Hypothyroidism in early pregnancy

[Triangleflower]

Hi everyone

I was diagnosed with subclinical hypothyroidism earlier this year, my TSH was only about 5 but based on endocrinologist advice I went on levothyroxine to bring it down to the ideal preconception level of 1-2. It came down slowly and then end of September blood test came back as undetectably low!

However I found out I was pregnant about a week after that blood test (6th Nov), I had another blood test on 14th Nov and TSH has jumped to 4.34 which I only found out yesterday. They’ve now adjusted my dose back up again and I’m really hoping it comes down quickly as I know I’m at increased risk of miscarriage.

Has anyone else been hypothyroid in early pregnancy and how did it work out? I know I could have a miscarriage with or without the hypothyroidism but am fairly worried about it!

Thanks!

I don’t have a huge amount of advice but I’m in the exact same situation, just a bit ahead of you. After TTC for a while, I realised that the subclinical hypothyroidism I’ve had for 20 years might be a problem… after blood test showing TSH of 6 I went on levothyroxine and got pregnant the first full cycle I was taking it!

I’m now 9 weeks, and theyre doing blood tests every 4 weeks to make sure my TSH is okay. They’ve upped my dosage each blood test so far, and the lowest my TSH has been is 3 - I think it keeps steadily rising due to early pregnancy and they’re not upping the dosage enough. The GP does keep saying that levothyroxine will work pretty much instantly, it’s just a matter of getting the dosage right. So far all okay, had a private scan at 7 weeks and saw baby’s heartbeat - so hoping that even though my TSH is still a little high the levothyroxine is doing its job!

Thanks for your reply @Suth3rland , congratulations on your pregnancy and glad it seems to be progressing well! What dosage are you on and how much are they increasing it each time, out of interest?

Helpful to hear from someone else in same situation!

Thank you & congratulations to you too!! I started on 25, then 50 and now on 100 - got another blood test next week so hoping it’s brought it down to where it should be 🤞 I’m really reassured that they’re taking it seriously and checking it so often! Are they doing the same monthly blood tests for you, and what dosage are you on?

Will cross fingers for you! I started on 50, then after a few months 50/75 alternate days, then a few months later it had gone to 0.97 but they thought to keep amount the same, then undetectable level so back to 50, and now they say day 1 50, day 2 50, day 3 75. I’ve asked for dosage change to be checked with endocrinology as that’s what NICE guidance says for pregnancy. I didn’t have much confidence in the GP I spoke to and he didn’t seem to even know that the TSH reference range is lower for pregnancy…gahhhh!

I couldn’t see that it says in NICE guidance that it should be tested every 4 weeks specifically but just “more regularly”. I am seeing my usual GP week after next and the first midwife appointment on 14th Dec so hoping one of them will agree to testing it every 4 weeks. Just hope I’ve caught it early enough not to risk miscarriage much more!

I had pretty much the exact same numbers as you. Very low TSH (0.1ish) pre-pregnancy. Shot back up to 4. Increased dose from 25 to 75, had monthly tests and thyroid levels were optimal all pregnancy. Writing this while i breastfeed my healthy boy.

The fact you already know you have a thyroid problem is good. You can keep and eye on things and adjust as needed. For many people it goes untreated and only gets discovered after losses.

Thank you, helpful to read from someone else too! Congratulations on your baby! I’m wondering if the increase they’ve put me on is too small to make a significant reduction to be honest

I've had hypothyroidism my whole adult life so before pregnancy, I have 3 children and I've also had one miscarriage. I would try not to worry too much, try and get the TSH levels under control and make sure the dosages are monitored during pregnancy (it wasn't every 4 weeks for me, maybe once every two or three months when I might be having bloods anyway). My levels have been slightly off in early pregnancy in all of them because pregnancy always increased my TSH, always had to up the dosage but I just adjusted it and all was fine. I also saw the consultant once at the 20 week scan each pregnancy. Beyond that it was never really mentioned. When I had my miscarriage, they didn't really suspect hypothyroidism to be the reason, it's just that 1 in 4 pregnancies end in loss and that has def been the case for me.

Thanks @seaduck this is reassuring, hopefully the numbers come down quickly were you under a consultant purely because of hypothyroidism? Or because your levels were higher?

I had subclinical hypothyroidism picked up through fertility testing and with my first pregnancy (which ended in a missed miscarriage) like you my thyroid jumped from 1.something to 5 by my 8 week bloods. There was no testing done so no way of knowing if this contributed to the loss.

I'm currently 37 weeks pregnant and have been taking medication for my entire pregnancy, they messed up my endocrinologist referral so I only got seen a few weeks ago but I've managed to keep my levels in the safe range throughout.

The endocrinologist said that levels should be checked every 4 weeks in the first half of pregnancy.

@Triangleflower Yeah, an endocrinologist- I think it's standard to see one so you should check if you will get referred when you have your booking/first scen.

Just to add, it didn't affect birth options at all, I was discharged again once they were satisfied with my levels.

Thanks for the info, sorry to hear about your miscarriage but congratulations on your current pregnancy I’m seeing GP week on Monday and then first maternity appointment on 12th so hopefully between them I’ll be able to get 4 weekly bloods.

Do they routinely check thyroid bloods at first midwife appointment even without thyroid issue history?

That’s good to know, thanks

Yeah your thyroid will be checked at your booking bloods and I'd raise your sub clinical issue too so you can make sure you don't get missed off!

Thank you, good to know the endo have come back to GP today as well and recommended I change to 75mcg daily so I’ll do that and hope it comes down quickly.