Vitamin b12 deficient AND underactive thyroid at 11 weeks

[LadyKate]

Just after some advice please as I'm getting conflicting information about if it's safe to have vitamin b12 injections when pregnant? I'm 11 weeks.

I have circulation problems and some mild blood disorders and routine blood tests by my rheumatology Dr showed b12 deficiency and recommending injections once a week however the locum GP who called me in was unsure if they are ok in pregnancy, then decided to prescribe it anyway.

In separate blood tests with obstetrics I was diagnosed with under active thyroid and prescribed thyroxin, which the GP knew nothing about as didn't have the records of that...

Has anyone had this before? This is my first pregnancy and I'm pretty confused about everything!! I'm seeing my midwife next week so was going to just wait and see what she said but then reading online (dangerous I know!) that b12 deficiency can increase risk of miscarriage so whether to just get it done ASAP?

Thanks...

Hi I have an underactive thyroid but no idea on the other. In pregnancy nice guidelines are to keep your tsh level under 2 whereas the normal level is under 4. This means that you might require more thyroxine. I say this to you as I've now delt with 3 gps (I'm 10 weeks) that don't know this! I had to fight for extra thyroxine which is important as an underactive thyroid is a miscarriage risk. Please read nice guidelines and equip yourself with the right info. My midwife on the other hand knew the guidelines and was supportive.

Thanks for that, yes my TSH levels were 9.7 which is a worry!! Can't wait to see the midwife just a shame it's another week away :(

What dose of thyroxine have they started you on?
I'm 11 weeks hun & had a underactive thyroid since my first pregnancy with DS who is 6.
my tsh levels were elevated at 5.8 when I was 7 weeks they increased my dose & thankfully it came right down.
I know it's hard but try not to worry some people find in early pregnancy that their body requires more thyroxine & theur levels caN increase over a week or two so altho yours is 9.7 it may have only elevated the past few weeks.
Has your GP mentioned referring you to a endocrinologist for care through your pregnancy? Xx

I also had the same issues with lack of awareness of the NICE guidelines, doctor told me that I 'probably would be OK' and they would refer me to consultant after 12 weeks despite the early weeks being most important. A lot of doctors are not aware of increased requirements for thyroxine during pregnancy, would recommend pushing to be referred to consultant (either by midwife or gp) who can monitor levels as required. Am now 24 weeks and have to have blood test every 4 weeks, plus additional consultant appointments

Ring your midwife none urgent number and ask advice. Please don't wait for a week you'd kick yourself if anything happens in the mean time (it probably won't).

Thanks everybody. They won't prescribe my thyroxine until next Tuesday at the clinic with new blood results and my 12 week scan. I've never even heard of an endocrinologist but thanks for the advice I will ask!
I agree I need to call midwife rather than wait a week xx

What your levels were high but they haven't prescribed you anything? At least you only have to wait until Tuesday hun but I would make sure they don't fob you off. So have they repeated your bloods again? Xx

You definitely need to get started on the thyroxine as soon as possible
As others have said you want your TSH under 2
Sometimes people have thyroid problems just during pregnancy so you should be referred to an endocrinologist so they can give specialist advice and care

B12 injections are perfectly safe in pregnancy
Post pregnancy you should have investigations to work out why you are B12 deficient.

I take sublingual vitamin b12 (dissolves under the tongue) and I am pregnant if you're worried about the injections. It works GREAT. Got my levels up really quickly. You can buy it on amazon.

My deficiency turned out to be undiagnosed coeliac disease (was also deficient in iron and vit d and always just thought I was one of those people that bread and pasta didn't agree with!).

Definitely worth checking out why you're vitamin b12 deficient after the baby is born so you can sort it.

Thanks again, yeah they have repeated the tests but you're right I'm quite shocked that they were so high and didn't prescribe there and then!
Both problems apparently make you really tired, I thought it was just standard pregnancy tiredness, I'm bloody knackered and have put on 10lb already!!
Will defo look into it after baby too thanks xx

I too have a bit b12 deficiency, have done for about 5years. I am 8 weeks pregnant and have been advised to carry on with b12 injections as normal :) The injections are a god send for me and keep my feeling human. Without them I am v v tired, have numbness in hands/feet, can't seem to focus on anything and generally just have huge mind fog.

Not sure about the thyroid thing though.

Congratulations on your pregnancy

Xx

I don't want to worry you, but the sooner you get started on Thyroxine the better. If I've misunderstood and your appointment is Tuesday 12 April, then fine, but if you mean you have to wait until Tuesday 19 April, I'd be ringing either your midwife or GP tomorrow to try to get seen in ante-natal clinic (if they're the ones going to be doing the prescribing) earlier.

