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. :)

Yes, a little dose tweak for me, 100mcg every day, up from 75mcg x 3 days and 100mcg x 4 days. Think that sounds reasonable :)

Hi - i have read a lot of information on this post and was looking for advice.

I have been trying to conceive for 8 months. I was concerned something was wrong and requested blood tests from GP. I received my results which indicate my TSH Is 5.5 and T4 is 13.2.

My GP advised my TSH is slightly elevated and spoke to a consultant who advised they wouldn't treat and that it shouldn't stop me getting pregnant.

I decided i wasnt happy with this response after research so ordered an advanced thyroid check on medicheck and also booked a private endo appointment which is tomorrow.

Can anyone shed some light on my results from medicheck

TSH - 4.4 (slightly lower than gp results)
T4 - 12.2 - (lower compared to previous tesr)
T3 - 4.29
THYROGLOBULIN ANTIBODIES - 286
THYROID PEROXIDASE ANTIBODIES - 124.
FERRITIN - 230
VIT d - 41
B12 - 56.9

Thanks x

Hi @NatW2021, welcome!

Your blood test results are very similar to mine before I started Thyroxine - lowish FT4, TSH higher than you'd like but not awful, and positive for thyroid antibodies which could indicate hashimotos but could also mean nothing.

My GP agreed to prescribe me thyroxine because we could see my TSH was creeping up over time (it went from 2.5 to 4 over a few months), but I think if I'd just had the static results they would probably have said no. Since your TSH is going down I'm not sure if you will be able to convince them to treat you given they've already said no, but have you flagged the NICE guidance in front of them which talks about different ranges for conception and pregnancy? Might be worth a shot!

If not, unfortunately I think your best bet might be the private endocrinologist. How did your appointment go?

If that's not a sustainable solution long-term then your GP should be able to refer you for various tests if you're still not pregnant after trying for a year, and you could ask to be referred to an NHS endocrinologist at that point.

Wishing you lots of luck trying to navigate this space - it's not easy having to advocate for yourself all the time, but definitely worth it (and we are here to support too!) xx

I should add that Thyroxine has lowered my TSH, although my FT4 numbers still change a lot from test to test, often at the lower end of normal.

The thyroxine makes no difference to the antibodies, they've stayed static around 300 for me (although expecting my latest private test results to come through in the next day or so).

You may have seen from this thread that while I haven't had an issue conceiving, I suffered two early miscarriages last year before starting thyroid treatment. I'm now coming up to 14 weeks pregnant, the furthest I've ever got, and while I don't know for sure of the Thyroxine is making the difference (I'm also on progesterone this time), my midwife said unprompted that the thyroid issues could have caused the previous losses.

Hi @nellyinthegarden

Firstly congratulations 😊

I had my private appointment on Saturday and the endocrinologist prescribed 25mg levo for two weeks followed by 50mg there after. He is writing to my GP for them to continue prescribing so i am happy with that i start the medication tomorrow.

I am now researching how to sort my low vit D which i think i know what i am doing based on lots if reading online.

I am now trying to navigate what to do to improve my b12.

Apparently low vit d/b12 can be a result od an under active thyroid.

Was this the case for you? X

That sounds really promising @NatW2021! Glad the private endo is recommending treatment to your GP 🙂 keep us posted on how it goes!

My vitamin D was low before I started thyroid treatment yeah - I just take one boots extra strength vitamin d tablet every day at the same time as my multivitamin and that seems to have sorted it. Definitely noticed an improvement in my sense of well-being when I started taking it (much more so than with thyroxine), so worth doing anyway, especially in winter!

I don't think I've ever had my B12 tested so not sure about that one. I am a fairly big marmite fan though so hopefully I'm getting enough that way already!

Hi ladies, I know this is an old thread but it's been super useful for me.

I tried to conceive for over a year before research led me to question my thyroid function. Had a few readings between 3-4, often later in the day so prob much higher in the morning. Anyway I managed to get a prescription after a fertility doctor wrote me a letter (was going to start ivf).
Within a month of taking Levothyroxine I was pregnant!

I have just had my TSH taken and it's 2.8 first thing. So I want to see about getting Levo again but doctor being a bit difficult, it's a new doctor, can anyone point me in the direction of the bit from the NICE guidelines which makes the recommendation for 2.5 or under for TSH? I looked but couldn't see it anywhere and actually found recommendations to the contrary.

Hopefully everything worked out for you ladies and you got your LO's x

Congratulations @winningeasy!! I think most of us have experienced a lack of GP knowledge in this area unfortunately. Has your GP referred you to an NHS endocrinologist? Mine did but it took a few weeks for them to get in contact and arrange bloods. Luckily I had some private endocrinologist advice on my records with the ranges for pregnancy referenced so I could refer them back to this in the interim. It’s really important to keep the TSH low in the early stages. You could direct them to the British Thyroid Association who reference the 2.5 when trying to conceive - www.btf-thyroid.org/pregnancy-and-thyroid-disorders-guidance-for-patients. I’d request that they refer you to an endocrinologist too if they haven’t already. Pregnancy vitamins are essential too. Pregnacare was recommended to me.
My thyroid function is pretty much nil now but my little boy arrived safe and sound at the end of April and I’m exclusively breastfeeding too which I worried wouldn’t be possible 🥰 Good luck and keep them on their toes!

