High tsh in pregnancy

[jinglebellmel]

After 2 consecutive miscarriages I've just had bloods back with a tsh of 5.75 suggesting hypothyroidism. Dr isn't willing to do anything until after a repeate test in 4 weeks.

Does this sound right? Is 5.75 not that high? I've read that it should be under 2.5 for a successful pregnancy am I'm worried in 4 weeks it may be too late and I'll already have miscarried. Do you think I should push this further or am I over reacting and being a nightmare patient? Thanks

A few years ago they would have said that over 5 was high. But they seem to have moved the goal post. I'd be pushing for a small 25mcg dose of levothroxine and/or a referral to a specialist.

Thanks sofa. So they have moved the goal posts and think 5 isn't high now? So frustrating to feel like you're being fobbed off!

I'm in Germany where the standards may be different but more recent medical practice is that TSH should be around 2 if TTC or pregnant. I was diagnosed as hypo when unsuccessfully TTC. I'm now expecting my second and in both pregnancies they had to increase my dosage Levi thyroxin a lot.

I honestly don't know what the link is to miscarriage. But if it is untreated you will certainly be exhausted. I would be pushing for a small dose of 25mcg or so as AP suggested and then in 4 weeks they should test the levels again to see if that brings it back to a normal level. Ask to see a different doctor if necessary. Hope you get a better reaction then!

Wretched iPhone. Levothyroxin not Levi's!

Thanks Chloe, really appreciate your reply. Hope you're pregnancy goes well.

I've made an emergency appointment for this afternoon and have some articles to take with me, not sure how how receptive they will be to that but it's worth a try.

Eep I would suggest not taking articles with you some GPs respond really poorly to that sort of thing. They studied a long time to get where they are. You know your GP so you'll know how receptive they are to that sort of thing. I would just hate for you to be fobbed off because you offend them or something, you know?? Totally not saying you're wrong or anything!! Just that people can be sensitive!

You're probably right kitten. I had wondered if it might rub them up the wrong way?! I don't know the GP, so I think I'll put them in my bag but only pull them out if it looks as though I'm not getting any where. Thanks for the advice.

The NICE guidelines are what you should look at. Don't take random articles unless you have a medical background then you have no idea how to assess if it's good or bad information. My TSH was 6 originally and I was put on thyroxine to bring it down to under 2.5.

Thank you tolt, that's good advice I hadn't thought of looking at NICE guidelines, will have a look.

I've just read the NICE guidelines and they've not followed them at all. Hope I can get this across to the GP without offending or sounding patronising/like a crazy hypercondriac googling lady!

Much better to go with evidence with NICE, really good idea tolt. They really should follow those guidelines so if you go back with that evidence rather than random articles you should get somewhere :)

Thank you all for replying. You've given me the confidence to push it a bit, as I'm not good at this sort of thing. Just can't face another miscarriage if there is anything I can do to reduce the risk, so really hoping I can get my point across.

Ideal TSH for successful pregnancy is 2 or under.
I've had 4 mc's due to undiagnosed hypo was 4.5 for years and was found to be 9.75 after the 4th
With this pregnancy my dose was immediately upped by 25mg the day I got a positive test and has since been increased by another 50mg with fortnightly bloods. It's vital in early pregnancy to get these levels right as baby gets its thyroid hormones directly from you. If you haven't enough to give then unfortunately it usually ends up in MC which is what happened to me 4 times in 18 months.
In my experience hypothyroidism is badly managed by GP's. I've gone through 2 trying to get better. My current GP is very receptive to me discussing various guidelines I've found and been concerned about. You really have to push sometimes to be taken seriously. Each trust has different "normals" but what's normal for one person is not normal for another.
Good luck for this afternoon.

Thanks so much womble could you tell me what dose they started you off on out of interest? I'd like an idea of what I'm hoping for.

Push. 5.75 is too high in pregnancy . It's important to adjust it as the baby is not making its own thyroxine yet

I was on 50mcg then 75 then 100 then 125. My levels went to 3.5 after 100 but I was still having bad symptoms so was upped to 125 and stabilised at 1.95.
This pregnancy I called my GP when I got my positive test (as he advised me to do) immediately upped by 25mg with bloods done that week (was 4 1/2 weeks pregnant)
Bloods came back at 2.95 upped by another 25mg, more bloods done 2 weeks later and were 2.3 so upped again and now stable at 0.95. Levels go a bit crazy first trimester.
It's all about expressing your concern but in a positive way rather than being confrontational. My GP is great and freely admitted its not something they go into in great detail whilst training but he has done lots of research whilst treating me and always said the minute he thinks he can't control it with me anymore he would refer me to an endo.

I agree that TSH should be under 2
Good luck with your appt

I was diagnosed with hypothyroidism at the start of the year with my TSH at 44! My doctors told me to not start TTC until my levels dropped to under 2.5. I fell pregnant almost instantly after reaching the correct levels and am now 24 weeks. At my last blood test (every 3 months) my level was at 3.2 but they didn't increase my dose or anything, as the T4 was still in the right parameters. I think you should definitely speak to your doctor about it though.

Once you start taking levothyroxine, you will be on it for life. Your thyroid will stop working properly if you are getting the thyroxine from tablets and not making it yourself. Maybe that's why they have been reluctant to start you on it just yet?

I didn't know that it stopped your thyroid working curiosity, thanks for the info and good luck with your pregnancy.

Thank you all so much for replying, it went much better than expected (was the same GP as I spoke to last time so a bit awkward!). She's put me on 25mcg of the thyroid medication, booked me in for more bloods on Monday and is referring me to an endocrinologist. I just hope they will up the dose soon enough for it to help with this pregnancy as 25 seems very low from what what I can see. Really positive though and all of your input really helped.

Excellent jingle, I'm so glad it went well x

Curiosity you will need more thyroxine during pregnancy - I think guidelines may be that you should be seen by an endocrinologist at this point or an obstetrician with specific interests - you need to ask for more input. Those who speak of their dose being immediately increased on identifying pregnancy are being well treated, and closer monitoring is needed thereafter.

Can't copy and paste it for some reason but if you google 'tsh pregnancy NICE guidelines' there is a PDF document for anyone who may be interested or come across this in future.

You've done the right thing and 25 is a good start. The issue might be that your thyroid corrects its self post miscarriage and you don't need it; however you are most likely to need it for a future pregnancy to be successful.

Monitoring is the key and being referred is great. Yes it does need to be below 2 for conception.

The thyroid in a healthy woman grows by 30-50% (the need for hormones increases by this) during pregnancy. If on thyroxine doses need to be adjusted accordingly and monitored.

Baby develops own thyroid after first two trimesters and the need reduces but mother's dose needs monitoring then.

(Incidentally the ancient Egyptians had a cord round their neck as a pregnancy test as when it tightened due to larger thyroid they knew this was a sign of pregnancy)

Well done OP and good luck!