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. :)

TSH must be tested first thing in the morning, and must be fasted. Just water.

It's likely a lot higher than that. As the day progresses it reduces.

Thanks @winningeasy . Not comfortable lying but will retest fasting and with a morning test and take it from there.

Hello all,

I hope that all of the recent deliveries/pregnancies have gone/are going really well and we have a growing gang of little ones on this thread. The thread and you girls helped me so much, so I just wanted to update you and anyone else who happens to read this thread in the future looking for hope/ advice that I am now 14 weeks pregnant naturally with my first, a little girl, and all is going well so far. My latest tsh is 0.31 and I have a consultant appointment in a couple of weeks just to monitor my thyroid. To those who are ttc my advice is keep at it, don't lose faith, I know just how hard that is, and keep investigating, I had a lot of trial and error with hormone tests, cycle tracking and supplements, quite apart from dealing with my thyroid. It took over 2 years; as well as being hypothyroid, I'm also now 41 with an amh of only 0.07pmol/l or 0.01ng/ml, a previous blighted ovum, and a cycle that was getting very irregular and disappearing for months at a time. It is possible. Best wishes to all of you.

I just got a notification on this thread as I had commented 2 years ago, well I now have a 1 year old! Took us 2 years to conceive. Never did get thyroid meds, but have recently had another check and awaiting results. Fingers crossed it will be sorted if we try for another.

I just got notification on this thread after posting nearly over 2 years ago too! I now have a 14month old and am currently 6+3 weeks with my 2nd! I am on 100mg of levothyroxine and so far so good! Hope everyone is well! X

Goodness me, I can't believe it was over 2 years ago that I started this thread! I'm delighted to read these happy updates - congratulations to you all. 😊

To add another good news story, I now have a 9 week old baby boy who was conceived naturally after nearly 2 years trying. We'll never really know why it suddenly happened after so long, but the positive pregnancy test did seem to coincide with my thyroid levels finally stabilising on levothyroxine.

Really pleased the thread has been helpful, and I hope it continues to be so.

@Owl86 ahhh so happy to hear this! Congratulations 🥰

Hi @Owl86 - I've just spent the last half an hour reading the entirety of this thread and am so pleased it worked out for you! I'm at the beginning of my journey with this and am currently going through the mill with GPS...I'm based in London/SE, could you please let me know the name of your endo specialist?

What a lovely thread to read the updates of! I'm also pregnant with our first, over 2 years since first posting on here! A few bumps in the road along the way, but we've made it to 21 weeks so far with this little one ❤
@Owl86 I'm delighted for you! 💙
@Songbird50 congrats 🥰 not far too far behind me!
@CTMcG @rathernotshare congrats on your little ones! 😊 I hope all goes well in your new pregnancy @CTMcG!

I know this thread is old but it’s been my saving grace and been such a help that I wanted to give my story too. After a year of TTC and a TSH level between 8.5 and 5.6 depending on when in my cycle I was tested, I went armed with all this information that I learnt on this thread to my GP. She reluctantly prescribed me 25mg of levothyroxine and the first month on it we got a BFP! It’s still early days but I just wanted to put this on here to encourage ladies that they know their own bodies and to do that you know and feel is right. Don’t stop until you feel you’ve been listened to.

So happy for you @Jellybelly888! Knowledge is power! GP awareness of hypothyroidism, optimum TSH and its impact of fertility is pretty poor unfortunately. Push for an endocrinologist referral through pregnancy if you can. They should be keeping your TSH below 2.5. Wishing you all the best!

Thank you so much, I’m still in shock! I knew thyroxine works fast but not this fast! Also, how quickly did you all up your doses when you got BFP? I am terrified at having a MC. I’m only on 25mg so going with the 30% more rule people have used on this thread, I should maybe have an extra 25mg twice per week I think. Just until I get some advice from my GP and insist she speaks to an endo. Gosh all so complicated isn’t it and annoys me so much that there will be couples out there being broken hearted over something that might be easily fixed!

Huge thank you to everyone who’s contributed to this thread. I found it incredibly helpful in trying to understand whether the doctors are correct who keep telling me my thyroid issues aren’t anything to worry about! We are having a really difficult journey to having our second child and paid privately to have some tests done and the only thing which seems to be a red flag is the thyroid issues - I have elevated TSH and antibodies. Would anyone be able to pm or email me the details of the London private endocrinology consultant mentioned? My GP won’t prescribe levothroyoxine unless I have an endocrinology consultant recommendation.

What's your TSH? Mine was 70 and antibodies and gp could prescribe levothyroxine, didn't even hesitate.

It’s 4.5 which I definitely appreciate is within a normal range but is much higher than the recommended 2.5

@Leadingwithloveandkindness mine was a very similar number, 4.4 I think. My GP wouldn’t have any of it as it was within ‘normal’ I was having multiple miscarriages, in the end a recurrent miscarriage clinic prescribed me levothyroxin as it wasn’t normal for pregnancy or TTC. They prescribed it whilst I was at the early stages of pregnancy and went on to have a happy healthy baby. Unfortunately GPs don’t seem to move from what is ‘normal’ to optimum for TTC.

My GP surgery did get a stern letter from the miscarriage clinic telling them they needed to continue monitoring my TSH levels throughout any pregnancy’s and in general, and in fairness they do call me every 6 months for a blood test

Before I had my baby my thyroid was at the higher end of the tsh range 6/7. I've always watched it as hypothyroidism runs in my family. Doctor would never prescribe me Levo even though symptomatic, even went private to see and endo and he said until my tsh is higher he wouldn't prescribe levo either. Fortunately I managed to get pregnant pretty quickly but after the birth that's when my tsh shot up. I did use the ovulation sticks when TTC and found them really useful as I didn't always follow the same period cycle.