As someone has already said, your TSH should ideally be maintained below 2 mu/L in pregnancy (maybe 2.5 max). The maximum TSH for general health is around 5.5 (that's at my hospital lab, although different labs do vary a bit). If you can't get an earlier appointment at clinic, then I'd have thought that really your GP should be giving you a starting dose immediately.

(Ask your GP for a print out of your results - they should be able to access them through your NHS record, even if they weren't the ones who requested the blood results - that will give you your result alongside the normal reference range that the lab used.)

As 1moretime said, you also need to ask to be referred to an endocrinologist to monitor you throughout pregnancy - ideally with 4 weekly blood tests of both TSH and Free T4.

I had been diagnosed hypothyroid some years before becoming pregnant and was still seeing an endocrinologist periodically as she refused to completely discharge me back to monitoring by GP as my practice seemed incapable of maintaining the parameters she set (repeated in numerous letters to them) and would file blood results as 'normal' no matter what. If my GP practice is anything to go by, they just don't seem to 'get it'. Anyway, when I was pregnant I was referred to one of the consultant obstetricians (who was also a professor of obstetrics at local teaching hospital) who had a special interest in endocrinology and ran a weekly antenatal endocrinology clinic. So it might be that there is something similar at your hospital.

I don't know anything about B12, but from what others have said, it sounds like it's safe in pregnancy.

I hope you get all this sorted soon.

Hi,

I have b12 deficiency and hypothyroidism. Doctors don't tend to have very much knowledge and are often misinformed on both problems. Your thyroid results are extremely high - you will need to keep increasing until you feel better. Thyroxine is usually increased as soon as you find out you're pregnant as well. Some people find they don't do well on thyroxine though and find Natural Dessicated Thyroid to be better. You can read all about it at stopthethyroidmadness.com - it's a very informative site.

B12 deficiency and hypothyroidism both have a lot of symptoms and a lot of them overlap. They are both very important that you get enough during pregnancy though as the baby needs them from you. In regards to the injections it is even more important that you have them. I spoke with a specialist doctor who said that I should carry on with my injections as normal. The problem often is that in the UK we get one injection every 3 months (after loading doses) and this is not enough for 99% of people. Most end up self injecting. I found no improvement until I was injecting daily. www.b12d.org And b12deficiency.info are both very informative. Given that you're pregnant, I wouldn't recommend sublinguals unless they're to top up between injections as they don't provide enough for most people as you don't absorb the whole amount from the sublingual. You can experiment with them later or inbetween injections but you want to get your levels up ASAP when you're pregnant as it can cause a lot of complications. What were your levels? There's also a very good facebook group I can give you the link to if you're interested.

Did they test you for antibodies? Both conditions have an autoimmune type. Both of mine are autoimmune and this is why I have both as autoimmune conditions tends to come in multiples - once you have one it is more likely that you will get others. I have a blood disorder also, antiphospholipid antibody syndrome, which is also autoimmune.

Both need to be taken seriously and treated but as long as they are they shouldn't cause complications to your pregnancy. You may be considered high risk now though, if you weren't before. I'm 20 weeks and have had no complications so far, except extra treatment. If you want any more info or to chat feel free to PM me.

Perhaps I should be clear - you do need to get on Thyroxine to bring your TSH down to under 2. The only reason that I mentioned the 'general health' threshold of around 5, is that even if your GP is unaware of desirable levels when trying to conceive/when pregnant, then to leave you without medication when you're also over the threshold for non-pregnant people - ie overtly clinically hypothyroid - is pretty disgusting IMHO.

Thanks again for all the info! ChewyGiraffe no the antenatal clinic (who waited 6 weeks to tell me about the thyroid results!) did another blood test to see levels again before prescribing thyroxine and it's not this Tues 12th it's next Tues the 19th, which I agree is ridiculous!! I will be calling the GP tomorrow to see if they can get me started on it.
Liss85 yes I have mildly raised antiphospholipid / anticardiolipins but not enough to be considered dangerous. I will check out those links thanks so much xx

Is that the two positive results? I was diagnosed after I tested positive for antiphospholipid antibodies twice. If you have that then it can be very dangerous during pregnancy without treatment because your liklihood of clotting is already increased.
When you go to the doctors ask for your b12 results and insist on being given the loading doses immediately. The b12 is just as important as the thyroxine. Hope they're more helpful than your consultant, good luck!

Just realised you said you were pescribed one a week - is that for the duration of your pregnancy? If so that's fantastic, much better than most doctors (although I have found rheumatology doctors to be very good). You should have loading doses first though, so 6 of one every other day. Also, if you have any neurological problems caused by b12 (numbness, tingling, memory loss, brain fog, balance problems etc) then NICE guidelines say you should have one every other day until there is no further improvement (most doctors refuse to do this though) I'm horrified they waited 6 weeks just to give you the results when it's the first 12 weeks that are most important. I'd consider moving to a different hospital or asking for a different consultant at least.