TTC and subclinical hypothyroidism

[Owl86]

Hi all

I'm 34, and my husband and I have been TTC our first baby since January. We've had no luck yet, but realise it's still quite early days.

However, I recently had a blood test after an ultrasound found a polycystic ovary. This came back negative for PCOS, but showed my thyroid function was out of whack. My TSH is 4.93, higher than the reference range, and my free T4 is on the lower (but normal) side at 14.7. So my GP told me I'm subclinically hypothyroid.

Not really knowing anything about thyroid issues, I asked what this meant for fertility and pregnancy. The GP said some fertility specialists like TSH to be under 2.5 when TTC, but it's more about optimising the body for conception than anything else. They didn't suggest medication right now, but said if I'm still not pregnant within the next 2-3 months they'd repeat the tests (with an extra check for thyroid antibodies/Hashimoto's disease) and refer me to the fertility clinic for advice if my TSH is still high. But if I do become pregnant, nothing further needs to be done.

I've since done my research and it doesn't seem to tally with what the GP said. As I understand it, for a healthy baby and pregnancy TSH levels should be below 2.5 and T4 ideally on the higher end of the normal range. And the NICE guidelines seem to suggest we should delay TTC
until I'm medicated and my levels have normalised and stabilised: cks.nice.org.uk/topics/hypothyroidism/management/preconception-or-pregnant/

I'm not sure how far I'll get with the GP, as they admitted they're not totally clued up on these matters. So I've ordered an advanced thyroid self-test kit to get a full picture of what's going on. I'm then thinking about seeing a specialist privately for advice on whether I should be taking thyroxine or not.

For anyone who's been through similar, my questions are:

1. What sort of specialist would be best to see? An endocrinologist or fertility specialist/reproductive endocrinologist?

1. Once on medication, how long did it take to get your thyroid hormones to the right level for TTC and pregnancy?

1. Do you have any suggestions or advice? I'm feeling rather unsure and overwhelmed by the whole thing.

Thanks so much in advance. :)

I managed to resist the urge to test over the weekend, but my period arrived today right on schedule. Not sure whether that's better or worse than seeing the negative test to be honest! Generally feeling a bit miserable but I know the hormones are mostly driving that. And given my numbers are all in the good ranges I'm going to stick on 25mcg for now, but will probably try and increase if I get pregnant again.

How are you feeling @Owl86 ? Hope your next round of blood tests show things going back to normal! And how are you deciding what other tests to look at? I'm considering tests for NK cells (partly because the treatment would be similar to trying to treat for thyroid antibodies, which I know I have), but put off by the price / limited number of places that offer it.

On the advice of a friend I've also just signed up for Natural Cycles and am going to see if charting my temperature works for me in any way. The friend who recommended it isn't currently trying to conceive (at least as far as I know) but is obsessed with all the data it gives her, and more information about your cycle can only be a good thing, right?

Has anybody else tried it? And do thyroid issues have an impact?

@nellyinthegarden So sorry your period came today. I know what you mean about not being sure whether seeing your period is any better than seeing a negative test!

I'm feeling OK, thank you. Obviously very bummed to still be playing the TTC game, but trying to shift my focus back onto other parts of my life and not let it consume me. This TWW is the most zen I've ever been in a TWW, so that's progress!

I'm only looking at having a HyCoSy scan in the near term, as I don't want to jump into having too many investigations too soon. I don't know what an NK cell test is, I'll have to Google that.

I did look into temping a few years ago, but decided it's not for me. My cycles are regular and I'm confident I nearly always ovulate between CD13-15 based on OPKs, CM and other signs, so I'm not sure what useful extra info it'll really give me. And as a big worrier with obsessive tendencies, I just think it'll be another source of stress. I'd 100% start overanalysing the data and looking for possible implantation dips or something. 😂

But that's just me, obviously a lot of people like your friend do find temping helpful so why not give it a shot? I don't know if thyroid issues would have an impact, I can't see how it would though. Let us know how you go!

