To want meds for thyroid to help me conceive

[ismythyroidok]

I know that the upper threshold for TSH before meds are prescribed is 4.2mIU/L but I've read some things online that it should be below 2 in order to conceive and keep a pregnancy. Mine is 3.5.
Anyone conceived with TSH at that level? If not, how exactly do I convince a doc to prescribe me meds when technically TSH is within the normal range?

How long have you been trying?
What tests have you had?
Has anyone medical checked your levels and suggested medication to reduce these?

@quisensoucie

How long have you been trying?
Just under a year

What tests have you had?
Ultrasound on my ovaries and uterus, AMH, semen analysis, hycosy for fallopian tubes. All came back normal.

Has anyone medical checked your levels and suggested medication to reduce these?
That's the question. Technically the results are within the normal range but from everything I read "subclinical hypothyroidism" makes it more difficult to conceive

I couldn’t conceive when subclinical. I was pregnant 12 months after taking thyroxine.

Are you the same person from the thread whose been trying for 9 months?

@Cmonluv not the same person but trying for a similar amount of time!
All tests are recent

@Cmonluv If you were asking me, no!

I'd ask for a referral to endocrinology based ont he numbers to assess for hashimotos, if they say no ask them to document you've requested a referral and why they've said no. Then see another GP at the practice, say you're unhappy, ask them to refer to endocrinology, if they say no, again ask them to document you've asked twice and ask for a copy of your medical records to attend a private endocrinologist. Also ask for their details at the GMC as if they are not referring appropriately you'll want it investigated.

If there's any reason to refer you theyll then Shit themselves and do it.

I don't have the answer OP by my levels are similar 3.9. When they were 2.9 last year they refused to prescribe medication. I had a new blood test before Xmas and they never called me with the results as 3.9tsh has came back as "normal" when it evidently isn't. They know I am TTC, have been for 13 months.

Very tempted to buy the medication online at this point

@Cmonluv understand, thank you! And what if she reasoning is just "it's technically within the normal range" ?

I had TSH about 4.5 and got put on thyroxine by an enlightened GP, was pg 8 weeks later after 11 months of TTC.

I think there is some NICE guidance that talks about lower levels for TTC? I may be wrong. Will see if I can find it.

Ask them if it's within the normal range for hashimotos? Ask if they have checked your other hormone levels, sorry, went through all this when I had multiple miscarriages but can't remember the details. Ended up being PCOS and lupus clotting agents in my case and the borderline thyroxine wasn't an issue but definitely try to get checked out.

If they won't refer I'd find a local endocrinologist for a private appt if you can afford it if you want to be sure, however if they'd till don't refer after all that it's likely their experience tells them there nothing to be gained so you have a decision to make.

Infertility is horrible I'm sorry, I hope you find a solution. Took us 5 years, 5 miscarriages and a lot fintests and then wham, our son arrived and it was as if the time melted away. I hope you find the same.

this is from the British Thyroid Foundation and says aim for TSH of less than 2.5 at the time of conception. Not NICE guidance but might help

Have you let your GP know explicitly that you’re ttc? They’ll usually be aware of the optimal TSH level for conception and might suggest a course of levothyroxine to get it up to the optimal level. Good luck!

This is terribly ignorant advice. A doctor won’t “shit themselves” because you threaten to refer them to the General Medical Council. You also don’t need to “ask for their details at the GMC” - the register is available publicly online. You can look up any doctor by their name or GMC number. It’s all freely available.

@ismythyroidok just call the practice to make an appointment to discuss this, and when you do speak to the receptionist, ask if any of the GPs have a special interest in fertility or thyroid issues. I think that they will be very understanding and helpful. They will also probably then book you in to repeat your thyroid function test. If they don’t want to prescribe levothyroxine and you disagree with their opinion, then request a second GP at the practice. If you still disagree because your blood tests and current scientific evidence and clinical guidelines suggest that giving you levothyroxine could be harmful, then I suggest you book in with a private GP.

Whoever suggested Hashimoto’s is also way off the mark. If you had Hashimoto’s then your TSH would be sky high, among other things not mentioned here. Please don’t start worrying about Hashimoto’s.

