Thyroid test results – help!

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I spoke to my fertility clinic on the phone yesterday to get my test results (in the last few months since having the tests I've had a miscarriage and an ectopic after 18 months of 'trying' so now know I can conceive). She told me my AMH was 13.4 (good for my age, 41) and that my thyroid result was 'ok' too – at 4.41. I've since been on Dr Google and it actually seems like thyroid should be much lower than this when ttc (below 2.5). So now I'm confused as they are obviously the experts but the fact she used the word 'ok' not 'fine' makes me wonder if this is something I should investigate further. Any advice gratefully received!

Funnily enough, I had a conversation with my GP about this earlier this week! When I was struggling to conceive back in 2020 my TSH was tested and was at 3, and the guidance at that time was that women whose TSH levels were within the 'normal' reference rang (below 53, from memory) but which were above 2.5 should be treated with levothyroxine to bring their levels down. I was put on a low dose of medication, which I stayed on whilst TTC and throughout pregnancy. I ended up coming off of it after pregnancy.

I'm now TTC #2 and had my thyroid checked as part of that and my levels were around 3 again but were marked by the GP as 'normal', so I wanted to discuss why we were taking a different approach this time. Apparently at some point between 2020 and now, studies have been carried out which suggest that treating women in that >2.5 but <5 TSH range doesn't make a significant difference (one such study here) and so the NHS guidance has been updated to reflect that - although the GP did indicate that their guidance said to treat if someone's levels were in that range and they were undergoing assisted reproduction, I'm unclear on why that would be.

Your clinic's response is likely based on this updated guidance, but it would be worth speaking with them to confirm this thinking. For what it's worth, my GP did actually agree to start me on a low dose despite being outside of the formal guidelines (on the basis that I conceived fairly quickly once my levels were lowered last time, and she considered the risks of treating to be sufficiently low that she was happy to take a 'can't hurt, might help' view on the subject).

Hope this helps!

I would seek another opinion (ideally see an endocrinologist) because I’d agree that your TSH should be under 2.5 for TTC and pregnancy, that’s what my private endocrinologist advised as well - unfortunately the NHS GPs are not always interested as long as you’re in their very broad band, that’s why I went private.

Sorry, in my post above, below 53 should be below 5.3 - if your TSH is 53 you definitely need treatment!!

I remember this from when I did IVF. If you weren't ttc, your levels would be normal and not treated. It improves your chances of conceiving if levels are lowered though. I took thyroxine.

Thank you so much – this is all incredibly helpful. I was really confused yesterday but this makes a lot of sense as to why she told me it was 'ok' and moved on.

It's very hard to get hold of anyone at my clinic (I'd been waiting months for that telephone appointment) but I have a very good GP so I'm going to contact her next week and see about getting a low dose of levothyroxine. I'm just at the point of being ready to try again post-ectopic surgery and I want to make sure everything is as ok as it can be to hopefully conceive and avoid another miscarriage (while aware that another ectopic is entirely unpreventable).

Fingers crossed – and thanks so much for your help.

Thank you – I'm going to try my GP in the first instance and then look at going private if they won't help me. Really want to get this sorted so I feel I've done everything I can to give myself the best chance.

Thank you. Hoping I can get this prescribed as want to do everything I can to improve my changes of conception.

When the Dr does a thyroid test they usually get two figures.

The first is the TSH and the second is for the T4 level. Did you receive a tesult for T4?

For some reason she only told me one result. I'm hoping at some point I might receive the full results in the post but we'll see...!

Just a little update on this to say my GP wasn't very helpful on this... and I've since I had another miscarriage (a mmc this time) in November. As soon as I found out I was pregnant, I rang the GP to ask about retesting thyroid and explained the British Thyroid Foundation recommend TSH below 2.25 for before and during pregnancy (mine was 4.41 at the previous test). She agreed to retest and it came in at 3.11 (apparently it can go down in early pregnancy)... but said that was fine and still no action needed. I'm obviously now overthinking it given that was my second miscarriage and wondering if anyone else has managed to get their GP to take thyroid results seriously?

I'm so sorry that you've suffered another loss, and even more sorry that your GP isn't taking you seriously. Not ideal, but could you seek a private GP consultation to see if they would prescribe medication and monitor your bloods?

Thank you @blackberryhill. It might not have made any difference but it's so hard when all this evidence online says it needs to be under 2.5 but the GPs won't listen to that because it fits their parameters of being under 5. I'm actually in the process of switching GP surgeries so I'm going to give it one try with a GP at the new surgery and if not, will look at doing this privately. I just don't want to find myself in the same situation yet again and know I haven't done everything possible to prevent miscarriage...

Having been through all of this and what you have been through I would agree with others.

Your levels are ‘normal’ for a normal person if that makes sense.

I tested in the normal range while ttc. I had a miscarriage too (actually two both not in thyroxine), but with the same levels had a healthy baby. I was above 3 both times. What they did find is that during pregnancy I needed to take thyroxine.

So my best advice is breath. Please don’t get yourself worked up and stressed which is the last thing you need. The levels you are presenting shouldn’t prevent you from getting pregnant nor should they automatically mean a miscarriage. I had normal levels (so above 3) and had two kids absolutely fine.

What you also discover is that 3 to me and 3 to you can and may feel very differently. You aren’t ‘too high’ and the increase is marginal so again please don’t worry.

It may be worth speaking to another GP but my gut feel is they will tell you the same. Being below 2.5 is ‘ideal’ but not a deal breaker and not necessarily the reason for miscarriage. Ranges can differ over time so being so close to the ideal may not warrant medication. Also while you are in the normal range they may not want to medicate you to push you lower if you are ttc. It isn’t as easy as just popping a pill. It’s months and months of finding the right levels, blood tests and checking. They up the meds each time and it isn’t advised ttc during this time.

Unfortunately miscarriages which I’m sure you know can happen for hundreds of reasons which have nothing to do with your thyroid and unfortunately miscarriages are quite common and ‘normal’ no matter how awful.

I say these things not to dismiss you in any way but to try and give reassurance on your thyroid.

Good luck.