Under active thyroid.(11 Posts)
Sorry if this has been asked before.
I am 6 weeks into my second pregnancy. I felt like my thyroid wasn't managed at all in my first, leaving me feeling pretty awful. Despite taking between 75-100 levothyroxine since I was sixteen I have never received more detail than normal etc.
Any tips on what I should expect or ask for?
Also, does anyone else feel that their thyroid was maybe the cause of higher levels of morning sickness during pregnancy?
Beating in mind my youngest is 10, things may have changed .
When I was pregnant with him, I was on 150mcg, and as a matter of course this was increased to 200mcg. From memory, I don't think any hypothyroid symptoms were any worse during pregnancy.
With morning sickness, for me it was pretty much the same 2nd time round. In my 1st pregnancy my thyroid wasn't underactive, so it's probably as fair a comparison a I can make.
Hope you start to feel better-morning sickness is grim x
It's not too bad yet. Just trying to be a little more pro-active this time round. My morning sickness was horrendous last time, but they say every pregnancy is different <hopeful>
I have found it nearly impossible to get this managed, and I have kicked up a fuss and had a private consultant obstetrician write to my GP. I am having my first endocrinologist appointment at 23 weeks.... which is verging on negligence given the critical period for the thyroxine dose to be raised is pre 12 weeks (post 12 weeks the baby makes it's own, but prior to this he/she is reliant on you, and too low a level can be detrimental to development).
My advice is go to your GP, ask for an endocrinologist referral as a matter of urgency, book a blood test so you have up to date bloods results, ring your midwife directly and ask them to call the endocrinology department as well. I was put on a standard waiting list, which is not appropriate for pregnancy hormone issues, as obviously pregnancy is not something that waits about.
You should have your dose raised by about 50%. It is not just about making you feel better, you need the extra for the baby too. The dose should be raised pre-12 weeks. If your GP isn't keen on doing this push for it. Go on google, take in some print outs - it is important.
Message withdrawn at poster's request.
Thank you for all responding so quickly. I was at a different doctors last time and they never changed my dosage at all.
I was a little worried about googling as you often end up paranoid and scaring yourself. This is really helpful as I know what I am looking for. I feel really stupid for being so naive and not chasing things last time.
Message withdrawn at poster's request.
From memory, the guidance (which many GPs/midwives don't know about/don't follow ) is roughly as follows:
- Get TSH and FT4 tested immediately on discovering pregnancy. TSH should be under 2 and FT4 in the "upper range" (I think this means above 12ish?). if it's not, adjust dosage.
- If it's going to take a while to get tests done, increase thyroxine dosage while awaiting outcome of tests as a precaution
- Get repeat tests done every 4 or 6 weeks in first trimester (can't remember which sorry!), then once per trimester. Adjust dosage as necessary to keep TSH <2 and FT4 in upper range.
Your midwife should also refer you for extra appointments during pregnancy with a consultant, who will keep an eye on your thyroid. Either the GP or the consultant can refer you for the various blood tests.
If you can't get to the GP soon, or if they won't do blood tests without a consultant's say so (which of course takes extra time...) then you might consider upping your dose yourself in the meantime.
I increased my dosage to 100 from 75 after reading these posts and the nhs website.
Had a doctors appointment today and requested to be referred to consultant. It was nice to know what I was talking about and be bossy!
Thank you everyone.
It's a bit of a problem at the mo that some gps and mws don't know much. one GP even admitted she had no idea. I second everything Minipie lists. Really great that youve been referred and you've not had the carry on I had!
my thyroid has been unusually crazy but I also know that other people haven't had to increase their dose at all so it's very individual. Mine was strangely fast early on so it's the first trimester that particularly needs watching- even after 2 extra 25's dose increases by 13 weeks my tsh was 11. In total i went from 125 to 225 but then spent the next 3 months slowly reducing every 4 weeks.
- stay away from google.
- when getting blood tests make sure the nurse knows to put t4 and tsh and how many weeks you are - sometimes the lab didnt do my t4.
-I went to a British Thyroid Foundation meeting (public arm of british thyroid association of endocrinologists) led by an obstetrician, a little late at 25 wks but the main advice was all the above, plus try to take pregnacare which is i think about the only one which has iodine - you need a little extra iodine. All dairy is a good source too, plus fish eg haddock so follow guidlenes on those.
- baby begins to make his own thyroid hormones around 26 weeks so dont be surprised if you need to begin dropping again. I'm almost on my pre preg dose at 36 weeks
- try to take thyroxine a few hours apart from calcium supplements and gaviscon so as not to interfere (can block it) - which means pregnancare too.
Obstetrician's view was that women should be allowed to up dose them selves at bfp without gp say so. I would do so myself next time based on how this pregnancy has gone, but i worried about doing it when I got my bfp - so well done!
just to add, the consultant obstetrician who gave the talk told us about the baby making own hormones at 26 ish weeks.
also, erring on side of caution and going slightly higher if in doubt is better as long as t4 in range and you feel ok for example getting a tsh of 0.5 - gps worry about a surpressed tsh but the consultant who gave the talk said it's not a problem during the short period of pregnancy, but that I may feel im on too much an need to drop before the end of pregnancy - after the massive dose increase at 13 wks my tsh went to >0.05 (so i was making no hormone at all) and I did need to susequently drop in 4 week stages at 22 weeks - however I was taking a brand that was withdrawn from distribution up to 13 wks for being unstable so unbeknown to the docs i was kind of overdosed and then had to slowly reduce. Some women with particular types of thyroid problems actually have to supress their tsh totally in pregnancy (eg thyroid cancer). What I have learnt though is to be super sharp about blood tests and asking for results and I now feel able to make decisions with the gps and consultants, for example trying an alternate day drop (150/175) last time as I did feel all over the place when (both hyper then hypo) when dropping each time over most of the summer.
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