Optimal thyroid levels when TTC?

[Frazzlerock]

I have an under-active thyroid which was diagnosed many years ago. I spoke to a fertility nurse who said I should aim to get my levels as close to 2 as possible. I was over-compensating so had my thyroxine reduced from 100 to 75, then to 50.
My most recent TSH has come back as 0.6. I'm told this is 'normal'. Is this okay for TTC though?

We've been TTC for 3.5 years and lost three babies so I'm desperately trying to do everything I can for a healthy outcome for our future rainbow baby.

[Happythoughts123]

@itswhereitsat I just spoke to my doctor and got the levels from my last blood test a couple months ago (which when I rang at the time was told was normal).

Tsh was 3.31
T4 was 17.3

[itswhereitsat]

I'm not a Doctor but have read quite extensively about Hypothyroidism. If those were my results I would say that I was undermedicated and would want a dose increase of 25mcg with a further test in 6 weeks to see where I was at. Both you TSH and FT4 have got plenty of room to improve, your FT4 is just in the optimal range but could still be improved further.. TSH should be around one for a non pregnant person and your FT4 should be higher. Also, there are no FT3 results (probably because they don't do it). This would show us where you are able to convert FT4 to FT3 (the active hormone). Some people can't. But based on that result you are undermedicated, you are normal but not optimal for a person with a thyroid condition. I would be asking for a dose increase for sure (and this is where the tiring battle begins)
There is an NHS document somewhere that say that the aim for being with hypothyroidism is to get the TSH down to 1. I'll see if I can dig it out.

[Happythoughts123]

@itswhereitsat thank you so much for your advice. I’m going to speak to my doctor next week about increasing my dose in preparation For ttc. Do you think with a level of 3.31 I will struggle to conceive?

My medichecks kit came today so will do that Tomorrow and send it off. Will be so interesting to see what my t3 is and also antibodies.

I’m so so glad I came across this thread.

[Butterflykiss00]

My last bloods my tsh was 19 and free t4 9
And they won't medicate me either just waiting on more bloods to confirm things, this was month ago

[itswhereitsat]

@Butterflykiss00

You have a TSH of 19 and they won't medicate you?. Your FT4 is through the floor. You should be demanding that you are medicated. What are the reasons for not putting you on Levothyroxine? It's not just about getting pregnant, there are serious implications for your health with levels like that. Do you not have terrible symptoms? When I had a TSH of 8.0 my hair was falling out.

[itswhereitsat]

@Happythoughs123
I'm pretty sure that your results won't stop you getting pregnant but you should try and get optimal for your general health. 50mcg is just a started dose, most people end up on 100mcg to 150mcg. It's just very poor management by your Doctor to tell you that results are 'normal'. You aren't alone though, it happens to loads of people.

[Butterflykiss00]

@itswhereitsat my hair does fall out and it's thinning, I get tired easily too, and headaches.

They just said because the t4 is at the bottom of the test range that they can't medicate. My thyroid antibodies are 78 and the reference range for hat is under 59

[bengalcat]

Butterfly kiss you’ve thyroid antibodies , you are symptomatic - ask for a referral to an endocrinologist or see one privately if you can afford

[itswhereitsat]

@Butterflykiss00

The NHS sets a very high level to treat Hypothyroidism 10.0. This is ridiculousy high, in some countries they treat at 4.5 and some at even lower. You have a TSH score of 19 which based on NHS guidelines you should be getting treated with Levothyroxine. You are not a borderline case or even a wait and see case as they sometimes do. You're extremely hypothyroid and needs to me medicated asap. Please go to your GP and firmly tell him/her that you are not happy that you are not being treated and asked to be referred. Don't take no for an answer.

[thankgoodnessforeurope]

I’m seeing my GP on Thursday for bloods. Which tests should I be asking for?

[thankgoodnessforeurope]

Also, really worried with a level of 4.03 what if I fall pregnant this cycle? We found out this and we’re prescribed meds the day I ovulated so was too late (we’d already been trying!).

Shall I stop TTC for 6-12 weeks? My egg reserve is so low, 3 months could mean I miss my chance?

[thankgoodnessforeurope]

Obviously I just want to be healthy first!

[Butterflykiss00]

Thanks for the advice, got a blood test in a Couple of weeks so will see what that says @itswhereitsat @bengalcat

[Frazzlerock]

Morning all

I have just had my Medichecks results through. Whoop!
@itswhereitsat would you be so kind as to have a look for me? I've screenshotted for ease. Looks like everything is in healthy range but are those results optimal for TTC and avoiding further MCs?

[Frazzlerock]

I've just seen the docs review. I guess I just need to make sure my GP or RMC consultant keeps on top of it if I ever get pregnant again.

