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. :)

@Owl86 yes, he did! Im home and just took my first dose. 25mg of levothroxine and she wants me to get my bloods checked again in 6 weeks! Its so weird that she said first option was to take no medication and see how i get on ttc, surely if the level is preferably 2.5 and under and i am at 6 and ttc, medication should be a no brainer but what do i know! X

Hi @Owl86 - Sorry I didn't reply til now! Had family staying but it was so nice to feel like someone else understood, so thank you! I hope the appointment goes well on Thursday! Let me know what your GP says :) I'm definitely going to go back to mine and push like @bumphope2020 and @Talkwhilstyouwalk have suggested.

@Cheburashka Thank you also, it was so helpful. We're on the waiting list for fertility referral now but I think it's going to be a long wait! I do know my GP pretty well and she is really nice so I think I'm going to go back to her with the NICE and British Thyroid association guidance. I wish I could take a folder in but i'll just have to send the links and hope she reads them! Haha!

@CTMcG Sorry it wasn't the news you wanted to hear. Although I think it's good that you have a GP that seems to know the guidance! So many of them don't realise and it could be something that means you conceive faster so that's brilliant!

@ChinChilly Let us know how you get on with the GP appointment tomorrow. I hope they listen! I imagine it would put your mind at rest somewhat. x

It’s great that you are onto the issue and pushing for it to be ‘fixed’ - it is usually pretty quick to improve once you are on the right dosage!

Just to share my experience, it took me nearly a year to conceive DC1. 4 months after he was born, I felt like I was dying and a blood test showed my TSH was 181. In hindsight I believe I was hypothyroid before I got pregnant, which meant it took a little while, and then pregnancy exacerbated it further.

I was referred to an endocrinologist and I very quickly (within maybe 6 weeks?) felt back to my usual self again. I then got a bit complacent with taking my thyroxine and I think my thyroid went out of whack again as I suffered two early miscarriages (I wasn’t actively TTC but wasn’t preventing either)

I then started to take it all a bit more seriously, had regular check ups with my endocrinologist etc and went on to get pregnant with DC2 in the first or second month of trying. I am now pregnant with DC3.

My endocrinologist likes my TSH to be under 2 when I fall pregnant and once I get my BFP, I see her straightaway and then every 4-6 weeks for follow ups and a blood test. For the first few times, my medication needed to increase but at 26 weeks, it now seems to be pretty stable at 250mg daily.

Wishing you the best of luck. I get the impression that in the Uk, it’s not something GPs are necessarily massively clued up on. But I wanted to offer some reassurance that it can be easily fixed and you will notice a difference almost instantly and most importantly, it is possible to go on to fall pregnant and have an uneventful pregnancy.

@FlyingGiraffe thank you! Now i am home from work and have looked through a few threads about it i am feeling more positive. The fact my doctor offered to start me on a small dose asap seems great considering quite a few people have had to push the matter!

Being on medication going into the 2nd month of ttc is great - it could potentially be pretending me from the heartache of MC's etc so have to see this as a positive thing!! Now if af would hurry up and show her ugly head! Cd34 today so expecting her this week. Cycles are pretty irregular! X

@FlyingGiraffe preventing not pretending!

@CTMcG yes, if you can prevent a miscarriage that would save a lot of heart ache and worry. I had a chemical back in January and cant help but think that if I do fall again that it's not going to stick without sorting my thyroid out beforehand 😣 hope AF turns up for you soon 🤞

@PrimeraVez Whoa 181!! No wonder you felt awful! I'm so glad they sorted it and you've been looked after since! It gives me hope though so thanks for sharing your story! I feel fired up ready to go to the GP now 😂

@FlyingGiraffe so sorry to hear about your chemical! Id prefer af didnt show up but i took a frer this morning as its due and bfn. Cant really say its late though as i am not sure of my cycles yet. I came off pill im December and my cycles so far have been 42, 42 and 34. Today is cd34 so going by my last 3 cycles, it should be today/tomorrow but literally too early too tell what length my cycles actually are!

@CTMcG Glad you got the meds and have taken your first dose already! Fingers crossed your TSH comes tumbling down very soon. 🤞

@FlyingGiraffe You're welcome, it's nice to feel I'm not alone too. Hope you can have a fruitful chat with your GP soon. I emailed mine some links the other day too - I now have a Bookmarks folder in my browser that's stuffed full to bursting with articles and resouces. 😂 And yes, I'll report back after my appointment on Thursday.

