Hypothyroid and pregnant.

[NurseRosie]

Hi everyone, I have recently found out that I am pregnant, I am about 4 weeks. I attended my GP today to let them know and get some advice. All of my friends who have hypothyroidism and have been pregnant have had an immediate increase in their dose. I currently take 150mcg and am completely dependent on my meds, I hardly produce any natural thyroxine. My GP was surprised when I suggested an increase in dose and refused, asking me to come for a blood test in May. I have been googling and found lots of articles that state many women require an increased dose in the first trimester.
Has anyone else had this experience or had an increase?
Should I seek a second opinion?

Hello- I am also on thyroxine- through both pregnancies I was stable on my usual dose of 100mcg, and had regular blood tests to check. It only went haywire after giving birth! If you are worried, ask for a second opinion to put your mind at rest, but it might well be the case that you are on the right amount and it will be stable throughout the pregnancy. Congrats!

There is NICE guidance on this that you can save under GP's nose:

At diagnosis of pregnancy, immediately increase the levothyroxine dose and check TSH and FT4 levels while waiting for referral to a specialist:
The dose should be increased usually by adding at least 25–50 micrograms levothyroxine; the size of the initial increase in dose will depend on the dose the woman is already taking and the TSH and FT4 concentrations. A 30–50% increase in dosage may be required. If there is any uncertainty about what dose to prescribe, seek immediate specialist advice so that there is no delay in the woman receiving an adequate dose of levothyroxine.
Check TSH and FT4 levels every 4 weeks until stabilized, aiming for a TSH concentration in the low-normal range (0.4–2.0 mU/L) and an FT4 concentration in the upper reference range.
Monitor TSH and FT4 levels:
Every 4 weeks during titration of levothyroxine.
Every 4 weeks during the first trimester, and again at 16 weeks and at 28 weeks of gestation, in a woman who is on a stable dose of levothyroxine.
More frequent tests may be appropriate on specialist advice.

*wave

cks.nice.org.uk/hypothyroidism#!scenario:3

Thank you, I didn't even think of checking NICE. I think I at least need my bloods checking. TBH he was quite disinterested and didn't know anything about it when I asked.

I wouldn't wait for a blood check as the time involved (levels drop enough to show up, you wait for test and for results, you increase dose, it starts working) is just too long in my view. I always went up by 25 to begin with when I knew I was pg. I was referred to endocrine clinic for last pg. I fucking hate GPS playing fast and loose with pregnancies.

Increase your dose and make a new appt with a different GP, bringing the guidelines with you.

Doctor told me get my blood tested every 6 weeks during pregnancy. I was only on a small dose to begin with but had to double the dose at about 20 weeks as i needed a slight increase.
Can you get a blood test done at least this week. Your doctor sounds a bit unhelpful.

see a different gp and get your thyroid levels checked. asked to be referred to endocrynologist, i have mine checked every 4 weeks. never had increase in meds in 3 pregnancies. worth getting it done regular to be sure so your dose can either stay same or go up or down. pregnancy affects thyroid a lot. x

Your GP was wrong and is not following guidelines! I would go back with the guidelines (perhaps see a different doc in the same surgery) and ask again!

Please go back and quote nice guidelines, gps are general they are not experts in this area. I went in and quoted nice and the doctor (not young) had never had a pregnant woman with hypothyroidism. I left with an appointment for bloods the next week, he rang that afternoon informing me that he'd left a script for extra thyroxine in the mean time.

My tsh is top of the normal range (not ideal in pregnancy) after post-partum thyroiditis after last pregnancy. I went to my gp and she had no idea (though did look at the NICE guidelines while I was there). She's medicated me, referred me to an endocrinologist and called me in for regular bloods so I'd suggest seeing someone else if possible.

Op, hypothyroidism can be a contributory factor in miscarriage. Sadly, i experienced this.

Go back & see another G.P ASAP.

Update us please! Good luck. X

I had a similar experience in both my pregnancies. As I had read about it, I simply increased the dose myself as soon as I got the BFP; and then regularly pushed for blood tests, and adjusted my dosage myself based on the results. I've had a thyroidectomy, so clearly need adequate replacement. But health professionals were basically not interested. Luckily they at least didn't argue when I asked for tests or new prescriptions based on the adjusted dosage.

