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. :)

@FlyingGiraffe Thank you so much. I don't know if turning 35 means I can go to the GP straightaway? I assumed I'd still have to wait till we hit the 12 month mark given we started TTC just after I turned 34. Can't hurt to ask I guess!

No, I've not had Day 21 bloods yet. I asked a GP about it before and they told me the NHS doesn't offer that test anymore because it's "old-fashioned"?! Then again, the same GP also told me we'd have to try for THREE YEARS before I could get referred to the fertility clinic (?!), so they clearly don't have a clue what they're talking about... 😂 If I don't have any luck with a different GP, I think I'll get a private home blood test or maybe try the Proov urine test strips which are now available in the UK.

You've certainly been waiting a long time for that appointment, hope you at least get some kind of timeframe soon! I think you were wise to go the private route for the initial tests. I suspect it'll be a lengthy wait round here too. Oh, and thanks for reminding me to investigate Ubiquinol! x

@Owl86 I think we can all totally identify with how you're feeling. Luckily it comes and goes but I need to be in the right mood to cope with friend's announcements and trips out with their little ones, and not to just put on a brave face :)

I've decided that lots of distractions and other things to look fwd to will stop me getting blinkered (which I'm prone to do) and keep me in the best headspace. As I'm almost 40 I was having a look at the stats. It's mainly the % of good quality eggs that seems to reduce with age so it takes more months to happen upon a viable egg, but when that egg does come up there's no reason we shouldn't stand as good a chance as we did in our 20s! And it's thought the eggs keep perfectly well in the reserve, it's during the 3 months maturation before ovulation that we need protect them from 'aging'. I agree with @FlyingGiraffe , I'm taking the ubiquinol for egg quality, proceive omega 3, and preconception vitamins. Plus now my daily Brazil nut! Just wish the ubiquinol wasn't so expensive, sigh. Trying to eat healthily, but I haven't given up coffee or gluten yet...I will if I have to but they are currently keeping me sane. I might eventually do the latter to see if it brings down my thyroid antibodies....

I've got one of Emma Cannon's books to start reading so I'll pass on any tips, and I might get It Starts with the Egg.

In Thyroid news, I just got my blood results, 3.85, so getting there...need to speak to the endocrinologist and my GP. It sounds like your T4 is stabilising nicely and the tsh will follow via the feed back loop. I do feel much better you know, even though I never thought I had symptoms, and this month I had my most 'normal' cycle yet since stopping the pill. Perfect temps and length etc, I'm sure the levothyroxine is helping.

Is there a particular dosage with ubiquinol? Any brands that people have researched and recommend? Pretty sure my period will arrive bang on queue tomorrow, and there was me feeling a tiny bit hopeful!

@Songbird50 Thank you. 😊 Yes, it was good news about my FT4 and I'm hoping the TSH follows soon via the feedback loop, like you say. I think I did read somewhere that a TSH that's been suppressed due to overrreplacement can take a little while to "bounce back" even once FT4 has normalised.

Glad your blood results are on the right track too. It's good you feel better as well, and that your cycles seem to be more normal. I have to say I haven't really noticed much difference in how I feel between being hypothyroid, within the normal ranges, and hyperthyroid. The only thing I've definitely noticed is lighter/shorter periods since starting levothyroxine. I think I did ovulate earlier than usual this month, which I'm hoping was just due to the overreplacement rather than anything else going on!

I've got the same questions about Ubiquinol as @Everythingcrossed2021. I think given my not-great FSH result, which could indicate lower ovarian reserves, I should probably do all I can to try and maximise egg quality. If this cycle is unsuccessful, I'll give Ubiquinol a shot. I was researching It Starts With The Egg over breakfast yesterday... Might be something to spend my 35th birthday money on. 😂

I'm taking 1 Solgar Ubiquinol 200mg softgel a day at the moment, the label says take 1-2. I really like this article as an easy read that explains the research and dosages :)

www.tomakeamommy.com/coq10-for-fertility-how-coenzyme-q10-improves-egg-quality-in-age-related-infertility/#

Doh! Forgot the link...

@Songbird50 Fab, thanks so much! Some weekend reading for me. 😊

Hi all!

How is everyone doing? - just checking in, its been a while! My thyroid levels are being checked every 6 weeks and I am now 17+5 today. TSH level is still good - 1.73. My T4 is 16.3, is this a normal range figure for T4? I know the TSH level is good but unsure of T4 xx

Hi @CTMcG

According to the tests I've had FT4 should be between 12 and 22, but 12-17 is optimal (that's not specific for pregnancy though). So sounds like your numbers are great! Hope things are going OK other than that.