@PrimeraVez Thanks for sharing your story, it's really useful to hear everyone's experiences and gives me hope. 181 sounds crazy but I'm glad you're on a more even keel now. I'm also glad things are usually quick to improve once you're on the right dosage. I hope finding that dosage doesn't take months, as turning 35 later this year I don't feel like I have the luxury of time (or, frankly, the patience!) to delay TTC#1 that long. But I guess there's no point worrying about that yet, and the first step is to actually get any dosage at all!

Thanks @Owl86 keep us updated on Thursday!

Hi everyone! I just found this thread, which is great. I am a fellow Hashimoto's-haver (don't want to say sufferer!) who is TTC (cycle 1, just got a BFN on 11 DPO).
I was diagnosed with Hashi's about 3-4 years ago (can't quite remember). I had a ton of weird symptoms but my thyroid levels were clinically normal for about 1.5 years, though my antibodies went through the roof.
I've been on levo (50mg) for about a year and a half now. After about 6 months of starting meds I fell pregnant (aged 37) with my first baby (last year). The pregnancy turned out not to be OK and we lost her to TFMR last summer, which has obviously been devastating. The chromosomal abnormality was not hereditary and apparently nothing to do with my thyroid so I don't want to scare you! It does mean I'm back to square 1 though with TTC.
At one point prior to going on meds my TPO was >1300 (the point at which they stop counting!). I've never encountered an endocrinologist that I didn't think was a waste of space to be honest (one even told me that despite my antibody levels he thought I didn't have Hashimotos and just needed a good sleep!), If have any struggles getting pregnant this year I will certainly seek out a fertility or functional health practitioner instead. I have a similar experience that I know far more about thyroids and Hashimoto's now than my GPs do. There are very powerful online communities that are brimming with a wealth of knowledge that can be very powerful.
I just wanted to offer something that I read for the first time last week. Apparently if you are supplementing with biotin (quite likely if you're taking loads of supplements to TTC?), these can influence the results of thyroid tests and it's best to have a week off before testing. Apparently there are patients that end up over or under medicated as a result. Might be worth looking into? www.thyroid.org/patient-thyroid-information/ct-for-patients/december-2018/vol-11-issue-12-p-3-4/#:~:text=Most%20commonly%2C%20biotin%20use%20can,hormone%20dose%20is%20too%20high.
If you're already on meds, you should also have your bloods taken first thing in the morning before taking your meds (so you have 24 hours since your last dose) and just take your meds straight afterwards.
The other thing is that (if you are determined enough), Dr Isabella Wentz has a lot of good advice on lifestyle changes that calm Hashimoto's down. Her books the Root Cause and the Hashimoto's Protocol are worth a read. I went gluten free for six months before I fell pregnant last time and I think it helped. Not quite summoned the courage to make any major changes again yet as it's been a really hard year and that all went out of the window when I got pregnant and massively started craving bread!
Anyway, just a few thoughts that might help!

Hi, read your post and was hoping to chat! I also had blood work done and an ultrasound revealed that my right ovary is polycystic. Which blood tests did you have to rule out PCOS? My doctor said as long as I'm having regular periods it's not a problem but I would really like to know the significance. It wasn't exactly a reassuring finding after she essentially just said "yeah its fine". I am the type that wants to know why this happens!

We have also been TTC since January after a MC. No luck yet. My ultrasound did reveal that I have a nice thick lining, I was Googling this and it might actually be too thick. Like 18mm.

My TSH also came back at 3.1 and I read the same thing you did about how it should be under 2.5.

Hi @GoingGently, thanks so much for sharing your story and useful advice. I'm so very sorry for your loss last year.

I read the same thing about biotin last night, funnily enough. It's not something I'm taking as a supplement right now, but I'll bear this in mind for the future.

Wishing you all the best in your TTC journey.

Hi @secondorange

I'm sorry for your loss earlier this year.

My right ovary is also polycystic, and I have regular periods like you. A previous transvaginal ultrasound in 2017 found both ovaries were polycystic, but another one a few months later said they were normal! All a bit confusing.

Looking at my blood test report, it seems they checked free androgens and gonadotrophin levels (FSH and LH) to rule out PCOS.

As I understand it, PCO is quite common and isn't as big a worry as PCOS when it comes to fertility. I found this article useful: www.omargailani.com.au/blog/polycystic-ovaries-vs-polycystic-ovarian-syndrome-13783/

I don't know much about endometrial linings, whereabouts were you in your cycle at the time of the scan? Mine was 10mm at ovulation, which I was told was OK.

On the TSH, it might be worth waving the NICE guidelines and British Thyroid Foundation resources in front of your GP and seeing what they say.

@ChinChilly How did you get on with your GP today? Any progress?