DP has his semen analysis results through tomorrow, I'm really nervous as we both had mumps after our 2nd loss (no idea how as we didn't know anyone with it and no one we know has had it since) and one of his testicles was affected. We have since had another pregnancy but I know that mumps can cause DNA fragmentation which can cause MC. It's such a minefield all this. I just keep waiting for the next block in the road for us. I can't help but wonder if it will be bad news after all our shit luck

[ceebee21]

I want to jump on this thread.... I am going through a MMC and also have an underactive thyroid... thinking it may have something to do with it!!

I have just spoken to my Doctor who advised that my blood results when a couple of weeks pregnant were showing TSH of 10.0 and FreeT4 of 17.2... my dose was upped by 25mcg at this point... but obviously no idea of what they are at now!

I have asked my doctor for further blood tests as want to TTC ASAP again.

Think I may look to get the bloods done through medichecks!

xx

[itswhereitsat]

Hi Frazzlerock,

Good news. You don't have autoimmune thyroiditis and your levels are all in range. One thing I note though is that for such a low TSH you have a pretty low T3 and T4 but I don't think that is a problem. I wonder what the cause of your Hypothyroidism is if not autoimmune which most cases are. Anyway, based on those levels I don't think that your Thyroid is the cause of your miscarriages.. Good at least that you can rule that out and focus on other reasons x

[Frazzlerock]

Thank you so much itswhereitsat. Yes I thought it looked good but I was also wondering about everything being very low on the scale. I'm sure it is fine though
I'm only on 50mcg after being on 100mcg for such a long time, so I'm pleased it all seems to be okay on such a low dose. Maybe my thyroid was the cause of my MCs as I am only recently down to 50mcg. At least I can rule out my thyroid being the cause of any future MCs - hopefully I won't have any more MCs. Three is enough for me!

I'm so impressed by Medichecks, thank you ever so much for the recommendation x

[thankgoodnessforeurope]

@itswhereitsat coming back to this excellent thread, which has been so useful!

I’ve since had confusing test results, after requesting all previous blood tests this year from my previous GP. Any advice on what it means?

In January this year I visited my GP with exhaustion and my results were TSH 4.48, T4 16.9. I wasn’t told this, all results “normal” and was given iron supplements (ferritin 19). However, now that I see my print out, it advised retesting and TPO.

In May 2019 TSH was 1.9 and T4 15.22 (I conceived around this time but lost it at 5 weeks). Ferritin is always 19-24, even now.

In September my results were TSH 4.09 and T4 15.6, again “normal” but fertility consultant (3 CPs now) said they were not and started me on 50mg Levo.

I was tested again, as was in for day 21 test, and results are (after 2 weeks on Levo) TSH 1.54, T4 18, T3 4.9 and TPO

[Broodyaf]

Hi all,
I am hoping some of you can reassure me -
So I was researching into TSH as mine came back from fertility clinic at 3.02
I asked for Levothyroxine or equivalent - they said I did not need it
I asked my GP - she also said I didn't not need it
I am heading over to Prague for my 1st IVF next month and this has been bothering me. I asked the clinic in Prague to prescribe it to me - they also said I didn't need anything but to go and get a full thyroid function test done and as long as T3 and T4 were ok They wouldn't be prescribing anything.

The new results came back and my TSH had increased (in the space of less than 3 weeks) to 3.13
T3 4.5
T4 13.3

I sent results over to Prague and again expressed my concerns. Doctor in Prague came back again and said no I didn't need anything

So I had to settle myself because surely all 3 cannot be wrong????


This

[thankgoodnessforeurope]

Were your blood tests first thing, and did you fast overnight before them?

[Broodyaf]

No & no
The 1st set was done at 2pm and 2nd set at 11am and no one told me to fast

[thankgoodnessforeurope]

TSH rises during the day. I’d insist on retesting. There’s a forum called Health Unlocked further upthread, lots of knowledgeable advice there if you post.

[Zest11]

Hi @Broodyaf

I see your concerns (my levels are v similar). I asked my fertility clinic and they said only if the tsh was above 4 and I was hypothyroid (some clinics would give it though). However it might be worth your gp writing to or referring you to an endocrinologist. Basically there is no evidence/research that with our levels we need treating. However, some clinics are prescribing it, I guess empirically. (Probably private ones)

For what it's worth my levels have been tsh 3 to 3.5 and ft 4 has ranged from 12-15. I went to my GP as well and he said he wouldn't give it to me with those levels. When I said to him I had obtained a low dose of thyroxine from "an alternative source" he wasn't too happy but said he would write to an endocrinologist to seek their advice. They gave a waffly reply (bit like this one!) and said I could be on 75mcg whilst ttc and should have blood tests regularly!

[thankgoodnessforeurope]

“the ATA recommended a TSH normal reference range of 0.1 to 2.5 mIU/L for the first trimester, 0.2 to 3.0 mIU/L for the second trimester, and 0.3 to 3.0 mIU/L for the third trimester [26].”

From: www.ncbi.nlm.nih.gov/pmc/articles/PMC5961023/


www.createfertility.co.uk/fertility-guide/conditions/hyperthyroidism-and-fertility