@SimpleStuff27 thanks so much! So glad you have a little boy ❤️

I am currently taking lots of pregnancy vits and plenty of antioxidants. Also taking L'Tyrosine (anyone taken that?) and eating a lot of iodine rich food, both of which is supposed to bring TSH down.

I'll include that link in my response back to the doctor. She did mention about speaking to an endocrinologist too.

I do have a reserve of levothyroxine, I can always take that if I miraculously get period anytime soon x

Following …

@winningeasy i echo the above, GPs generally aren’t that clued up on thyroid function, although under 5 is ‘normal’ it’s not optimal and definitely not good for TTC.

Unfortunately I never actually managed to get my GP to agree to treat my thyroid and had to have 3 miscarriages, referred to a recurrent miscarriage clinic before being treated. I was already pregnant at the time and my TSH went up to 9 if I hadn’t had been under the clinic I’m sure I would of lost this pregnancy too. My little girl arrived safely in July. My GP will no longer prescribe levo as my TSH is now 0.84 after 4 weeks of being off levo.

Definitely push for a referral to an endo! I took proceive pregnancy and TTC vitamins for this pregnancy and I would recommend them, they’re abit pricey but worth it in my opinion.

Hi @winningeasy, congratulations on your pregnancy! I think NICE removed the specific reference to a TSH of under 2.5 from its guidance, but as others have said, the British Thyroid Foundation mentions it in theirs. Definitely request to be referred to an endcrinologist if your GP is being difficult. Fingers crossed you can get things sorted!

@SimpleStuff27 and @ChinChilly Congratulations on your new arrivals! 😊 It's lovely to hear your good news and I hope you're both doing well.

I'm now 7 weeks pregnant myself, after 20 cycles TTC. We were due to start fertility treatment the next cycle so it came as a huge surprise! My TSH the week before conception was only 0.1 (I'd ended up slightly overreplaced with levothyroxine), but it was 1.03 when I got tested again at 5 weeks pregnant. So my endocrinologist has kept my dose the same for now, but told me to get another test at 8 weeks as he wants to keep a very close eye. I have a suspicion my TSH will have gone up by then and I'll need a dose increase at that point. I'm finding it all very anxiety-inducing, but at least I'm being closely monitored.

That is fantastic news @Owl86!! So happy for you! My TSH was very low when I conceived too and went up to 2.9 at 11 weeks so I had my dosage increased at that point by 25 mcg. From then it stayed pretty stable and has been brought back down after baby arrived. I know it’s hard but try not to worry. Another blood test at 8 weeks is great and you have started nice and low!

I didn’t take anything other than pregnacare and an extra vit D @winningeasy. My endo consultant just said to focus on a nice rainbow diet low in gluten and sugar and high in good proteins and fats like avocados. Plenty of water, fresh air and some gentle exercise like walking or pregnancy yoga (I loved this).

@winningeasy very many congratualtions! You should be given an endo referral per NICE guidelines I believe, And thank you for re-igniting this thread, I'm over the moon to hear about safe arrivals and bfp for @ChinChilly @SimpleStuff27 and @Owl86 .

No luck for me yet, but all this news gives me lots of hope :) I did get pregnant at the start of the year but devastatingly it was a blighted ovum discovered at the 12 week scan. Next time I would have an early scan because it then took a good 6 months to resolve that and I've just managed to get my cycle back on track with Vitex (last cycle which was first on Vitex was perfect with lovely temps and progesterone readings). TSH is also now perfect so that's good news. But yesterday an at home test revealed an amh <0.2 gahhhh! I'm going to organise to get it retested and for full fertility tests and a consult next month to see what options if any there are. For now I'm just very hopeful that the Vitex is working some magic, it was infuriating not even ovulating and therefore not being able to try. This seems like a small but massive step forward :)

Thanks for your messages guys, such a bloody shame it's been removed from
NICE guidelines, I wonder why.

I have sent my new doctor my results from thyroid panel, some links and also the letter I got previously from a fertility expert so will see what they say.

I am currently at 2.68 TSH - 8am, fasted - unmedicated. So I am very borderline. I have been researching what nutrition / supplements can help and thought it would be useful to share. For me I am debating whether I actually need it and can make changes to lifestyle and diet to bring it down.

