Hypothyroidism care when pregnant?

[BloominMoomin89]

Hello all,

Just wondering what care everyone has got/is getting with their hypothyroidism whilst pregnant.

With my 4 year old, i saw a consultant at 13 weeks but thats it. GPs all pretty clueless and midwives kept saying GPs were in charge. Consultant suggested i should have had monthly blood tests before seeing him and then an extra growth scan which never materialised. He's 4 and well so no issue then.

GP seems more concerned in Kent and midwife more clueless than before about blood test monitoring.

I can't remember what the antibody thing is; might be something or nothing or might be if you're hyperthyroid with the antibodies. But I know one sort can crop up in hyper and autoimmune hypothyroidism so just worth checking.

But you're clearly well versed in having to fight for all this already appears to come with the territory if you have thyroid issues.

I and at least 2 friends have had the 'anxious mother' dismissing card thrown at us; I now back every request with "I'm just double checking this as I've had this issue before/ understand this can be an issue for some pregnant women/ can have an impact on pregnancy outcomes/ am experiencing hyper / hypo symptoms." (The last two I have had during this pregnancy)

My "baby" is now 12 ... But with all 4 of my children, I have never had any specialist treatment or care due to my thyroid. I was dx when I was 17 years old. I had a lot of problems with one of my daughtes and I now wonder if it was my fault, because of my UAT

Cookie, no not all are clueless but in my personal experience many are not sure or don't know. The main issue is that a woman can easily slip through the net if she's not aware as its gp responsibility but she may not see the gp at first or if she does, they may not flag it up if they're not aware of the first trimester issue. There's an assumption it gets dealt with by the hospital from 12 weeks by the mws and gps.

I'm sure there's increasing knowledge but my own personal experience and those of the 4 women I know in rl has not been great in the past few years. And there's enough threads on mn too.

sushi I'm sorry if this has worried you. If you were on thyroxine baby would have been ok, you may have struggled quite a bit. Some of your thyroid may have been working. Being vegan in pregnancy with a healthy thyroid appears to be more of the issue. Remember that baby's thyroid starts to work around 12/14 weeks.

I had a very poorly controlled tsh in my first pregnancy, especially the first trimester (eg tsh 8 then 13 despite raises as the batch of thyroxine was faulty) and ds is absolutely fine and doing well at school.

Please don't blame yourself

Sorry to piggy back this post, there seem to be some posters that are much more informed and understanding of thyroid issues than I have got myself.

Prior to being pregnant my TSH was 5.6 (being monitored due to strong family history of hypothyroidism and some swollen glands). T4 was in normal range so monitoring offered, rather than any treatment.

At 8 weeks pregnant, TSH is 3.5. GP does not feel need to see me as it has gone down. 3 monthly monitoring has been discontinued.

Have attempted a bit of reading myself, the TSH of 3.5 still sounds high.

Should I be satisfied with the GP response, or be asking for something else?

Any help will be much appreciated. I'm extra concerned now I have a (13 week) little one on board. Xx

Nad are you 13 weeks now? Have you had your scan yet?

See gp and show nice guidelines key part here:

"*◦	Pregnant
▪	Check TFTs immediately once pregnancy is confirmed.
▪	Discuss urgently with an endocrinologist regarding initiation of, or changes to, dosage of LT4 and TFT monitoring while waiting for review — trimester-specific TFT reference ranges may vary locally.*"

Some don't realise there's a different range to follow during pregnancy. Ask them to call hospital but really you should be seeing a consultant at your 12 week scan who would be managing you.

Ideally it should have been another raise at 3.5 (I was raised at that level by 50) but I do need to reassure you that you weren't hugely out of range. Also, if you have residual thyroid function your thyroid may be managing, however ideally you should be being monitored.

Unfortunately nice don't say anymore in the actual guidelines to keep below 2.5/3 tsh as they state to refer to an endo, who would do this. In practise this doesn't seem to happen much. I asked for the gp who didn't think I needed any extra this time (despite needing a lot more last time) to call an endocrinologist or the hospital, which she did and then fed back what they wanted. I was 3.5 and they did increase by 50 this time but it was a tad too much and I settled at an alternate day dose.

I must say that even if not pregnant, most people don't feel well till in the lower half of the reference range, and this is clearly stated even in the subclinical guidance in nice:

cks.nice.org.uk/hypothyroidism#!scenario:1

"Aim (in most people) to reach a stable TSH level in the lower half of the reference range (0.4–2.5 mU/L)."

Google local trust guidelines too and take them in. I've posted an example further up thread.

If you've had your scan and didn't see anyone, I'd consider calling the hospital directly and querying this.

@Nad1122 at my last doctors app (before pregnancy) my TSH was 3.2 and the doc agreed to increase my dose by 25mcg. I did have to ask mind but she agreed to see if we can get it under 2. I will be asking for a check of this when I see them this week. I think you should ask for an increase and see what they say.

I had consultant led care, saw consultant twice but also had 2 extra midwife appointments. I had a monthly blood test at GPs, meds were increased twice and had 2 extra growth scans. I then had 2 GP appointments & blood tests and a telephone appointment after baby arrived to stabilise my meds. Now back to annual medication review.