Hi all :)
@Owl86 I managed to get booked in for the private appointment and DH has already had his SA come back as normal/above average so that's a positive. I have AMH bloods and a scan next week then a consultation about the results two weeks or so after that so I feel like we might know a little more by this time next month. Good to hear you're feeling zen! Fingers crossed for you!

@Everythingcrossed2021 Sorry AF came for you too :( Now AF has almost stopped I feel a bit more positive again, but it does suck doesn't it?!

@nellyinthegarden I used to temp and used Fertility Friend to chart it on. It reassured me that I do get the temperature rise after ovulation (I was using ovulation sticks too) but I decided to take a step back and stop because I was getting obsessed or upset by it! Now I know like @owl86 that I ovulate around cd12-cd16 I'm fairly confident without it. I think I'm going to go without tracking anything this month and just try to dtd every other day instead :)

Hi all,
I just wanted to offer a bit of hope and share some advice I’ve received along the way.
I was diagnosed with hashimoto’s in August 2020 after coming off the pill and my cycles not returning. Luckily I have private healthcare cover that allowed me to see an endocrinologist straight away. It took about 6 months to get things stable and another 4 months for my cycles to return. Even then they weren’t regular. During this time I’d had ultrasounds showing cysts on my ovaries and was really starting to panic. My endocrinologist was great though. Kept my TSH under 2, advised to avoid/reduce gluten and processed food and eat plenty of good fats and protein. She recommended taking a pregnancy vitamin from the outset to get my vitamins in check and I took a bit more vitamin D because I was very deficient. She also recommended gentle exercise, like walking/yoga, reducing stress and getting plenty of sleep. After a year of trying to prepare my body for pregnancy I was starting to lose hope but she reassured me that if I relax and look after myself I would get there. 5 months after my cycles returned, whilst on holiday, I managed to conceive and I’ve just had my first scan at 12+2 weeks pregnant. Everything seemed fine which was a huge relief! What I have found since then, now that my private cover has ended because this is a ‘chronic condition’ 🙄, is that the GP and midwife don’t seem to be aware of the maximum 2-2.5 TSH level during pregnancy. Thankfully they’ve referred me to an NHS endocrinologist now. When my levels go above this I feel incredibly tired and bloated so it definitely makes a difference to me. I’d recommend pushing to see an endocrinologist if you’re in this position or trying to see one privately (although I appreciate the cost makes this option much less accessible). Alternatively, just keep asking questions until they get fed up and refer you! I’m also having to push for 4 weekly blood tests myself but thankfully my GP is going along with it.
Moral of the long story is don’t give up hope, see the wait as preparatory time where you get your body in the best position you can for your baby and don’t be afraid to question your GP on your blood results and frequency of tests. Good luck everyone! I’m keeping my fingers tightly crossed that I can keep this little one growing.

Hi! Thank you for the message, this has given me hope :) Just reading all the above messages now.
To jump in i've recently been diagnosed with under active thryoid, 2 months taking levo and levels are now nearly where they need to be so hoping it wont be too much longer (almost 1 year TTC) but grateful i found out about my thryoid relatively early.. anyway, back to reading all the above! x

Thanks so much for sharing your story @SimpleStuff27, and congratulations on your pregnancy - I'm so glad you got there in the end! 😊 And welcome to the gang, @TTCThyroid2021.

Hi waves place marking as awaiting results from my 🩸 hope that's ok 💕

Thank you both 😊 I forgot to mention that I also went caffeine-free, drank minimal alcohol (glass of wine every couple of weeks) and have been eating one Brazil nut most days to supplement selenium. Apparently that and vitamin D are good at reducing the thyroid antibodies. Doing something different to hopefully help the situation made a difference to how I felt mentally. I felt like I was taking more control of the situation. But I appreciate that some of these sacrifices may push people over the edge of a happy lifestyle. Go with what works for you. It’s been a long journey for me and I’m still very worried about the future but I’m doing my best. You’ll all get your time eventually. Stay strong and focus on you xx

Thank you for sharing your story @SimpleStuff27! It’s so important to keep the hope alive, and stories like that do help! Can I ask how long you changed your lifestyle habits like caffeine free and booze free before you got your BFP? It’s something I’ve been considering too but like you say, it’s hard to give simple pleasures up when this is going on for longer than I had anticipated…

Lovely to hear your experience @SimpleStuff27 and happy news, congratulations! And I love Brazil nuts, that will be a nice new daily treat, great tip!

