Subclinical Hypothyroidism

[GemmiLou]

Long post! Does anyone have subclinical hypothyroidism or know or have any experience of it? So My husband and I have been TTC for the past 2.5 years. We had fertility tests done at our fertility clinic and all was fine except my TSH level was above range at around 4.21 and 5.17. They put me on levothyroxine to get levels down (now on 50mg) tsh level got down to 1.29 in March this year and we conceived naturally! I went to my GP at 4 weeks preg and asked if my dosage needed to be increased and he said no. Now Ive had a miscarriage at 10 weeks pregnant. Its been horrific. Ive since paid for a private blood test for tsh levels to be tested. Its now 3.34 so above range again despite continuing the meds. Ive done lots of research on this and I believe that my levels rose during pregnancy causing miscarriage as I was not monitored.. levels need to be kept under 2 for pregnancy until 12 weeks. I dont want to risk conceiving again risking another miscarriage whilst my levels are not stabilised but I also dont want to wait any longer. My GP is refusing to refer me to an Endocrinologist as he tells me I dont have a thyroid problem. He wont increase my meds either which is really all I need and then extra blood tests when pregnant. I dont know what to do. What would you do? This is so frustrating.

Can you go private? I'd just book an appointment with an endocrinologist myself tbh. Get them to write to your GP. I'd be very angry at your GP, how dismissive! MC is horrible enough, they should be giving you anything that might help.

I do have private healthcare but I cannot access a specialist until I have a referral or open referral from my GP. He wont do that. I asked him twice during my last appointment. He said no need. Ive spoken to my private healthcare too to see if there is another way around it and they said they can only help with a referral.

Sorry about the miscarriage, but a TSH result of over 3 TSH (and under 5) would not have caused it. My IVF clinic deliberately let my TSH rise over 2.5 during my BFP because (and I trust them as my consultant is a specialist in female endocrine disorders) high TSH tends to cause early implantation failure / chemicals rather than miscarriages.

A ten week miscarriage is most likely to have been caused by chromosomal issues. However there are some other issues that can also cause this. Have you been tested for autoimmune issues? Clotting disorders?

If your GP won’t do further testing go to a Bupa GP (£40-£60) and ask them for an open referral letter to a consultant. Some private Gps may even be able to give you the referral on the NHS.

Thanks for your reply. Did you get your happy outcome?
Thanks for explaining. My fertility clinic did advise me to book an appt with an Endocrinologist based on my levels. My last T4 was 19.4 and my most recent TSH was 3.13 a few weeks after miscarriage. What it was when I was pregnant Im not sure as my dr did not order any tests. Ive never been checked for either of those things you have mentioned.

So your T4 was slightly out of range for sure, but your TSH was within range; so that may have been classed as a normal result. It might be there’s an autoimmune process going on or you have genetic disorders but can’t do anything more than get the referral letter if your GP won’t help. I suggest going to a private gaene (ideally one trained in India or the US as they are far more clued up in female endocrine issues per my experience) as well as the endocrinologist.

I am still pregnant even after my TSH levels were deliberately raised but one of my conditions (not the thyroid ) causes late miscarriages / stillbirths so I’m not counting my chickens yet. I’m in my second trimester now.

Regardless of your thyroid being sub clinical your thyroid medication should be increased as soon as you are pregnant by 25-50% and NICE guidelines are you should be under the care of an endocrinologist if pregnant and on thyroxine (I have an under active thyroid and a 4 month old).

I would look up NICE Guidelines then go chat to a different GP in your practice. You can also often search for your hospital guidelines which have reference ranges for tsh in pregnancy. If you can’t see a different GP - move surgery.

As pp says your tsh wouldn’t necessairly be the cause of your miscarriage but it’s improtsnt it’s managed correctly in future pregnancies .

I’m very sorry for your loss - hope you get some answers/more confidence in a GP soon xxx