Mesima mushrooms - For anti bodies and auto immunity / calming down our body's immune response (this is what I took before I got pregnant last time)

www.indigo-herbs.co.uk/shop/buy/mesima-mushroom-products

L'Tyrosine - a lot of research suggests it works in a similar way to Levothyroxine to reduce TSH (less bioavailable but still) - a lot of athletes use it

Thorne Research - L-Tyrosine (500Mg) - 90Ct amzn.eu/d/3QeBxOf

Wild Nutrition Thyroid Connect - this is a multi especially for thyroid health, it's got Holy Basil and Olive Leaf, and it's all food source so it's much more bio available

www.wildnutrition.com/products/food-grown-thyroid-connect

Ashwagandha - supports the adrenal glands especially where there is fatigue and reduces cortisol

Pukka Herbs | Wholistic Ashwagandha Organic Herbal Supplement | Ashwagandha, Seaweed, Ginger and Spirulina| Perfect for Calming | Contains Iodine | 60 Capsules | 1 Month Supply amzn.eu/d/2F9S2nC

Sea kelp - the best source of iodine and iodide - so important to take this as a food rather than a pill as the balance needs to be right between the two and you cannot get that in pill form - I sprinkle this one meal a day, you can barely taste it

www.planetorganic.com/products/the-cornish-seaweed-company-kelp-flakes-60g

I had my full thyroid panel tested before I started taking L'Tyrosine, kelp and Thyroid Connect, so will take at the beginning of next month and see what the results say. I had been taking Mesima mushrooms when I got tested last time and my antibodies were in check thankfully so hopefully that has been helping. Regarding ashwaganda I take this now and again, but have had periods where I have taken everyday, especially when I feel a bit frazzled. I'll start taking it daily next week I think. Will report back on my next set of results.
Have also started doing yoga twice a week and am trying to meditate daily. Am eating a lot better and trying to minimise gluten and sugar but not being militant. Am getting into baking so trying to use non gluten grains. Did keto for a while (had a lot weight to lose post baby and got married a few ago) but I don't think it's for me long term, am bringing in more healthy grains, some berries, beans, lentils and pulses etc

X

@Songbird50 so sorry about your loss, that is utterly devastating. Sending hugs. Yes heard good things about vitex working for some women, I think the herb is called chasteberry and can help bring down prolactin which is typically high if you have an under active thyroid.

Congrats on the new babies and pregnancies xx

Hi @SimpleStuff27, thanks for the congratulations and sharing your experience. 😊I had my latest blood test yesterday, at 8+2 and exactly 3 weeks after the previous test. I've got the results back already and my TSH has shot up from 1.03 to 4.65, with my FT4 down to 13.1 from 16.3. I'm waiting for my endocrinologist to advise on increasing my dose, but I'm feeling very worried now. At least we've caught it early, I guess.

@Songbird50 So sorry to hear about your loss. 💐Great your cycles are back on track with the Vitex, and wishing you loads of luck for your tests and consultation next month.

@Owl86 try not to worry too much at around 8 weeks my TSH was 9 and FT4 was about the same and I wasn’t being treated at all at the time

Hi I just wanted to jump on this thread if that's OK, as there seem to be a lot of experienced well informed people here!
I am currently ttc and dida private thyroid test a couple of months ago after reading about the links to fertility and conceiving.
My TSH was 4.34, just out of the normal range and classed as subclinical hypothyroidism. I went to my gp to ask for medication to lower it, to get it under 2.5 for conceiving. The doctor was really dismissive and was only focused on that they don't treat TSH under 10, he just didn't seem to be listening to or getting the point of that it should be under 2.5 when ttc. He tested me and I got my results back and they have classed it as normal because my TSH was 2.67.
Firstly I'm not sure whether to still push for medication to bring it under 2.5, I feel like this will be difficult to get because it's close to 2.5 now.
Secondly does anyone have any idea what would have caused it to fluctuate like that?

Thanks in advance for any wisdom any of you might have!

What time of day did you have your blood test? TSH is highest first thing in the morning so an early morning test gives the most convincing result if you’re borderline. It should also be done fasting (you can have water) and before taking levothyroxine if applicable (I realise not the case for you).

Thank you for replying

Both times were mid morning but not fasted, I hadn't realised I was meant to do that!

I should have said I’m not a medic but picked up the info from the very helpful HealthUnlocked thyroid forum.

@Owl86 - congratulations so lovelt to see you got your BFP, have been TTC for 18 cycles and losing hope!

My TSH was initially 5.5 in January GP wouldn't treat so i went private and been on levo since then. My last TSH was 1.12 but still not pregnant. I am lm on 100mg.

I noticed you said your TSH was really low when you conceived, did you change your dose for it drop so low?

I have some left over 50mg of levo and wondering if i should up my dose to see if it makes any difference? I am getting desperate now. X

Hi @NatW2021, thank you for the congratulations and I'm sorry you're having a tough time. I can relate to the losing hope, I was really struggling around 18 months too.

My TSH only dropped as low as 0.1 because it had been a bit too high at my previous test, leading to my endocrinologist increasing my dose. But the increase was too much for me, so I ended up overreplaced. My TSH target was actually 1, which my endocrinologist considers ideal for fertility.

I totally understand the desperation, but if I were you I wouldn't increase your dose without medical advice - being overreplaced isn't a good thing either, and your TSH of 1.12 sounds perfect. When was your last test?

Take care and I'll have everything crossed for a positive outcome before much longer xx