My TSH is down to 5 now so making progress and I've been increased to 75mcg of levo daily on the back of that result. This month is our first proper month of trying after all our hiccups, but I've caught a stomach bug, it's crazy how frustrating these things are...like work trips that are suddenly at the wrong time. Never would have thought twice about the timing of these things before. Talking of temping, I've been using the free app Femometer as my cycles have been irregular and I wanted to check I was indeed ovulating. I like the app a lot, but I too can get obsessive and what I thought was a super temperature rise this month turned out to be the stomach bug arriving. Oh dear!

@Owl86 My gp surgery lost power and closed for a week, delaying my exemption submission but it's in now. You suddenly got me thinking...do we get a physical certificate...so I googled and found this: services.nhsbsa.nhs.uk/check-my-nhs-exemption/start
Turns out mine's been registered after about a week, hope yours is on there too?

@mrsmacmc Of course! Feel free to join in when you've got your results. 😊

@SimpleStuff27 I don't seem to have Hashimoto's (very low levels of TPOAb and TgAb antibodies), but to be on the safe side I've been taking a Brazil nut every other day for the last several months plus increasing my Vit D intake as recent tests showed I was nearly deficient. I've always drunk very minimal alcohol and caffeine (extremely boring, I know), but it's clearly making no difference in my case anyway! 😂 Thank you again and wishing you all the very best for the rest of your pregnancy. 😊

@Songbird50 Glad to hear you're making progress and have had your dose increased, but so sorry to hear you've been struck down with a stomach bug - that's blimmin' typical! Hope you feel much better soon. And thanks so much for sharing that link - just checked and I'm registered too, phew! My understanding was that we were supposed to get a physical certificate within 10 working days of the application being received. If it doesn't arrive soon, I'll ask the surgery about it when I call for my next set of blood test results.

13DPO today. Not tested but I just know I'm not pregnant, so just waiting for my period to arrive sometime over the weekend so we can take Cycle 9 by the horns. Having really been pretty chilled this cycle, I woke up at 4am this morning worrying about TTC (and the fact I'm turning 35 soon). D'oh! 🙄🤣

Welcome @mrsmacmc! It's so nice to have people to talk to who understand what the numbers mean without needing a long explanation about the differences between TSH and FT4, so I hope you find this little group useful when you get your results in.

And have just added Brazil nuts to the shopping list, thanks for the tip and the hopeful story @SimpleStuff27 😀 I hope we're all in your position soon, and that the next few months go well for you!

I've been taking pregnacare conception and extra vitamin d since the spring, and definitely noticed a big difference in energy levels and generally feeling well as a result (much more noticeable than when I started on the thyroxine) - I was permanently anaemic and vitamin d deficient before then, and think I must have been for years!

Hope your weekend is ok @Owl86. I was feeling really crappy when my period arrived on Wednesday (not helped since it came with cramp, headaches, nausea and sore boobs, as if to taunt me!). But feeling much more cheerful and positive today. Also took my temperature for the first time this morning (but will remember the warnings from you and @FlyingGiraffe not to obsess over it too much!)

Oh and welcome @TTCThyroid2021 too - sorry I missed you!

Thanks everyone. I have spent a lot of time reading through these feeds over the last 14 months or so. Seeing stories that show that conceiving is possible helped me stay positive so I’m hoping it does the same for you.

