Confused about TSH advice

[WhatTheFudge0]

I'm really confused about whether or not I need any treatment for my TSH levels.

I'm almost 6w pregnant as result of a FET abroad. My TSH levels are 2.9 iu/L and my clinic have advised me to see my gp about this as they say the levels should be less than 2.5 in first trimester.
I do not otherwise suffer from a thyroid problem.

My gp seems to think my levels are normal and was very dismissive of my fertility clinic's advice.

I've read a few threads on here and most people in similar position seem to have had medication prescribed but I'm not sure if that's because they were already on medication for thyroid issues.

Has anyone experienced anything similar? Should I just see someone privately?
Reading up on the consequences of untreated levels of TSH just scare me senseless. It's all causing me so much anxiety.

I have thyroid issues and am already on medication but they do like to see a tsh of below 2.5 in the first trimester. When I was pregnant last time I spoke to gp about upping my meds as my tsh was 2.8 he spoke to a endocrinologist as he wasn't sure and they confirmed under 2.5. Could you speak to another gp at your practice? I'm almost sure it's in the nice guidelines you could quote that at them. There are lots of private gps about which I don't think are too expensive if you can't get anywhere with your normal gp. It's a very grey area I have found some drs know about it and some just don't know anything especially when it relates to pregnancy

I had a similar issue. I found out my TSH levels were marginally high (5.6) while trying to conceive even though it was causing me no real issue and I was adamant to find out why/fix it so I went private. NHS GPs do not seem to be very clued up on thyroids and pregnancy. My private endocrinologist was emphatic about my TSH being under 2 in the first trimester to reduce the risk of miscarriage and told me to call him immediately once I conceived. He explained that as the foetus cannot produce its own T4, it is reliant on you for yours so it puts more pressure on your thyroid, and so you want your thyroid to have “optimal” TSH levels during the first trimester. My GPs reaction was quite literally “there is no evidence of TSH levels having any impact on miscarriage” which I found so frustrating. My endo told me that is not an unusual reaction, because GPs just don’t have enough expertise in it. I would suggest you get yourself to a private endocrinologist. Very low dosage levothyroxine would likely fix it quickly.

Thank you both for your reply.

Did your TSH levels go back to normal after birth @SezP ?

Still pregnant! Good luck with it all. You are generally in a good position anyway, so I would not worry too much.

I think your fertility clinic is being very cautious to suggest you need to act on that - anything under 4 (and over 0.5) is ok, so with a reading like that I really don't think you need to worry too much.

Can your GP organise blood tests for you to have a second read taken in 3 or so weeks? With thyroid function, the direction of travel is what's really important. He or she doesn't need to refer you to a endocrinology department to arrange tests. It will help you know if things are getting worse or if they're broadly stable. Your TSH lags behind T3 and T4 - ie if there's a problem, it will show up in the latter two earlier than in your TSH level. So keep an eye on those! And ask your GP if the blood test can cover those too.

Aw good luck with the rest of your pregnancy!

Thank you@Noodlesoup123 - that's really helpful. I'll ask for another blood test to check all three in a couple of weeks.

I'm thinking this difference in guidelines is from different countries? Or nhs v private (where they over investigate)?

In my experience the difference is between NHS and private fertility clinics specifically. Fertility clinics seem to like your TSH levels to be under 2 in order to improve chances of getting pregnant (or ensure an under active thyroid isn't going to get in the way of conception). NHS is inevitably focused on the clinically significant cases (over 4 or almost none).
^
You've obviously cleared the conception hurdle! However, I understand that typically everyone's thyroid slows down over the course of pregnancy - particularly from mid way through. So worth keeping an eye on (though your midwives can maybe help with that in the longer run?).^
^
Honestly, I think half the issue is that thyroid function is so horribly complicated that fertility clinics want general rules they can stick to! I've had a thyroid disease for years (overactive) and I barely understand it at all.^