Thyroid issues in early pregnancy

[Everhopeful76]

Hi- just wondered if anyone could help with this as am sure I ve spoken to several ppl on here who have either developed hypothyroidism whilst in the throes of treatment or have a pre existing thyroid condition.

Am in very early stages of pregnancy and have hypothyroidism, the levels of which can go high or fall at quite an alarming speed. My GP has recommended bouncing up my thyroxine 50mcg daily with immediate effect, am also going for a blood test to check current levels. She says anyone who falls pregnant with pre existing thyroid condition, then this course of action would be recommended but it just seems quite a "hit" so early on and am worried about symptoms going more hyperthyroid. In a way having more energy is great but I did think it would be a gradual thing and would be increased in multiples of 25mcg to begin with.

Am also very aware that this is an immune issue which is a known factor for miscarriage and so in that way, its better that am keeping that risk to a minimum,rather than be worried about me having palpitations and high energy, but have seen levels rise so high I was having adrenaline attacks hence my concern.

Anyone had this experience or have an opinion on this. I am very grateful. Thank you

Hi,

I developed hypothyroidism during my last pregnancy so I know a little bit about this. I understand that of course you are worried about taking any/too much/unnecessary medication throughout pregnancy, but there is really no cause for concern in your case.

It is difficult to say how much of a "jump" 50mcg a day is for you (what were you on previously?) but it seems very unlikely that such a small dose would cause hyperthyroidism! The NHS has got some really great evidence based policies when it comes to treating thyroid disorders in pregnancy, so as long as your doctor is following the policies (which it sounds like she is), then there is no problem:-)

Hopefully you'll also get some more reassurance when you get the results of your blood test, but in the mean time if you have any concerns, just phone your GP (sometimes the surgery can arrange a call back, so she might be able to talk through your concerns without you having to go in).

Good luck with your pregnancy x

Thank you NotAClue82. That's really helpful. I have been increased to 175mcg from 125mcg. I was on that higher dose 8months ago, but had lost a lot of weight in preparation for IVF. So its not an alien amount, and since feel more reassured that it would be better to be on too much, than too less.
My thyroid has always been a bit haywire so I know my GP will monitor closely from now on,and my appt is Thursday
Do you have a link to any of these evidence based policies, are they NICE guidelines?

To reassure you about the 'jump' - thyroxine has a 10 day half life and so doesn't jump up that quickly in terms of blood levels.

You do need to raise as the extra need in the first trimester is 30-50% and baby relies on your thyroxine until the last trimester (perhaps a bit before) when their own develops.

I can post more later

Thanks Clarella, I wasn't aware of the 10 day half life
If you can post any more that would great, thanks

www.mumsnet.com/Talk/pregnancy/2604235-Hypothyroid-and-pregnant

Hi again, Here is the link to another recent thyroid/pregnancy thread. It contains a reference to the NICE guidelines I think.

The British thyroid foundation have information about thyroxine and pregnancy - good source of info.

When I have more time I can chat more!

I think that the miscarriage risk increases as Tsh increases hence needing Tsh below 2. I actually don't think the autoimmune thing is an issue specifically for thyroid antibodies but happy to be corrected.

I had a merry nightmare in my pregnancy which I can describe later, but all was absolutely ok and the advice is to start taking the extra straight away on bfp.

In America they raise by two extra doses a week (as the half life is long it's possible to do this) or the equivalent raise taken over the 7 days. I tried the maths and it's roughly equal to what nice advice here.

Do you have all your recent results and can you post them here?

And what dose of thyroxine are you on now?

After hearing this programme I had to tell my GP what to do point them towards the nice guidelines.

www.bbc.co.uk/programmes/b01cjwvm

Hi,

I am pregnant and hypothyroid (hashimoto's).

My thyroxine was initially increased by 25mcg by my endocrinolgist ( coincidentally I had an appointment to see him the day after my BFP). Had I not already been seeing him my GP would have referred to the endo.

My midwife, obstetrician and endo have liased over my care with the midwife doing my blood draws and the other too monitoring it. I am have extra scans as part of the monitoring too.

In your position I would insist on referral to an endocrinolgist and your tsh should be closely monitored. It needs to be low ( under 2 pref around 1) and the levothyroxine you take crosses the placenta to the fetus which doesn't have a functioning thyroid until the second trimester.

Hi Corabell -did you have hypothyroidism since falling pregnant or pre-existing condition?
My thyroxine has been uplifted from 125mcg to 175mcg. I have had this condition for over 10 years, and never more than 3months has gone by before a blood test checking levels. I needed to lose weight for IVF treatment and that impacted on my thyroid levels, was over replaced quite severely on 2 occasions within this last year.

I will definitely pursue a referral thru GP as the extra scans would give me peace of mind too.

Clarella - My last blood result for tsh (in late Jan) was 1.2 (spot on) although my T4 was out and GP reduced from 150mcg - 125mcg. I have a blood test on thurs will see what the tsh is there, hopefully will not have deviated too much as I am only 5+2 weeks pregnant and only found out I was last Sun, so have got on it straight away
As long as GP allows me check levels every 4-6 weeks am ok with that ( I ve checked the basic guidance published by NICE and will have a good read later
Also thanks for the other weblink about thyroid and pregnancy -will have a gander at that too

Notaclue -thanks for the link you sent thru, I ll join the pregnancy mumsnet conversation too. Haven't come across many who have the condition whilst pregnant- but plenty I know have developed it after pregnancy

I was diagnosed 9 months after having me first baby BUT I had been to the GP 5 years earlier querying my thyroid function. When I reviewed my blood tests my tsh had at that time been out of range (4.9) and my thyroid antibodies were sky high so it should have been pursued at that time. So, I suspect I had sub clinical hypothyroidism during my first pregnancy, but thankfully baby was fine.

Corabell - that's quite reassuring that despite your thyroid levels being wrong it didn't impact on baby.How far along are you with 2nd pregnancy?
I have always felt that the biggest risk to pregnancy for me would be hypothyroidism. Probably also my ageing eggs(as am 39). I also have endometriosis but has been largely confined to 1 ovary so don't think that is my primary issue, although bloody nasty thing to have around the time I had laparoscopy, as was in so much pain
Challenges are part of life I guess
Thanks for your post, is reassuring