Hypothyroidism in pregnancy- does anybody on MN know about the effect on foetus?

[duchesse]

Does anybody know anything about high TSH/low T4 levels in pregnancy?

I am about 11 weeks pregnant, and due to a history of borderline hypothyroid occasionally tipping over into clinical hypo, requested a thyroid test at my booking in visit two weeks ago. I am not being treated for the low thyroid, as the doctors decided that it was not bad enough to treat.

The results are:
TSH 4.39
T4 14.4

The TSH is high (the endocrinologist I saw suggested that anything over 2 was potentially harmful to the baby's cognotive development) but the T4 is within normal limits.

So here is my question:

Does anybody know if it the higher TSH or the low T4 that can cause the problems with the foetus?

Also, I thought I would mention a very interesting paper I just read about the link between morning sickness and thyroid levels. The suggestion was that the more T4, the higher the likelihood of sickness. Which would explain why I've had hardly any sickness in this pregnancy so far.

I would be very thankful for anybody's experiences of this.

TSH is the hormone that tells your thyroid to produce more thyroxine
The high TSH won't cause the issue - that is just flagging up that your body wants more thyroxine (T3 and T4)

did they check your T3?

in your shoes I would want treatment asap or at least an urgent referral to an endo

I am hypo and in pg need to take more thyroxine

Does your endocrinologist plan to monitor you very regularly during pregnancy? Is it an NHS endo?

My TSH was a fraction higher than yours and they put me on thyroxine - and I'm not pregnant. If I was pregnant, I'd definitely want monitoring and prob to be on thyroxine.

Thank you Eldon and Korma. I seem to be stuck in apathy hell. The GPs here seem to know very little about the effects of low thyroid on the developing foetus, and the endocrinologist I saw 2 years ago in one breath said I ought not to have a TSH above 2 and in the next said there were no reasons to treat.

The reason I am so worried is that I had a miscarriage at 13 weeks 2 and a bit years ago, and it appeared on the scan that the foetus was lacking a brain. Might just be random, but might on the other hand be caused by the low thyroid. I have asked the question, but no medical staff appear to be interested or know anything about it. It is extremely frustrating.

Doozie- the cutoff is 4.5 I think. Every time they test, it's around that figure. It was once a little over, but they usually seem very satisfied with leaving me wavering just within normal limits. I on the other hand feel like sh1t sometimes.

And no, they basically washed their hands of me the last time I was tested and found to be just below clinical. It's as though they need fighting all the time and it's very wearying.

Very low thyroid can cause mc

Not sure what the risks are if you are more borderline but get a referral anyway

In the US they treat for TSH under 3

My understanding is that untreated hypothyroidism in pregnancy is potentially dangerous, can lead to miscarriage, premature birth and also lower IQ in baby.

Now you are clearly borderline at the mo, so probably not too bad. But pregnancy depletes your thyroxine (I think) so you need very regular blood tests to make sure you don't dip into hypo.

I was TTCing and my levels were just slightly over normal. They told me I had to get my TSH below 2 before getting pregnant.

Would you like me to ask my endo what he thinks? He's v good.

In the states, endos believe that a TSH over 3 is hypo. They are more conservative than here.

Oh, Doozle, that would be very sweet of you. My lovely midwife is putting herself on a crash course in thyroid knowledge before she sees me next. The GPs are just useless on stuff like this, and it takes months to be referred to the endocrinologist. She advised me to ask the obstetrician when I see them, but to my mind it might be too late by then.

Can the MW get you an appt with the Obs sooner?

I think she probably would, but she doesn't seem to understand the importance of the thyroid levels on the foetus. She showed me the levels on the screen earlier and I talked her through them, but I don't think it's something she's ever come across tbh.

Hi duchesse - firstly many congrats on your pregnancy CKS libraries (on line) give clinicians like G.P's guidance on how to treat conditions such as hypothyroidism in pregnancy. Google cks. There are scenarios for clinical and subclinical hypothyroidism. I took the info along to my G.P. I got treated for subclinical as I was ttc. Started off on 75mcg but it crept up to 125. In pregnancy it is always increased by 25mcg as soon as I discover I'm pregnant. Ideally your tsh should be below 2.

