TTC with underactive thyroid. What levels do I want? What would you do?

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Hello

I know there are quite a few MNers who have experience of ttcing while hypothyroid and wondered if I can pick your brains.

So, I was diagnosed as hypo while TTCing DC1 - we'd had 10 months of nothing, blood tests showed TSH of 10, started on thyroxine 50mcg a day and bam a BFP 6 weeks later.

I am still on 50mcg a day, never needed to increase during pg, was able to decrease a little after pg but now back up to 50mcg a day. TSH is currently 2.15 and T4 is 15.5. T3 is 6. We want to ttc DC2 starting next month and of course would like it to happen quickly this time and keep levels at their best for foetal health if/when I do get pg.

So, two questions for you all:

1 - if you were me would you increase your dose so as to reduce TSH still further? I have read on some sites that TSH would ideally be between 1-2 to conceive. I think mine was about 1.6 when I got pg last time.

2 - if and when I do get pg, should I immediately increase dose when I get a BFP? Again I have read on some sites that this is the most recent advice, to increase by 30-60% (no idea how you are supposed to know how much within that range ) right at the start of pg, then get tested every 6-8 weeks.

I know I should ask my GP all this, and I will, but suspect I may not be given the most up to date advice in this area (based on previous experience...) so thought I would check with the MN Oracle as well

Thanks in advance

Yes you'd want your TSH under 2

cks.nice.org.uk/hypothyroidism#!scenariorecommendation:7

"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."

Ah thanks! I knew there was a page like that that I saw last time, but couldn't find it. Right, I shall go to GP with this in my pocket.

Stupid question but if I only have 50mcg tablets, how do I increase my dose by say 30%? Can I just take an extra tablet twice a week, or do I need to get 65mcg tablets? (maths probably wrong but you see what I mean). The tablets are so small I can't really halve them... I think.

I think they do 25 mcg tablets but you can just take an extra dose twice a week instead

Hi Guys sorry to wade in here.
I've had underactive thyroid for over 8 years, finally stable in last 1-2 years. I am taking 75mcg daily. Have spoken to my GP and she said not to do anything until BFP, then GP will adjust dose accordingly as harmful to self-adjust.
My friend also has the same meds and has managed 7 children without any problems!! Her meds are normally 75mcg but has regular blood tests and can go upto 300mcg towards last trimester.
Hope this helps.

I think 2.1 should be fine. I wiuld have a go at that if you are stable. My clinic wants under 2.5 for ivf (and that pushes it up)
But yes as soon as you are pg you will need to increase.
It may depend on your gp if they would be willing to increase.
Mine was 4 and they didnt call re the results - it was only a letter from clinic when saw gp that has upped my dose.
Are your cycles regular? Have you any symptoms? Are you cold ?

Thanks everyone, sorry for late response, I've been away.

My cycles are fairly regular, could be a few days' difference from month to month (but I also have PCOS so always been a little irregular). I am always cold medicated or not ...! Don't think I have other symptoms though - how do I tell?

I don't really know if I'm "stable". I've been on the same dose since diagnosis in 2011 (including through pregnancy) and my bloods have always been ok during that time (bit of fluctuation but always within the ok range) so I guess that means I'm stable?

Seems like there are different views on whether to increase as soon as I get a BFP, or wait and ask GP. The trouble with asking the GP is that it takes ages to get an appointment, then she's likely to want a blood test before giving a higher dose, so that takes another week, then the increased dose takes some time to kick in ... by that point I could already be say 9 weeks pg or more and a lot of development/MC risk happens before that. What are the risks if I up my dose by myself and then blood tests show I've gone a bit too far the other way, I guess I'd go hyperthyroid?