Is this a normal standard of care?

[MrsSnow]

Finally pregnant after 10 years + ttc via IVF and miscarriage.

I made an appointment to see the GP to inform that I was pregnant and also to give him additional information from my IVF clinic that my bloods need monitoring due to thyroid issues. He said go see the nurse for the booking in appointment. So booked an appointment with the nurse.

The appointment with the nurse consisted of signing a form for free prescriptions while pregnant, repeating the information given to GP re medications and thyroid, and hospital choice. She said the hospital would contact me for a booking in appointment.

This morning I have recieved a date for a scan from the hospital and nothing else. Does the booking in appointment happen after the 12 week scan or before? Is this all normal?

Normally you would see a midwife before the 12 week scan at around 10 weeks but I have heard of some ladies having it afterwards.

Did they do any blood tests?

No bloods done, which is why I am worried as IVF clinic specifically said I need bloods done and frequent monitoring of thyroid.

Hi.

First of all massive congratulations. You should have the booking in appointment before your scan, I had mine at 6 weeks but I was very early. They ask you and your partner questions about family history health and take bloods from you and do your weight and height and then you just wait for a scan date.

In regards to your thyroid issue I can only tell you what has happened to me so far, I'm 34 weeks. They discovered I had an underactive thyroid at about 12 weeks and I have had to have bloods done every 4 to 6 weeks to monitor it. I know sometimes they have to up your dose while your pregnant so my advise to you whilst everyone fannies about is to just book a blood test with the nurse at your gp surgery and explain your pregnant with a thyroid issue and need to check what dosage of med you should be on.

It all sounds fairly normal to me though they don't really care about you until you hit 12 weeks which is shit because that's when your most vulnerable and worried but try and relax xx

Sounds like I'll have to go back to GP/nurse to get a blood test done.

Thanks

Yeah midwives won't get involved with thyroid because they don't understand it. That's what I have been told anyway.

Your gp and eventually a consultant will take charge of it x

Yes go ask for a blood test for thyroid. Many specialists recommend that your dose should be increased immediately once you know you're pregnant.

Where I am the booking appointment is actually our 12 weeks scan and that's when we first see a midwife could be the same for you x

Thank you so much for your replies. It sounds like GP/nurse are passing the buck. I'm currently 8/9 weeks the scan appointment is for when I'll be 13/14 weeks so definitely sounds like I need to get back to the GP and get them to organise blood tests.

Not sure about thyroid tests but booking in procedures seem to vary on area to area. But where I am, you have your booking in appointment and scan together between 12 and 14 weeks at the hospital.
Here you see the m/w for thorough booking-in, past and ongoing issues, blood pressure and urine etc. Immediately followed by the scan combined downs screening along with all other bloods. Hope that helps. If in any doubt though go back to your GP. Good luck with the pregnancy.

In most cases, the need for thyroxine raises sharply in the beginning of pregnancy, and that's also the time when it's most important, as baby's own thyroid is not functioning yet. I always demanded to be tested and had to go up from 125 to 150 first time, and from 100 to 150 the second www.ncbi.nlm.nih.gov/pmc/articles/PMC2533153/

I've had a thyroidectomy so I was already on thyroxine. I'm giving blood every 4 weeks and have had my dosage increased. You need to have your GP arrange blood tests and be monitored regularly. Midwives don't have the expertise on this issue.

Yes your GP needs to organise a blood test every 6-8 weeks through pregnancy, and also refer you to the consultant clinic at your hospital who will monitor it more carefully

Congratulations on your pregnancy! What kind of thyroid problems do you have?

I asked to see an endocrinologist after 15 months of TTC as I had a thyroidectomy for Graves' disease when I was 10, what's left of my thyroid isn't v stable and GP wasn't sure about best thyroid range for TTC.

Anyway turns out I was 3 weeks pregnant when I saw the Endo but didn't know it and he was happy with my T4 being 24 (high side of normal). My T4 had shot up to 28 when he checked it that day so when blood results came back GP has reduced my dose from 200 to 175 when I went at 4 weeks to confirm I was pregnant. I'm seeing the endocrinologist again at 12 weeks and ideally he'll see me every 6 weeks throughout my pregnancy.

I wasn't happy with my thyroid going unchecked between weeks 3 and 12 so at 7 weeks I've had it rechecked and my T4 has fallen to 19. GP wanted to reduce my dose again but I'm now symptomatic - knackered/freezing/lethargic so I phoned endo & he said stay on the 175 til I see him at clinic & he wants me to get more blood taken before I see him at week 12.

I saw midwife at 6 weeks for booking appointment but she's leaving my thyroid checks to the GP & Endocrinologist. I have Obs consultant appointment at 13 weeks along with my scan.

NICE guidelines state thyroid should be checked every 4 weeks in first trimester then again at 16 and 28 weeks if dose is stable. I had to book these blood tests myself as my GP seemed unaware of the need for this.

Sorry for the essay but just wanted to show you exactly how much care I've had already & how much my thyroid has changed. Don't let them leave you til 12 weeks. Have a look at the NICE guidelines - they recommend increasing your dose by 25 - 50mcg immediately, getting bloods done straight away & being referred to a specialist urgently (Endocrinologist not the obs consultant) at the point of the pregnancy being confirmed. You need repeat bloods every 4 weeks initially. Demand your GP gets the ball rolling with these things & don't back down.

Ok I've booked another appointment with my GP (in my pct, gp gives a blood test sheet to take to the blood test centre at hospital outpost) so will ask for blood tests. From what I can gather my appointment at the scan is just for a scan and blood test re downs. So no midwife contact before then.

IfYou when I first went to my current ivf clinic my tsh were raised to 3.9 and so they put me on levothyroxin as they felt I would not get pregnant without. My GP felt this was unnecessary. So while I am on thyroid medication Gp/nhs don't feel it is necessary.

Thank you once again for your help.

That's great MrsSnow. Make sure you ask for a referral to the Endocrinologist too. The midwife did offer to check my thyroid bloods so I'm sure they would repeat them if you asked at your scan appointment. Or maybe ask to see the MW earlier that 12 weeks to discuss your concerns.

I'd imagine IVF clinic wanted to bring your TSH into the middle of the therapeutic range in anticipation of it climbing again once you were pregnant. It seems like the smart thing to do but unfortunately some health professionals don't really understand. I'd arm yourself with an much info as possible and keep pushing. Your pregnancy is too precious not to.

I'm lucky where I stay - I phoned my GP surgery today, told receptionist I'm seeing Endocrinologist next week & he wants bloods before I go and they've booked me in for tomorrow no questions asked.