Your mw could have a chat with an obs endo and ask for guidance. That would be quicker than waiting for an appt.

Congratulations...hope this helps, I was in same position and hubby is an Endocrinologist so..
Aim for a TSH of around 1 (DH says he would be happy with under 2 so around 1 is a good aiming point!!!). You will need to get your levels checked regularly, you also need a Plan, written by your endo and agreed by GP otherwise each time you need to change your dose to get to around 1, you will have to go through the whole explanation/ discussion/ arguement etc with GP.
DH says most (he would be suprised if not all) clinics would see you as an urgent, so may be worth discussing with your Gp / mw/ consultant sec to get you around the choose and book system that might not see you as quickly.
Also if you cannot see an endo quickly DH says that most of the hosps run a joint clinic where you can see the consultant who will take you through your pregnancy AND a medical consultant together and they should be able to manage you well enough. Your mw should be able to sort this.
DH says dont worry, but do try to get sorted ASAP

Good Luck

Thank you so much Stuck- I just can't believe how laid back they are all being about it. I thought maybe I was overreacting, but I just feel like a problem patient every time I try to raise the issue with them.

Oh, and thank you too Ladylush. I can always feel when my thyroid is misbehaving as I get a lump in my throat. This lump appears as soon as I start to feel hypo, and has done for the whole time the thyroid's been playing up, and stops again as soon as I start to feel better. The endo I saw decided it was "just a gland".

Don't know if this helps at all, but I have a friend who is hypothyroid, and has ahd 2 healthy babies. She gets extra monitoring while pregnant, but otherwise seems to carry on as normal (although I think she was on treatment)

stuck- would your husband think my levels were worth bypassing the system over? My GPs just seem to take the not abnormal (or whatever it says) label next to the results at face value.

Have only skimmed the other posts, however here in Australia they automatically test thyroid function in pregnancy (no one even mentioned it to me in the UK). I was found to be subclinically hypo (sorry don't know levels) and automatically prescribed thyroxine...

duchesse I got the same thing just before I started taking thyroxine. In fact it was so bad that I went to A+E as I felt my neck was constricting. It went after a month on treatment. If you print the cks stuff you could highlight the relevant bits (treatment and monitoring in pregnancy) and tell (not ask!) them to phone an endocrinologist to advise on treatment until you can be seen. Sorry you might have to be a bit bolshy but it's your baby! Good luck - much ignorance int this area.

Your levels are defo worth treating especially as you are pregnant. Even women ttc should be treated if their tsh is higher than 2.

Stuck- do you by any chance happen to know at which stage of pregnancy the low levels pose the most threat? Is it worse early on, or can normalising the levels at any point in the pregnancy improve the outcome for the baby. Am still having trouble believing that this pregnancy may actually progress (it took a long time to get to this stage) and am slightly in shock to have reached 11 weeks seemingly without any problems.

MW is very ignorant. Your TSH should be between 0 and 2 for optimum health.

With a result like this your GP should refer you to a hospital ante-natal clinic and they should do more regular blood tests and check for thyroid-related antibodies. The risk is worst in the first three months because after that, the baby's own thyroid gland will do the job. It takes a couple of weeks for the medication to kick in.

I suggest an immediate GP visit and a demand for 25 mg of levothyroxine (a very low dose indeed) plus the ante-natal clinic referral.

I am on my 5th pregnancy and this will hopefully be my third child. I have had thyroid problems for a very long time and this is the first pregnancy where I am being referred to an endocrinologist. Previously they have just checked my levels every 3 months and tweaked my thyroxine. New gp at my surgery has just booked me in to have levels checked this week, she was quite concerned that I had never seen an endo especially during my previous pregnancies!

thanks silently. Have you had this low thyroid in all the other pregnancies? And did your babies have any problems at birth, may I ask? And at what stage did you lose the two that didn't make it? Sorry to ask so many questions, but I am very anxious about this. Feel free to ignore me!