Hypthyroid pregnancy & tiredness

[InsufficientlyCaffeinated]

I've had an underactive thyroid since birth so it has been fairly well managed throughout my life.

Currently pregnanct, 8 + 4. Had my bloods tested at 4 weeks & they came back as normal. Dr increased dosage immediately by 25mg anyway and the test was a few days after. Felt fine after meds increased but now I am so completely tired. I know it's normal to be tired in pregnancy but I'm finding it difficult to function. Getting 9 hours sleep and still could crawl back in to bed. Is this just normal pregnancy tiredness? If you have/had a pregnancy while hypothyroid, how often were your bloods tested? Dr says I'll be monitored but stupidly I didn't ask how often I should be. Don't to waste their time making appointments just to be reassured but also don't want to ignore something that could be a big problem.

Every 4 weeks, you should aim for TSH under 0.2. The tiredness is sadly both common and harmless.

Currently 35 weeks with a tsh of 0.47. Feel appointment much better than my I did at 8weeks, even though my bloods then we're fine. My endo says TSH under 2 when pregnant is fine, but I know I feel tons better when it's well under 1. I have my bloods done every 6 weeks and have maintained a consistent 0.4something.

Everyone is knackered in the first few weeks, thyroid issues or none! Just make sure you ge t bloods done regularly. All the best.

"Every 4 weeks, you should aim for TSH under 0.2."

I'm assuming this is a type and is supposed to read a TSH of under 2.0, as that would be far more normal advice. Also, most places will only check TFTs every 12 weeks (8 weeks after a dose change at most).

But yes, early pregnancy is exhausting. I'm now 16 weeks with DC5 (no current thyroid issues but I have post-partum thyroiditis in the past so need my TSH monitored - which reminds me that I haven't phoned to get last week's results) and only now feel I am emerging from an exhausted haze.

That exhaustion is normal in a pregnancy, in my experience. It's awful! I had to sleep for two hours every day in the afternoon. I would sleep like it was the middle of the night and there was no getting around that need to sleep!

Separate question - hope you don't mind me asking, my baby was born with congenital hypothyroidism. He's 12 weeks now and seems to be doing fine. Is that what you have?

I'm worrying about the same thing! Was diagnosed hypothyroid about 3 years ago but has been managed well since then on a low dose of thyroxine. I went to my GP at four weeks pg because I had read that they would usually increase dose straight away, but my GP didn't want to do it until I had a blood test. That showed my TSH was 1.9 so GP didn't increase my dose. But this is higher than my usual TSH level and an increase of +0.3 since November when I was last tested. I'm now at 6+4 and feeling so exhausted. Although I know it is not uncommon in pregnancy, the fact that I am tired all day (possibly more so in the morning) and not just in afternoon/early evening is making me think it is thyroid related.
Should I ask for another blood test? Also, I have found that recommended TSH levels in pregnancy vary, some sources I have read suggest TSH should be kept below 1.5 in the first trimester. Does anyone know if this is correct?

If you have a thyroid condition you should be referred to a consultant endocrinologist during pregnancy.

Try to insist on seeing one as soon as possible - or at least getting your thyroid test results sent to the consultant to be looked over. (I asked for this but only saw the cons at post 20wks)

Can you get your bloods taken by a healthcare assistant at your GP surgery and then have a phone appointment if necessary? If your thyroid levels are normal then you won't be taking up too much time. If they climb upwards then you should speak to a doctor anyway.

It really is best to get a specialist involved. GPs can follow the guidelines on TSH levels but they don't always know exactly how to manage a thyroid condition in pregnancy and that can mean the dosage is changed unnecessarily and then changed back again later. A specialist is more experienced in judging what will right itself and what requires a change. It's not just about measuring the hormone levels, it's also about how you feel.

My dose was reduced in early pregnancy, my TSH levels read as below 2.5 but I eventually felt as bad as I did before I was ever diagnosed with hypothyroidism. I went back up to my old dose and now feel tired sometimes, but I can actually get out of bed in the morning.

UK endocrinologists tend to advise keeping TSH in pregnancy in the lower half of the normal range, so less than 2-2.5.

