Hypothyroid and pregnant

[Bloopbleep]

I can't get an appointment with a doctor for two weeks to discuss this. I just found out I'm pregnant and I'm hypothyroid. I take 150mg levothyroxone daily. My last tsh was 1.something which is good but I was told to keep it under two. Should I up my dose of levoT before going to the dr? Would 25mg be enough or too much? I'm worried that leaving it for two weeks could raise my risk of mc.

[curliegirlie]

If you're under 2 you should be fine, and your mess won't necessarily need to be increased. I found out a few months before I fell pregnant that I had hypothyroidism. My TSH levels were 8 or 12 when I found out, I was put on 50mg of levothyroxine and TSH had dropped down to 2 by the time that I fell pregnant a few months later. My strength of levothyroxine was kept the same, which surprised me, but my TSH levels were fine throughout, and my prescription has actually been dropped to 25mg since I had my daughter.

[Bloopbleep]

Thanks

[UnoriginalNN]

I increased my dose from 50mg to an average of 75mg which is working well (50mg one day, 100mg the next) - I'm sure my mw said the official advice is an immediate increase of 25%.

Can you get a telephone appt sooner?

[Bloopbleep]

Thank unoriginal I'd heard the 25% thing too but I'm worried if I take too much it will be detrimental too. My surgery don't do telephone appointments which is most annoying

[celizabe]

I have had two MCs - both while on Levothyroxine.

The first time I did not have my dosage changed (and I didn't know enough to challenge the doctor) by the time I had the MC I was massively hypo. The second time I did have the dosage changed, from 150mg daily to 200mg, this was too much for me and sent my hyper (asked for a blood test the day of the MC).

I got a BFP on Friday (28th Oct) and immediately phoned the GP and they didn't have any appointments for my GP until the 14th Nov so I've taken an appointment with a random doctor on Thurs (3rd Nov).

In the meantime, I am self medicating by adding 25mg to my daily dose to bring me to 175mg per day. I'll ask for blood tests etc. when I see the doctor on Thursday.

The NICE guidelines all say to increase the dose immediately. Perhaps, you could try phoning your doctor again and asking for a phone appointment? Stressing the urgency? Or maybe have a chat with a pharmacist to ease your mind?

[Bloopbleep]

I spoke to my GP today who didn't know and said he'd call once he'd found out but he didn't.

[celizabe]

I would try to speak to them again tomorrow if you can and quote the NICE guidelines, but in your shoes I have upped my dosage myself and haven't waited for the GP.

A lot of them are very ill informed, my GP was until after my first MC when I gave them the NICE guidelines. You need to mind yourself.

I hope you get the care you need x

[Wonderflonium]

Keep ringing the surgery until you get your answer. You shouldn't wait two weeks.

[Womble75]

My GP immediately upped mine by 25mg followed by fortnightly bloods in first trimester. You want to keep it under 2. I've had 4 mc's due to undiagnosed hypo. I've been upped by 75mcg since becoming pregnant and my TSH is 0.9. Everyone is different but it's really important to monitor it closely in first trimester. Baby gets its thyroid hormone from you so I would do as others say and keep pushing your GP.

[Bloopbleep]

Thanks! I'll up by 25mg until I get hold of him again.

[libm127]

I am hypothyroid and 9 weeks pregnant. I've found the NHS to be really bad at managing this!

I had a blood test at 5 weeks and my TSH was 2.9 (which I now know is a bit high, but the doctor said was fine). I then begged the midwife to do another TSH with my booking bloods at 7 weeks. My TSH was 3.3 with total T4 of 15. So my thyroid levels were normal but my TSH was too high for pregnancy. Everything I've read suggests that you should aim for a TSH below 2.5. TSH over 2.5 with normal T4 is called 'subclinical hypothyroidism' and it can still lead to worse outcomes for mum and baby.

I told all this to the doctor on the phone, who told me that my TSH was fine. I had to quote various medical articles to her. Finally, she upped my thyroxine from 150 to 175.

All the recommendations say you should get your bloods done every 4 weeks with hypothyroidism but, again, this seems to be news to my doctor. I think they assume the OB will take care of it but I don't have an appointment with an OB until January - pretty sure I'll need another increase before then.

I'm quite shocked that neither the doctors or the midwife seem to know that this is a problem, or be familiar with the guidelines.