Good luck OP, I hope your conceive soon x

This is not applicable to the OP. This guidance is only for patients with what is referred to as primary hypothyroidism (I.e. autoimmune thyroid disease or previous surgery, radiation or radioiodine treatment).

True - but if those women (ie with a hypothyroid diagnosis) need to be below 2.5 at conception, then doesn’t everyone?

Studies like this certainly suggest so

@riverlodge90 urgh so annoying!! Hope you get your answers (and hopefully meds!) soon!

NHS Guidance is that you should be below 2.5 when TTC. I said exactly this to my GP when they suggested I might not need treatment.

I was 4.9 at diagnosis, but my diagnosis was off the back of getting a full private thyroid check through Lets Get Checked. My TSH was 5.9 according to them, FT4 on the lower side of normal and TPOAb was high. It was very clear I have Hashimotos but am early stage. I took these results to my GP which they repeated and it came back TSH 4.9, FT4 12.6 (below normal) and TPOAb was high, they confirmed the Hashimotos and that was the same consultation where I told them I needed to start thyroxine as I'd be TTC. DS2 was conceived the next month which was also the first month of trying, I had a TSH of 3.1 at that point. But there's more to the thyroid that just your TSH reading, I have a friend who has hypothyroidism and a completely normal TSH level. But that's cause her body doesn't recognise she's low on T4 and stimulate her thyroid accordingly... you really do need a full picture to draw any conclusions.

The impact on my cycles (which is why I wanted to get checked pre-TTC) was that my luteal phase was short at ~10 days. Ever since my levels were sorted I've had a textbook 14-day luteal phase.

If your GP wont consider a full thyroid check, I'd recommend getting one done privately, it's not ideal but might make a stronger case for the GP to do a repeat depending on what it shows up. Good luck

This is great advice! So glad that you had it sorted out privately and conceived so soon after.

eh, @TwoUnderTwitTwoo you don’t necessarily have to have ‘sky high’ TSH to have hashimotos. You can have antibodies for years before you’re TSH climbs out of range. Hashimotos is the most common type of thyroid disease 🫤.

Also, the NICE guidance that states that a TSH should be no higher than 2.5 when trying to conceive is for EVERYONE, not just those with hypothyroidism. You are giving uninformed advice.

First line fertility recommendation will be to put you on thyroxine to bring your level down so if your GP knows you're TTC they should put you on it to try. 🤷‍♀️

I have Hashimoto's and my TSH is always in "normal" range, but my antibodies are sky high.

@ismythyroidok I'm sorry you're going through this, I completely relate and want to scream every time the NHS act like I'm asking for £100000 when all I'm trying to do is understand & improve my health.

Does anyone have the link to NHS or NICE guidance on TSH levels when trying to conceive?

I have Hashimoto's, was diagnosed a few years ago but wasn't offered treatment as thyroid markers are normal except antibodies. I've never once had any doctors mention the range should be below 2.5 TSH when trying to conceive.... i''ve been ttc for 3+ years and I've even under infertility care for the past 18 months (yes it really is taking that long to even get a diagnosis).

I have a doctor's app next week to beg for an endocrinology referral as I want to be in the best position possible before starting any ovulation meds or IVF and also don't want thyroid issues to escalate if I do conceive! Last time i asked for a prolactin hormone test and was pretty much laughed at and refused - so doing my research and going into my appointment with all the facts so they hopefully say yes.

@Nolly1994 What are your latest results? When was your FT4 last checked?

They only check my TSH now so I'm guessing it'll be the same for you, but I would want my FT4 done on repeat if I hadn't started Thyroxine yet.

My last free T4 was 9.5, back in May.

I actually only got diagnosed because i got private thyroid testing done which showed the antibodies. The NHS then re did these tests and confirmed hashimoto's and said to do yearly testing of TSH and T4 and to basically wait for these to get worse before starting any medication (which i do understand as i wouldn't want medication when it isn't needed). I have definitely had worse symptoms the last 6 months though and a thyroiditis flare up, now constantly feel like i have a lump in my throat.

Just frustrating no one has clocked this range should be lower when ttc.