Update from me - I found out earlier this week that I'm pregnant for the third time this year (currently 4+4). Both previous pregnancies have ended at 6-7 weeks, so I think the next two to three weeks are going to be pretty horrible. Trying to reassure myself since this is the first pregnancy I'm on thyroxine, so at least something is different. Really hope it's enough, since I'm certainly not feeling any joy or excitement yet. And what's making it worse is that today would have been the due date for the first miscarriage, so my feelings are all over the place 😖

Went for some GP blood tests yesterday, and going to have another private postal test in about 3 weeks time so I can adjust my thyroxine dose if needed (my GP is totally useless on that front).

Hope everyone else is doing ok and is less stressed than I currently feel! X

@nellyinthegarden congratulations!! I am sure this is a very scary, stressful time for you. I have all my fingers and toes crossed for you and little bean!!

How is your levels currently? When I fell pregnant, my TSH level was 3.85, levothyroxine was upped by 25mg and since then my level has stayed between 1 and 2 xx

Thanks @CTMcG. When my levels were last tested (about 8 weeks ago) TSH was 2.36 and FT4 was 15.6 after a couple of months on a low dose of thyroxine (antibodies were about the same). I should be able to get the results of yesterday's blood tests in the middle of next week, so will have a better sense of how things are going then.

Because of the two previous losses I have been referred to a consultant at the early pregnancy unit for a 'reassurance' scan, so if we make it to 6/7 weeks this time I'm hoping they can also advise on thyroid issues and/or refer me on to an endocrinologist. Although I still have the details of the endo @Owl86 recommended months ago in case I need them!

@CTMcG great to hear all is going well, that your TSH is good, and how the monitoring continues .

@nellyinthegarden congratulations . I'm only at the start of this journey so can only imagine how you are feeling, but it sounds very understandable. Even where I'm at I'm trying to protect myself from all of the emotional highs and lows. I don't know whether you've ever seen this family's story: www.tommys.org/baby-loss-support/baby-loss-stories/recurrent-miscarriage-and-autoimmune-disorders I came across it a few weeks ago and it reassured me we're doing all the right things.

Thanks @Songbird50 - I hadn't seen that Tommy's story before and it's definitely a bit reassuring 🙂

@CTMcG Lovely to hear from you and so pleased everything's going swimmingly so far! Can't believe you're 17 weeks already. 😊

@nellyinthegarden Congratulations on the positive pregnancy test. 😊 Your worries are completely understandable, I'm sure I'd feel the same in your shoes. As you say, you're on levothyroxine this time so hopefully you can draw a little reassurance from that. Fingers and toes tightly crossed for you. 🤞

As expected, my period arrived on Friday so we're now into Cycle 10. But I rang the GP this morning, pointing out that I'm now 35, and she's agreed to start preparations for a fertility clinic referral. So she's requested a blood test for AMH, prolactin, testosterone and some STIs, and my husband needs to have another semen analysis as his orginal one was over 6 months ago. Once all the results are back, she'll write the referral and send everything off.

So yeah, the ball's in motion. I'm due my next thyroid check in about a fortnight, so the GP said I might as well get all the other blood tests done at the same time to avoid being poked with too many needles! My husband's speaking to his GP tomorrow to ask about getting an SA, but I suspect we may have to go private for that again if there's a long wait. Otherwise it'll hold up the referral.

@FlyingGiraffe Am I right in saying you had your fertility consultation the other week? How did it go?

I saw an endocrinologist and GP for my hyperthyroidism and to be honest the GP was just as useful and much cheaper..

Hi all, how's everyone doing?

Just thought I'd pop on with an update. I had my latest thyroid check a few weeks back, having reduced my dose to 50 mcg x 3 times a week. My TSH has suddenly shot up from 0.06 to 9.35, which almost double what it was when I started levothyroxine! Heaven knows what's going on now, but suffice to say I'm definitely out of the hyper/overreplaced zone. The endocrinologist has put me back on my original dose of 50 mcg daily, which seemed to work well initially. Really hoping to finally stabilise in the next few months as I'm finding all this swinging about very stressful.

It also seems that my prolactin is elevated, so that's frustrating as well. Does anyone here have experience of this? I know it can be caused by an underactive thyroid. I'm going to ask the endocrinologist about it in the new year.

My period arrived at the weekend so starting Cycle 11 now. The GP's going to submit my fertility clinic referral after Christmas once my husband's recent SA results are back.

@nellyinthegarden Been thinking of you and crossing my fingers - I really hope things are going OK? x

Hi all, Happy New Year and I hope everyone had a good festive holiday and is doing well. Sorry for the radio silence from me, I was away and off grid, think I have managed to unwind which feels good.

