Pg with under-active thyroid?

[Christelle2207]

Hi, I have been TTC for 1 yr, eventually got diagnosed underactive with TSH of 8.9, started 25mg levothyroxin in October. Am convinced that thyroid had something to do with difficulty getting pg but that's another thread.

5 weeks later (4 weeks ago) it had come down to 5.5, dosage (after pushing for it) increased to 50mg, then last week I got my BFP!! I am now between 5 and 6 weeks, I think.

Going for next blood test on Wednesday. GP seems to think that under 4 is ok but dr google is convinced that if pg you need to aim for between 1 and 2.5.
Worried that she won't give me any more prescription if I get down to about 4 though has admitted that I need to get checked more regularly when pg.

Any others out there with hypothyroid- what TSH is safe in pg and do I need to worry about my baby (other than normal worrying of course!)

Thanks

Think Bartlet has done a great job of setting things out here, just wanted to add my own personal experience.

This is my second pregnancy, and in both pregnancies I was told (by the hospital as where I live most of my antenatal care is done by local hospital) to immediately increase my thyroxine by 25mcg once I knew I was pregnant, and to have a blood test after.

They checked my blood again at 13 weeks and increased me by another 25mcg and I go to get my bloods checked again in a weeks time.

I've not met my consultant yet this time (will meet him at 20wk scan) but last time he told me he wanted to keep my TSH between 1 and 2.

I'm sure you'll get good care, but I know my local GP seemed surprised by the hospitals suggestion of increasing my thyroxine immediately before a blood test was taken (my last non-pregnancy TSH level was 3.1) and ended up asking me questions about what happened regarding my thyroxine levels in last pregnancy.

So it's good to have advice from Bartlett to back you up, in case you come accross a health professional who may not be that up to speed why underactive thyroid in pregnancy

Grr, you do need to be seen by an endocrinologist and I (because, let's be honest, you've only got my word that I am one! ) am not good enough via MN!

Next TFTs in a month sounds fine - if anything, a bit too frequent as TSH 'needs' 4-6 weeks to settle down.

Glad you have a dose increase though. Sure the midwife will refer you on to one of us!

Wow... now slightly panicking as my underactive thyroid has been more difficult to control than a bunch of hyperactive schoolchildren at alton towers (I know - definitely a mixed metaphor there).

definitely not borderline underactive either as was previously on 150mcg, and have been upped to 175mcg on finding out pregnant. Still - i get to see the Obstetrician (sp?) mid january, so will have lots to ask.

Thank you Bartlet for your input.

Hi
Just wanted to update. I am now 11 weeks pg and at the end of December my TSH was down to 2.1 which is obviously a vast improvement, thanks to 75mg. I am back for more bloods next week and at my midwife appt she put me on "shared care" which means some of my antenatal appointments are with an obstetrician so I have my first of those in early Feb. Both the midwife and gp seem completely unconcerned though, I feel it's up to me to keep an eye on things.
reiki would be interested to know what your obs said?
Best of luck all
x

Well I saw the Obs today - and my case is apparently a little different I think.

I'm not being monitored so much for being on Thyroxine, but because initially I had an overactive thyroid. (I was sent underactive when I was about 19 or so as being overactive was not playing nicely with meds).

If I've had an overactive thyroid - apparently there could be antibodies in my system that can affect the LO. So - more bloods today, and then will see where we are. Now slightly more worried and trying really hard to stay away from Dr Google - but wait for next communication from Obs.

The only thing I can say though Christelle is to ask absolutely ANYTHING you're worried / concerned / even remotely thinking about. The Obs I saw today was really lovely, and even tried to let me hear the LO's heatbeat - bit futile with a anterior placenta at just 15 weeks tho!

Let us know how you get on with your Obs appt. Early Feb will be here before you know it! x

You are right 1 and 2.5. is ideal for first trimester. I started out 1.9 and went up to 2.2 at 15 weeks. The baby has its own thyroid now but I insist that at every MW appointment I get a blood test for t4 and tsh. I would ask your GP to raise you to 50mcg or 100 (I'm on 100mcg). Tiredness is going to bite you throughout your pregnancy, having low thyroid levels is only going to make that worse.

oh just read your update glad your levels are down :)

Hi
wanted to update this thread in case of use to anyone. Am expecting my baby on Friday!! Because of diagnosed underactive thyroid my midwife put me on shared care (mw & consultant led) which led to a few appointments at the hospital with various consultants at which point they did take note of my tsh scores and kept upping my dose (after I asked them to). I eventually saw the endocrinologist in April who put me up to 125mg (on which I've been since) and wrote a letter to the gp to say that my tsh should be kept between 1 and 2 and that under 4 is not good enough! And to be referred back to him after after having the baby and also if I get pg again. He admitted that gps have "no clue" when it comes to treating thyroid problems in pregnancy despite the gp being adamant than he had done this successfully for years. My tsh a couple of weeks back was down to 0.9 after being under 2 for some time. So I'm nearly at the end of the pregnancy now, I have to hope that the baby hasn't been affected in any way, fingers crossed but scans were all fine and pregnancy has been normal.
I have been astounded as how proactive I've had to be though at getting tested regularly and insisting on gettting thyroxin increased. Sure there are lots of hypothyroid women out there, diagnosed and not, who are not getting the right dose or care because they've not for whatever reason done their research and/or are not pushy enough with the docs.
Anyone else out there with underactive thyroid - you really do need to push to see a consultant and get your tsh down as soon as possible. GPs in my experience (I did see 3 different ones) useless!

If anyone is interested here is the NICE clinical knowledge summary - which should be uncontroversial with any GP - cks.nice.org.uk/hypothyroidism#!scenariorecommendation:7

Your GP should automatically refer you to a consultant obstetrician when you tell them you are pregnant. This is standard protocol for anyone with a thyroid disorder and I would think as you are newly diagnosed they'll probably want to see you sooner rather than later. I had my appointment last week and there was the obstetrician and endocrinologist both there.

On the dose front, wait until you get the results of your blood test next week. Then you can talk to your GP about optimum numbers and refer them to the above page. I wouldn't worry yourself too much in the meantime.