[Bloopbleep]

Hey libm thankfully my tsh and t4 are good but no one knows how often my thyroid should be tested. GP said maybe hospital will do it but I need to wait for them to send me an appointment.

[shouldwestayorshouldwego]

Ask to be referred to an endocrinologist, they managed my pregnancy and were the experts.

[DirtyDancing]

Preggo with second, hypo after birth of first. Was on 100mg, GP upped it by 25 immediately. Since been to see consultant at 14 weeks and it's been upped again to by further 25 (so now on 150)

[SpinALittleFaster]

My GP said no need to increase and they'd do bloods at 12 weeks. I saw my midwife a week later and she said they automatically increase by 25mg as soon as pregnancy is confirmed. My midwife was able to arrange for my prescrption to be increased without going back to a GP.

[Bloopbleep]

That's interesting spin I won't get to see a midwife/consultant until 12 weeks. We don't have an introductory appointment you just tell them date of lmp and you get your booking in and scan at same time. It worries me how blasé my GP is about this yet is so strict with antihistamines and antiemetics :(

[Picklingaround79]

Bloopbleep I'm just curious to hear how you got on with your GP in the end? I'm 26 weeks and my TSH has been creeping steadily up every test since I conceived (was diagnosed with hypothyroidism after first baby and been on 50mcg since). However every single test result has been accompanied by a 'normal' from the GP. I've been feeling worse and worse recently and have started getting the old symptoms back so asked to be tested again. Results back today showed 2.41 but yet again I've been told this is fine. Are GPs not up to date with the guidelines or are the guidelines wrong?! Feeling really worried and unsure about whether to just up my dose regardless...

[chloechloe]

pickling I think a lot of GPS in the U.K. are not up to speed on thyroid issues and seem to believe that a TSH under 4 is normal. I live in Germany and every Dr I've seen (whether GP or gynae) is happy to medicate to bring TSH under 2 if you are TTC or pregnant. In both of my pregnancies I've had my bloods checked every 4 weeks - I was diagnosed as hypo when struggling to conceive and have had to increase my dose in both pregnancies - it doubled in the first and went up 50% in the second.

I wouldn't suggest self medicating though - rather push the Dr to do something (can your midwife help?) or insist on seeing another one.

[chloechloe]

www.btf-thyroid.org/projects/pregnancy/202-thyroid-in-pregnancy-information

Maybe the link will help - it clearly states TSH should be under 2 in pregnancy.

[SociallyAcceptableCookie]

This is very interesting. I had a faint positive yesterday and happened to have a GP appointment. She couldn't confirm I was pregnant but ordered TFTs and said as soon as I was confirmed, she'd recommend seeing the midwife earlier than normally recommended. I might not be fair to her but I suspected she wasn't sure what to do and wanted to midwife to take care of it. My plan now that I have a bfp (today!) is to phone in and ask to speak to the GP I trust most with my thyroid issues.

[Picklingaround79]

Thanks everyone - I've just called the GP and have asked for a callback with my Doctor. I've also printed the British Thyroid Association reccs so I can read them over the phone, that's made me feel more confident. Back when I was diagnosed and became pregnant, I did see an Endo who told me that ultimately, practicitioners shouldn't just take into account test results but how the patient is telling them they feel.

As I felt *-ing awful when diagnosed, then bloomin' marvellous after just a month on meds (and conceived immediately after that) I think she's right. I just can't understand why (all) my GPs have consistently downplayed the Hypothyroidism, and why they don't listen to what you're telling them!

Before pregnancy, when I kept coming in reporting hair falling out, extreme fatigue, weight gain, muscle spasm and even worse - repeated chest and throat infections - they kept telling me "don't worry, it's all normal with a young baby". In the end as we were trying and failing to conceive our second, I went to a private fertility consultant who immediately tested my thyroid and found the culprit. My GP should have tested months before that and saved me 150 quid!

Then now I'm pregnant, the GPs are saying; "don't worry, it's all normal to feel this way in pregnancy." Grrrrr......

It just makes me feel so annoyed that this is yet another issue where women's needs/medical issues seem to be bottom of the pile and something we have to argue for again and again... it makes me so tired!

Thanks for the advice everyone xx

[booox]

I know this is a zombie thread but just adding for future readers.

NICE guidelines changed to these in April 2016:

cks.nice.org.uk/hypothyroidism#!scenario:3

Note increase as early as 4-6 weeks, last paragraph.