Everyone is different but heres my experience. At 12 weeks both pregnancies I had my bloods done, and thats when I needed to increase my dose (25-50mcg) and then increased again at 28 weeks. Around 20 weeks I went for my thyroid appointments at hospital, this was setup by my midwife and I see them only if I need an increase. This pregnancy (I am currently 26 weeks) I now have bloods done every 4 weeks. If my results come out funny they ask me in for an appointment. Last pregnancy I stayed on my last pregnancy dose for about 8 weeks post birth before reducing.

Worth asking them to take bloods. It never was an issue in early pregnancy for me because I was on fertility treatment and they took them anyway. This time I went into the GP because I was fussy headed and said I think I needed my bloods done at 14 weeks, which they did and increased them. Good luck!

Thanks everyone, I've just been back and demanded a second opinion. I have an appointment for early Monday with someone else. The receptionist didn't seem convinced with the GP I had seen. I've also self referred to the midwives, they said they will check my bloods at booking in but better to go back to my GP in the meantime.

My doc told me as soon as I got pregnant to increase my dosage by 25%, even before seeing her (but to get bloods done quickly). Good job as my TSH was ridiculously high when I did get to see her, even with the increase (it'd been stable before but was always temperamental). They monitored with 6-8 week bloods. I went from 100mcg to 175 & now post-baby am on 125. Bub was born perfect. Keep on top of your blood tests - & good luck!

When I saw my consultant at 11 weeks she prescribed an increase and said I need bloods done every 4 weeks.
If you are still symptomatic at all, a lot of people find they're better on Natural Dessicated Thyroid. Either way, Stop The Thyroid Madness website is well worth a look for amazing info on hypothyroidism.

Good. And wave the NICE guidelines. The need for thyroxine increases early in the pregnancy - and besides the mc risk, it's especially important to get your dose adjusted as the baby is not making his/her own thyroxine yet (start about week 11ish iirc). So waiting for months and months to see someone, have tests and then increase is not ideal.

Good. Gps are IMO clueless about thyroid issues in pregnancy.
You should be referred to a Consultant which may mean more hosp appointments but all will be well. I was diagnosed just before becoming pg and had quite high tsh for most of my pregnancy while trying to get the right dose of thyroxin. DS unaffected but it caused me quite a lot of worry! By 2nd pregnancy tsh levels had been steady and low for quite some time and I was discharged from Consultant early on.

Hello! Also hypothyroid and 33 weeks now Print off and take the NICE guidelines with you. Some GPs - and midwives too - are completely clueless as others have said. My dose was increased as per the guidelines at 4 weeks and I've had my bloods done every 4 weeks since.

And don't wait until 11-12 weeks for the increase as you need it early on as the baby can't produce its own until 12 weeks ish when the plan cents is fully functioning.

Just seconding everyone else's advice. I just happened to have an appointment with my endo the day after my BFP and he immediately increased my thyroxine by 25mcg. I also take t3 liothyronine and that remained the same dose. ( he also took bloods that day)

I am under the care of the endo and an obstetrician on account of my hypothyroidism and they have liased with my midwife who has generally taken my bloods and the three of them have liased in my care.

In your position I would insist on a referral to the endocrinolgist and vigourously wave the NICE guidlines at your GP.

Thanks everyone, I will keep you updated after my app tomo x

So I went today and could only see the nurse practitioner who was very patronising and rude. I was in trouble because by the time I'd made it to the front if the massive queue I was late for my app, despite being there 15 mins.
She asked me where I'd got my info and I quoted nice. She said she used to be a midwife and had never heard of an initial increase or blood test and it wasn't standard practice. She said that I was over thinking and if I carry on with this anxiety I will give myself a miscarriage. I quoted nice again, informed her of studies I had read, friends experiences and our conversations. I stated that I didn't want to put my baby to any risk and being completely reliant on my meds I was worried about my tiredness. She asked if it was my first baby and said "ahh, that's the issue, that's why you are so anxious, tiredness is normal". I'm not even that anxious btw and I know tiredness I'd normal but it would be nice to eliminate another contributing possibility. She wrote me a blood card for me to appease me, stating it was to sooth my anxiety and there was no clinical need. There were no apps for this. I burst into tears when I get home. I looked at the card, she only asked for tsh, didn't put on I was in early pregnancy and missed off my NHS number. My friend took my blood at work so we'll see.
Awful treatment yet again.

Wow that's appalling! Even if you were just anxious first time mother (you're not), staying you're silly and will give yourself a miscarriage is certainly not normal!