 has started climbing again. I'd ask to see an endocrinologist urgently as I know my GP surgery hasn't been particularly consistent or confident interpreting my blood results while pregnant.

[newbian]

GPs are useless when it comes to thyroid disorders in my experience. I had one reduce my dose based on his own opinion that it was "too high" and the consultant had to fight him to get it put back up as the GP was completely ignorant of other complicating factors in my case.

I'm 27 weeks and have had my dose put up twice (I've had a thyroidectomy) by the endocrinologist but in some weeks I didn't need more and in some my levels went totally out of whack. This after being on the same dose for more than a year. Pregnancy does cause your needs to change significantly, so you will be best in the hands of a consultant who is checking your levels regularly. It's not necessarily the case that you'll just need more from the start. Good luck!

[honeysucklejasmine]

I had a blood test done as soon as I knew I was pregnant and levels were normal. I am seeing the endocrine clinic consultants on the 17th (12+6) so imagine they will want to test again. I get the impression I will be turned in to a pin cushion during this pregnancy

[WeePoppy]

The obstetrician increased mine from 75 to 100 when I first saw her after my BFP at 9 weeks. Standard procedure apparently (I have Hashimoto's disease). The thyroid function was tested again at 12 weeks and everything was fine.

[bananafone5]

Interesting to hear everyone's different experiences! I'm only 6 weeks but my TSH and T4 have tested normal so far. The doctor put me up by 25mcg and I'm waiting for a referral to the specialist obstetrician.

Out of interest, can anyone tell me what they usually do and how often you have to see them during the pregnancy?

[Junosmum]

yougetnothing mine was also put up late - 17 weeks.

I saw the GP who told me my level (1.7) which I know to be the lower end of normal, exactly what you want for pregnancy so I didn't push for it to be adjusted. I then saw the endocrinologist who told me that is the TSH level is below 2 it doesn't need putting up but if it's above 2, or you display symptoms, then it needs to go up. Mine went up last week as although my level is 1.9 I'm getting symptoms (mainly thrush, which is a really odd one!).

Thyroid TSH levels being too low (below 0.3) can have similar side effects to them being too high (DO NOT GOOGLE!). So please be careful self adjusting your dose if you don't know what it is. But similarly don't be afraid to self adjust your dose if the GP won't increase the dose and you know your levels.

Get a blood test every 4 weeks until you are referred to your endocrinologist.