Hi @Everythingcrossed2021 - I cut caffeine straight from diagnosis in July/August last year and did drop my alcohol intake quite early on. I still had a few drinks on special occasions. I’ve always suffered with really bad hangovers, probably related to my thyroid, so limiting the quantity did make me feel a lot better. I feel like the medication, taking it easy and the vitamins (particularly vit D) made the most difference ultimately though. But ‘taking it easy’ is easier said than done if you’ve got a stressful job or home life. I think that’s where walking, yoga or swimming helps. Something quite relaxing. Good luck!

Hi @nellyinthegarden - There’s a fair amount of research on selenium benefits so hopefully that helps. Just don’t eat too many as you can quickly get too much! I think one per day is probably the maximum. Good luck!

Hi @Owl86 - the 2ww is so stressful. I’m nearly 34 so a similar age. It’s a double worry when another year passes and everyone keeps reminding you about your ‘biological clock’ 🙄. The social pressure makes everything 100 times worse I found. I kept my struggles largely a secret because I didn’t want to be talking about it all the time with friends and family or them feeling sorry for me. It doesn’t stop people making random ‘baby time’ comments though. People should be more careful about these things. Good luck!

Hi @Songbird50, just to say I got my medical exemption certificate though the post yesterday. Has yours arrived yet?

@SimpleStuff27 Thank you for the luck and encouragement. 😊

As expected, my period arrived bang on schedule on Saturday so onto Cycle 9 we go. CD6 now so I'll be in my fertile window next week.

Just been down to the hospital for my 4-weekly blood test, so hopefully I'll get my results on Monday if I'm lucky. Really hoping I'm now out of the hyperthyroid zone since reducing my levothyroxine dose. 🤞

Hi @Owl86 my certificate/ card arrived this morning just after I read your message, we must have been in the same batch! Nice to have that sorted. Hope your test results hit the sweet spot next week.

@Owl86 sorry to hear you're on to the next cycle too. Hope your bloods come back in the right range next week. Let us know!

I had my private fertility scan this week along with AMH bloods. I'll get the results at our consultation in a couple of weeks time. The nurse talked me through everything and seemed happy with the scan. She was happy I had my thyroid within the correct range for ttc and thinks they might suggest progesterone to support the luteal phase as I start spotting so early. Fingers crossed anyway 🤞 It was £225 for the scan, amh, SA and consultation so I'm pleased we've gone ahead with the private investigations now.

Hi All,

I hope you don’t mind me joining this group. @Owl86 - very kindly sent me through the link following a question I posted about slightly elevated TSH levels. I spent the weekend reading through the chat and it was so reassuring to read everyone’s stories and not feel so alone on this point.

A bit of history on me. I’m 33, came off the pill in April and had three normalish cycles, although periods were lighter than what I remembered from my last pre-pill patch. Since July my periods have been out of whack with my cycle around 33-38 days. I decided to do a home hormone blood test after my GP was super unhelpful and basically just told me to come next April and it highlighted a slightly raised TSH of 2.59 which google told me was too high for conception. After then obsessively trawling the internet for everything and anything there is on TSH and it’s link to fertility I decided to bite the bullet and pay for another thyroid test at home which just came back this afternoon and hasn’t helped matters at all 🤦🏼‍♀️🤦🏼‍♀️

Anyway, feel a bit despondent now. My dad is a dr and keeps telling me the 2.5level is not important and that FT4 is the only result you really need to be looking, but then why do all the fertility guidelines state 2.5?. I have a GP appointment in December and I am going to ask for a private referral to an endocrinologist, but wish I’d never started digging so deeply into this as it’s not helping my stress levels on TTC.

How has everyone else found broaching this with their GP and even with endocrinologists?

xx

Hi charro86!
Sorry to hear you’re struggling too.
I’ve been quite persistent with my GP and during my 1st appointment she wrote to our hospitals endocrinologist for advice. The advice came back that TSH should be under 2 and when I get pregnant to be referred back to them. That was 12 weeks ago now and my levels have come down from 8 to 3.9 so still a little way to go.
I would definitely push your doctor to get you referred , it helped that I had symptoms (feeling the cold, tiredness, struggling to lose weightm) and the doc did say she wouldn’t have referred me if I didn’t have symptoms,
Hope that helps and you get the answers you’re looking for :)

@TTCThyroid2021 - thank you so much for your advice. It’s always nice to hear someone having a good experience with a GP! And that’s great news that your TSH has come down . Have you done anything / taken anything to get this to come down or is this natural?

