Pregnant with subclinical hypothyroidism

[Spideryplant]

I'm still a bit in shock so apologies if this comes out jumbled.

DP and I just started TTC this month. Currently in tww. Unrelated to conception/pregnancy I had blood tests done about three weeks ago which I just called to get back yesterday (could have done it weeks earlier but forgot which I am obviously kicking myself about now). My TSH level (thyroid stimulating hormone - if it's too high it suggests your body isn't producing enough thyroid) is 4.9 which apparently is marginally high, and the notes just said I should talk to the gp about it at my next appointment. Of course I googled it and apparently while normal TSH levels are 0.4-4, for pregnant women they should be 0.4- 2.5, and levels over 4 are linked to higher rates of miscarriage and still birth, and lower iq if child is actually born alive. This seems to be the case even if the mother begins taking additional thyroid medication as soon as she finds out (one study showed the average iq of a child born to a mum with TSH over 4 to be 94 if she hadn't had treatment, and 97 if she had, both of which are significantly lower than population average). Official NHS advice is to delay TTC until TSH is reduced to the right level.

Of course, my initial thought was fuck, I wish I had known about this before TTC (trying to conceive), and I stopped hoping against hope that I was pregnant and started hoping that I wasn't. Did a test just now and of course it's a BFP (big fat positive).

I don't even know what I'm asking really.. I was really excited about the possibility of conceiving but now I'm terrified. Does anyone have any thoughts/experience/knowledge about this? I have an appointment booked with the doctor tomorrow.

@mumsnethq - I have just emailed and asked if this could please be moved to the pregnancy board

Don't panic just get treatment. I was diagnosis with postpartum thyroiditis after first DS, and was on thyroxine for pregnancy with DS2. Chances are my first pregnancy was whilst hypo. Don't worry. Thyroxine is safe during pregnancy.

My TSH was 14 at 5 months pp. It rarely goes below 4 now, even with treatment. I had 2 successful pregnancies, no miscarriages

I was similar and had to keep upping my thyroxine dose throughout my pregnancy. My baby is now 11 weeks old. Obviously too early to say anything about IQ but try not to worry too much. You'll already be doing enough of that when the baby arrives. And congratulations on your quick conception!

I didn't know any of the info on the op's post. I have hypothyroidism and have had 2 DC, luckily no MCs and both children are far too clever (for their own good!).

Get tyroid blood tests in each semester, more of the offer it. Ask for a refural to endocrinology consultant and enjoy your pregnancy!

Thanks all. I'm at work and just can't concentrate at all. I really hope that the GP is knowledgeable about this stuff. Also hope that she agrees to medicate me straight away. I keep thinking about my poor little baby's brain trying to develop and being unable to. Apparently the brain stem is there from 16 days after conception!

@CustardCreamLover, I know, it seems ridiculous that I got a positive in the first month, especially given that I'm 37 next week

With DS2 I was already diagnosed and on levothyroxine but by 9 weeks my TSH has gone up to 11. My medication wasn't upped until I saw the endocrinologist at 17 weeks. DS2 is now 6 and a bright kid (but I remember worrying about the IQ thing).
Do you know what your T4 level is? If your T4 is still within normal range then baby will be getting thyroxine.

Good to hear about your son @sacrecoeur0712. Idk what my T4 levels are, they didn't test for that (blood tests were actually done because I've been having heart palpitations - which I understand is a symptom of too much thyroid ). Going to push for more blood tests hopefully on the day tomorrow as I really want to know wher I stand and also to start taking meds asap

@Spideryplant ask the GP if they did check your T4 (thyroxine) level - it's usually tested alongside TSH. I know whenever I'm tested my GP always looks at both numbers as an indicator. Good luck.

Thanks @sacrecoeur0712. Saw the doctor this morning and she had taken my T4 which was 10.6 so just within reference range. Had more bloods taken today. She wouldn't give me any drugs until I've seen the consultant (which won't happen till I've registered with maternity services - doing this today) which is incredibly frustrating given the effects of a deficiency in very early pregnancy . I've now booked in to see a private endocrinologist on Monday which still seems like a very long time away..

OP, NICE guidelines say you should be referred to a consultant endo if pregnant or TTC with thyroid issues.

If your GP is being an arse, get another GP. There’s a book on amazon called “Your healthy pregnancy with thyroid disease”. It’s American but you might find it useful.

Also, don’t worry too much about the IQ thing (I know, easier said than done). Your TSH is only slightly over reference and many people have healthy pregnancies without even knowing they have a thyroid issue. You can do this.

@Spideryplant I believe your T4 result is fine for 1st trimester - see attached pic for ranges in pregnancy. I think your private endo will put you on a low dose of levothyroxine because of your TSH but try not to panic before then, I know it's easier said than done.

It's my understanding that pregnant women with hypothyroidism should be referred to an endo too, but in my current pregnancy I've been told I'll only be referred if my levels are out of normal range. I've had to push hard to get regular tests too. In my experience GP's have a limited understanding of managing thyroid disease in pregnancy and mine doesn't even seem familiar with the NICE guidelines. It's very frustrating.

Thanks both.

I'll have a look at that book LividLaughLove.

To be fair to the GP she wasn't saying that I shouldn't see an endo, just that the way to do it would be through maternity services, and she did write me a referral letter for the private one when I asked.

I've done quite a bit more reading. All the evidence seems to show that treatment in 2nd trimester or after does nothing to help which is not surprising if the fetus starts making its own thyroxine at about 12 weeks anyway. There's just no evidence at all re treatment in the 1st trimester. No one has done the studies

Hi I’m just wondering what the outcome was? I’m in the same boat TSH 2.5 & really worried 😟

I wouldnt panic too much Irish. I'm 9 weeks and mine is 4.5. I had to fight to get my meds upgraded to bring it down a bit but it will all be fine 👍

Hi @Spideryplant.

I am hypothyroid, on thyroxine. I have had 4 pregnancies, 2 children, currently pregnant with one and one ended in miscarriage but in all of them, they have had to up the dosage towards the end of the first trimester because my TSH was higher than the reference ranges, pregnancy messes with your hormones. My two boys are fine, developed as normal and they will have been exposed to too much TSH in the first trimester. I certainly don't think my miscarriage was caused by hypothyroidism.

Its great they have caught it now, they will be straight onto treating it I imagine.

Thank you for your reply. The lady in the Early Pregnancy Unit said the level is fine but i know from my own research ideally it needs to be lower. I suffer with anxiety anyway & I’ve had a MM & ectopic since last August so I’m extremely nervous 😟