@Owl86 the swing in tsh is frustrating, hopefully the endocrinologist will be able to adjust the dosage ever so delicately this time. I've just had my results back and I've reached a tsh of 2, waiting to hear my next dosage instructions but hoping it'll be quite a cautious adjustment. That's interesting on the prolactin, I wouldn't see it as bad news though as all info is empowering and I think that's one they can quite readily do something about...definitely mention it to our endocrinologist as I think it's also part of same field.

Hi all! Hope you’re all well. We had a Christmas miracle and got our 1st BFP on cycle 12. Literally just as my TSH came down to 2 from 3.5 6 weeks ago. Have had my 1st appointment through with an endocrinologist for mid feb which I’m slightly worried about as I’ll be 12 weeks by then! Anyone else has this experience? Should I be getting tests done by the GP?!
Sending lots of baby dust xxx

Hi everyone! Happy New Year!

Things still going ok here at the moment (thanks for the crossed fingers @Owl86 !). I'm almost 11 weeks now, and have had three early scans all showing things progressing as they should which is amazing and also so hard to believe. Waiting for the invite to my NHS dating scan now, which is the next big milestone - should be before the end of January.

@TTCThyroid2021 congratulations! My midwife referred me to an endocrinologist but not until 16 weeks which seems a bit mad - that, combined with my GP refusing all but the most urgent appointments, means I'm totally self-managing my thyroxine dose with private blood tests to keep my TSH below 2.5 in the first trimester. It crept up a bit around week 8 (to 2.4 from 1.6 at four weeks) so I upped my dose by about 30%. Don't feel any different so hoping all is ok.

@Owl86 that's quite an alarming swing in your TSH - hope the new dose helps you settle again soon, and the referrals come through quickly!

@TTCThyroid2021 Congratulations! That is such lovely and inspirational news. And @nellyinthegarden I am so happy things are progressing as they should :) I think nellyinthegarden has it spot on, levo dosage needs to increase by about 30% in early pregnancy: www.btf-thyroid.org/pregnancy-and-fertility-in-thyroid-disorders

And you should be tested every 4-6 weeks. I'd speak to you gp until you're under the endocrinologist's care, and if you get no joy supplement with some private tests like nelly for peace of mind :)

Hi all,

I'm glad I found this thread and hope you don't mind me joining the conversation! I checked my results from a blood test last year and noticed my TSH is above the range to ttc:

4.26 TSH
15.3 T4

I've asked my GP to give me a call tomorrow so hopefully I can ask for a retest for more upto date results. Fingers crossed things have naturally corrected themselves.

Hope you are all well!

Hello all!

Congratulations @TTCThyroid2021! I’m 23 weeks so far and needed a 25 mg Levothyroxine dosage increase at 11 weeks but some people need more sooner. I’m on 125 mg at the moment. The first 12 weeks is when the baby is reliant on your thyroid, before the placenta kicks in, so it is the most sensitive time I believe. The advice is to test every 4-6 weeks in this early stage but a lot of GPs and midwives don’t seem to be aware of this. I’d let the GP know you are concerned and mention the British Thyroid Foundation guidelines - www.btf-thyroid.org/pregnancy-and-thyroid-disorders-guidance-for-patients. If all else fails, I’d book a private test. You can order them online pretty easily I think.

For anyone who is on the conception journey, this article is really helpful. It sets out lots of things you can do to prepare your body. www.theinvisiblehypothyroidism.com/11-things-i-did-to-optimise-conceiving-with-hashimotos-and-hypothyroidism/

I hope 2022 brings some good news for everyone!

@SimpleStuff27 lovely to hear that you are getting on well. Very exciting. And thank you for the link, I'll get reading :)

Welcome @Bobduncan, you'll find this a very friendly and supportive thread. I'm so happy I found everyone too.

Thanks @Songbird50! I've just spoken to my GP who said 4.26 TSH and 15.3 T4 is absolutely fine and won't cause issues this isn't what I've seen elsewhere! She's agreed I can have my thyroid retested though which stupidly is making me nervous now! Fingers crossed all is well. Hope you all are well and having a good day so far!

@Songbird50 Yeah, I've had a quick Google about elevated prolactin. Assuming my thyroid is the cause, it seems like the problem will either sort itself out once my TSH has come back down, or it can be easily fixed by some other medication. I've booked a follow-up appointment with our endocrinologist for next week so I'll get the chance to discuss it with him then. I'm glad your TSH is now down to 2! Have you had your dose adjusted?

@TTCThyroid2021 Congratulations on your BFP! 😊 Lovely news. And @nellyinthegarden, I'm so pleased all is going swimmingly so far.

@Bobduncan Hi and welcome to the thread! :) I had very similar thyroid results but didn't get very far with my GP either. So I ended up booking a consultation with a private endocrinologist who put me on levothyroxine, with the aim being to get my TSH stabilised between 0.5 and 2. I'd wait and see what your retest shows and then take it from there.