The Endocrine Society guidelines recommend TSH less than 2.5.

press.endocrine.org/doi/full/10.1210/jc.2011-2803

I am hypothyroid and pregnant. Coincidentally I had a pre arranged appointment with my endocrinologist just after BFP so I had bloods drawn and was put up 25mcg as although my tsh was fine (0.36) my t4 was bottom of the range. Bloods were taken at booking and no further changes needed so far. My midwife is doing the blood draws for TFTs and emailing the endocrinolgist for his advice.

I would also say it is normal to feel completely wiped out in early pregnancy - in fact the crushing fatigue is very similar.

... Very similar to the hypothyroid fatigue.

Thanks all. I rang the doctors surgery but they will only give me a blood test if the GP has requested it. Have managed to book a phone appointment with GP tomorrow so will ask for an immediate blood test and a referral to an endocrinologist. FX!

Havaline I don't mind at all. Mine was a breeze to handle throughout most of my childhood and pretty much until now. Had regular hospital checkups throughout childhood until I got to about 15 when I started to level out then was handed over to GP care initially for quarterly check ups, now have them annually.

Only really difficult time I remember was in my early teens when I had a sudden growth spurt and had to move to 6 weekly monitoring as my TSH was all over the place. Got really overweight, then they upped it too far and lost lots of weight suddenly and food went straight through me (sorry, TMI). Eventually though it got back on track. Obviously I don't know what it's like to be diagnosed later in life but from what I've read of others' experience I think it must be easier to always have it and always be treated so that the doctor is always on top of it. Saying that having always had it I think I've just treated it as a background thing and now I'm pregnant I feel rather clueless!

Thanks everybody for your responses. I haven't been offered endo care. I think I'll arrange another appointment and discuss it properly.

I have also been hypothyroid from birth. I was increased by 25mcg at the start of my pregnancy and have stayed on that dose ever since. I was only tested once at the start to make sure the increased dose was OK and not again.

I think your tiredness is normal early preg sleepiness. I was the same in my first pregnancy, slept all weekend and straight after work! You mght pick up again in.the second trimester!

"so will ask for an immediate blood test"

Just to warn you, peamad, that while your GP may or may not request the test, a lot of labs will not repeat TSH measurements until 6 weeks have elapsed since the last one.

A referral to an endocrinologist would be very sensible and is advised for all pregnant women with thyroid problems. At my local hospital, women on thyroxine are given a leaflet advising them to increase their thyroxine dose by a certain amount as soon as they are pregnant in anticipation of the increase in thyroxine required, so your hospital might be the same and might be happy to initially advise your GP on the phone while you wait for your appointment.

Thanks for your reply that's so good to hear!

Hope you are feeling a bit better now!

My dosage was put up by 25mg at 12 weeks, and then tested a few weeks later.

It was tested again at 28 weeks but the results never turned up so just had bloods done again (31 weeks) so waiting to hear back next week I guess.

My GP was not very clued up on hypothyroidism and pregnancy, but I am seeing the endocrine consultant at the antenatal clinic.

Hi all
Sorry to hijack the thread. I'm currently ttc and my most recent bloods showed tsh of 3.9 (an increase from 3 when I was last tested a year ago). I'm aware that the recommended level is 2-2.5 for pregnancy so asked my gp to increase my dose. She knew nothing about this and I had to really fight with her to get it. I'm now taking an extra 25mcg after a lot of arguing!

I'm not confident that I will receive the care I need when I get my bfp. Can I ask for a referral to a consultant or should this be automatic?

Harriet- Google the NICE guidelines on hypothyroidism and pregnancy, and highlight the section starting your thyroxine needs increasing on getting a bfp and take that with you.

My midwife did my referral to endo on my booking in appointment.

Yep. Also came on to say to google the NICE recommendations. They were really useful when I found out I was expecting this time (now 19+1). In my previous pregnancy my then GP and also my midlife refused to order a repeat blood test as my test results at 4 weeks were OK.

Thanks junosmum and probably - I will do. I had a telephone appt with my gp recently where she tried to tell me there were no NICE guidelines on this - I was at my computer so read them to her over the phone! Even then she was really unwilling to increase my dose because the guidelines talk about an increase only once you get a bfp, not in advance of that. The obvious logic of increasing in advance given I was having symptoms and had clearly deteriorated escaped her! Suffice to say I'm trying to move practices...

As long as referral is automatic and not reliant on her discretion I'm happy!