I am not sure if I have any symptoms. I do feel the cold and always have cold hands / feet and my BBT temps are on the low end, but I’ve always been like that and looking back through past blood test results my TSH has always been below 2. Maybe a little bit of exaggeration with the symptoms might help when I go in for my appointment!

Check out Mary Shomon's writing for the best advice on managing hyperthyroidism. I used her articles on pregnancy to guide me, and I am so glad I did.

Hey everyone! Hope you’re all doing okay. Welcome to some of the newbies that have joined the gang too. I’ve found this thread particularly helpful, so I hope you do too! @FlyingGiraffe glad to hear that your scan went well and your partners results were all good too - one less thing to worry about! Update from me. I had my bloods done earlier this week after 6/7weeks on a double dose of 50mg. Not that impressed with the results:
TSH - 2.7 (2.9 before)
T4 a 14.9 (15.6 before)

Slightly confused as to why it’s not reduced more with such a significant increase in dosage so I’ve booked in a consultation with my GP on Tuesday. But at least that TSH is still coming down in the right direction! I’m about 9 DPO and not feeling very hopeful, but that’s a coping mechanism now after all the months of trying! Self preservation I think. The next thing to try for us is really reducing our alcohol in take to see if that makes a difference, and I think I’ll do OPKs again next cycle after a good few months not doing any measuring etc. Fingers crossed for you all for your next cycles! X

Hi @Everythingcrossed2021 😊
That does seem odd it's not moved more. I think it's great that you've managed to get a GP appointment to discuss it. Fingers crossed they can increase the dose. It is good it's coming down to almost within range though. Maybe another 25mcg will shift it? Let us know what they say on Tuesday! 🙂

@Charro86 welcome 👋 your tsh isn't too far out of range so they may not medicate you yet, but may suggest re-testing again in 3 months like my GP initially did. Mine came down naturally a little bit, but I was still above 4.3 so the endocrinologist decided it was worth trying. I've been on levothyroxine since June or July now and I'm still not pregnant so i haven't found it to be a miracle worker! There is something about Iodine helping with thyroid levels so it might be worth trying Pregnacare conception as they have 100% of the recommended daily allowance in. Just be warned that some people find they changed their cycle lengths!

I'm in the tww but have had some pink spotting first thing already (nothing since but that's usual) I decided not to use opk's this month so I have no idea when I ovulated, but I'd guess I'm only 3 or 4dpo. I think I'll use them again like you @everythingcrossed2021 next month. I have zero hope either now. Our consultation to discuss my results is next week so hopefully we find out what's going on and where we go from here 🤞

Hope everyone else is ok and having a lovely weekend xx

Hi all, just a quick update from me. I got my latest blood test results last week:

FT4: 17 (down from 25.5)
TSH: 0.06 (up from

@Owl86 sorry you're feeling down. It's so hard isnt it. I understand how you're feeling - a few of our friends are pregnant or have given birth recently, and I've found it really tough. I guess the plus of turning 35 is you can now go to the gp?! It might be worth trying to get on the wait list. Have you had day 21 tests etc? I've been on the waiting list since March after having the basic blood tests and they still dont know when I'll be seen. I am in Wales though! I think England is likely a lot faster from what I've read on here. I'm glad weve gone for private tests in our case as it doesnt sound like we'll be seen anytime soon and time isnt on our side. In the meantime I'm trying all sorts! Ubiquinol, vitamin c & e, a hot water bottle to keep the feet warm! Anything is worth a try now 😂 fingers crossed your tsh comes up with the new dose. Hope you're ok anyway and feel a bit better this evening xx