@Owl86 not really, the GP just said that because my TSH and T4 are both within normal range it isn't something they are worried about, if one was out then they would be. It really is fighting a loosing battle with GPs and thyroid issues

@ChinChilly Sorry to hear that - how frustrating! :( Could you possibly see an endocrinologist privately? Maybe they can talk some sense into your GP.

@Owl86 Thank you for linking the article! Looked all over the net and couldn't find anything. I never did have free androgens checked, wonder if I should do that for peace of mind. My lining was 18mm at CD17, I ovulated CD14. I think I'll ask some follow up questions as far as normal range, everything I'm seeing is like 14mm to 16mm max.

@secondorange No problem. :) If you're going to push the raised TSH issue, and they want to retest your thyroid in a few months, maybe they could check your free androgens/testosterone at the same time? Did they check your LH and FSH? Or just nothing at all?

Hope you get some answers about the lining too.

Hello can I please join in for some advice. I had a mmc at 9+5 in march (baby measuring 7+1). I've always had a lot of the thyroid symptoms so asked for a blood test. My tsh was 2.48 so just under the 2.5 for ttc but it's right up at almost 2.5. Could this level have caused my mmc and could I push for meds at this level do you think?

Sorry to hear others are experiencing similar it's not fair we have to investigate and push for all this ourselves! X

@justwant2beamum I'm not in the UK so I guess my endocrinologist follows different guidelines, but she prefers my TSH to be under 2.0 when I fall pregnant and in my first trimester.

With that said, 2.4 isn't wildly outside of this range, so I don't think it would necessarily represent an issue. Somewhere around 8 weeks pregnant, mine went up to around 5, and whilst my doctor quickly adjusted my medication to bring it back down, it wasn't a panic stations situation.

When I was ttc we were under a fertility specialist due to my pcos and endometriosis. However my thyroid function came back very similar to your results, the specialist instantly put me on thyroid tablets and told me that my levels had to stay below a certain number. I managed to get pregnant but felt really 'off', couldn't explain it other than I felt freezing all the time and was wearing thick jumpers mid summer. I spoke to my gp who gave me a blood test and said my thyroid levels were a bit higher (if I remember rightly it was 4 point something) but it should be ok. I rang the fertility clinic and they told me someone would get back to me later in the week.
Que a scan a week later where I found out I had miscarried. The people at the clinic put it down to my thyroid levels.

The next time I got pregnant I called the gp and asked for a blood test straight away. My thyroid level came back high again so I asked to be put on the tablets that day, the gp said their guidelines said not to unless it was much higher but I stuck my ground and demanded I was put on them. That pregnancy resulted in my almost 4 year old dd sat on my knee . I then went on to have my son and was again put on the thyroid tablets straight away.

If your numbers are higher than 2.5 ask your drs to look specifically in to fertility thyroid numbers and ask that you are put on the tablets as a precaution. Gps aren't specifically trained in this so they don't always know (that's what mine told me)

@Wheresallthesleepgone sorry to hear about your loss and well done for sticking to your guns! It potentially saved the life of your little one!❤️ it seems i have a decent doc, she give me the option to start on small dose straight away which i did (ttc and if i get pregnant i will ensure to ring doc the same day and ask for blood test/up my dose!

@Owl86 good luck with your apt today!

Thanks for the luck, @CTMcG! My surgery nearly accidentally cancelled my appointment earlier so things have got off to a good start... 😂 All back on track for this afternoon now though. How are you getting on with the levothyroxine?

I just got my Medichecks Advanced Thyroid Function test results through. My TSH was 3.6 this time, so lower than the 4.93 a few weeks ago but still above the 2.5 TTC threshold. And my free t4 was a little higher than before, but still in the lower half of the normal range.

I was negative for antibodies and everything else they checked was normal apart from my Vitamin D - apparently I'm almost deficient even though I've been taking a 1000iu mouth spray daily for well over a year. So that's an interesting surprise as it could be influencing my thyroid function. Not sure if the spray isn't working or I just need a bigger dose. Some summer weather would be helpful too! ☀️

Also, my ferritin was normal but on the lower side, so Medichecks advised I take a look at that too.

@Owl86 I have mentioned it to my GP again and she is going to run some bloods and check the levels. Funny you mention about vitamin D mine were really low on my last bloods so I had a really high dose for 7 weeks so it will be interesting to see if that has made any difference. Vitamin D is also linked to fertility.

@Owl86 so far so good, my mood is horrendous though, i cried at my boss yesterday& my emotions are all over the place. Im on cd38 and just wish my blooming af would show up as that normally shifts my terrible mood!