Hypothyroidism in Pregnancy

[meggles]

Morning - I have 'stable hypothyroidism'. Have been on medication for 15 years - the same dosage for 5+.

we're trying for our first child, and was wondering how early, and how often in pregnancy my TSH/T4/T3 levels will be tested. i don't want to go to the doc at 5-6 weeks pregnant, for him/her to turn around and ask me why I'm here.

also - i'm american and still learning about the NHS. do i even see a GP during pregnancy? do I see a GP for the first appointment 'to confirm the pregnancy'? can i just call up and make appointment for midwife directly?

also - looking on my surgery's website, it says that the midwife surgery is on wed. unfortunatly, i work away from home tuesday-thursday. i would almost never be able to make a wed appointment. any idea what alternative i would have?

sorry - for the loads of questions from a not yet (or probably not yet) pregnant person.

hi there I am also hypothyroid,stable, 3 years now. and am pregnant with 1st baby, 35+4 approx. you need to be tested in each trimester, first time should be around 8 weeks ideally, you can ask your GP or midwife or obstetrician if they don't automatically test you (I'm having a hospital-led pregnancy because of diabetes, so my Obs has given me a blood form for thyroid tests every 2 months so far & the results go straight to him rther than my GP), My obs put my dose up from 150mcg daily to 175mcg daily from the 1st trimester & hasn't had to raise it since. Your baby can't make its own thyroid hormones whilst inside you so its very important that your levels don't dip too much, so I always remind them when its been about 6 weeks from my last blood tests, I like to keep on top of them!!

as to the rest, it really varies depending on your pregnancy, health & the area you live in, but if it helps: I went to see my GP initially but he just confirmed that the pregnancy tests that they do are the same as the ones I had bought in the chemist so they didn't need to test me again! He gave me the referral and number of the community midwife, then that midwife sent for a hospital appointment whereapon they diagnosed me with diabetes and all my appointments have been at the hospital since, with the obstetrician and midwives on the surgical team there. your alternative to the GP midwife weds appointment would probably be a local community midwife centre, thats what I was offered initially, and as far as I know they're every day of the week...

good luck! (& by they way, in my opinion its best to be proactive with the health system in the UK, don't just sit back and expect that they will sort stuff out for you...)

Hi - I'm also hypothyroid and currently 18 weeks. I've had my thyroid function done at 11 weeks and I'm due to have it done again next week.

I've been referred to a specialist consultant via my GP as my thyroid is due to Hashimotos and I understand that this can sometimes cause the thyroid of a pregnant woman to go into overdrive after the birth or in the third trimester !!!

My advice is to go and see your GP as sooon as you find out your pregnant and voice your concerns - as with most of the NHS if you don't ask you don't get !

Brightonbleach - do you no if your baby will be tested with the heel prick test for thyroid deficiency and does having hypothyroidism increase the chance of your baby having a thyroid problem ? This is one question I can't seem to get a straight answer too !

morning. thanks for your advice. because you've been referred to a specialist consultant, does that mean that you have to give birth in a consultant led center?

as for tendency for children to have thyroid disorder. I'm not a doctor, but I can tell you my experience. thyroid conditions run in my family: great-grandfather, grandfather, mother all hyperactive. me & material cousin hypoactive. Me because of Hashimotos, my cousin unknown.

all these diseases have manifested during "changes" - me during puberty, cousin during incredibly stressful relationship, mother during 2nd pregnancy, etc.

because of my family's tendency - and because women are more likely to have thyroid conditions (at least hypo, not sure about hyper), my mother insisted on a thyroid tests for all her daughters every year (I'm one of 5 sisters, and we grew up in the US where seeing the pediatrician is an annual event) even if I had to pay privately, I would do the same for my future children. it's such an easy blood test, and such an easy treatment.

Firstly, congratulations! I'm currently 25weeks with my first and also hypothyroid. In case it's helpful the official NHS guidance for treating pregnant women with hypothyroidism is here

You should see your GP straight away so he or she can up your dose by 25mg and run a blood test. Blood tests should then be done for you once a trimester, and you will probably be offered consultant-led care. It's worth insisting you get given the numbers after each blood test - your TSH levels should be between 0.4 - 2.0.

Good luck and I hope all goes well

morning Meggles yes, it means I have to give birth in a consultant-led ward in hospital, I have 2 specialists (thyroid & diabetic) though, so being hypothyroid will have you being more closely-monitored but won't count you out of a midwife-led birth or even a home birth - as far as I know...

Under Hi have been told my baby will have the heel prick testing done on the ward, both for hypothyrdoism and diabetes, yes. I don't know if it increases the chances directly of him having the same condition; I only know that these particular conditions do tend to cluster in families (but they don't hit everyone in the family!) so he will have to be tested regularly. my family has both hypothyroid disease & diabetes (types I & II) - which are both endocrine disorders and often linked - running throughout - 2 set of grandparents and great grandparents & my aunt, several cousins & great aunts that I know of. more typically in women I might add, but not exclusively. Its less common & more complicated in children though, by quite a way, so I am hoping obviously that it will not rear its head in childhood of course!

blondie- thank you so much for that link. as soon as we confirm pregnancy, I'll go see the GP, and won't feel like i'm wasting her/his time.

Hello

Just joined this thread as I am TTC no.2 with hypothyroidism (think it might be Hashimoto's - it's due to antibodies in the bloodstream). I got it soon after having DD, and expected it and was having regular tests as my mum had long undiagnosed hypothyroidism.

The NHS link was really useful. I did ring my dr when we started TTC to see if there was anything I needed to do, she just said to be tested straight away, but it was interesting that they said to increase the dose as soon as pg is confirmed while waiting for tests. I'll make sure and print that out and take it when I eventually get pg and see the GP.

I have had hypothyroidism for over 11 years now and have had three babies in the last 6 years.

Much depends on your area (I had babies in 2 different areas) but you can expect more regular blood tests to monitor it, at least every trimester but it may even be every month, and also extra scans to check for growth (I had one at around 34 weeks).

In my first two pregnancies my thyroid remained stable and I did not increase my dose at all. However I did need an increase approx one year after my first child was born. In my last pregnancy my thyroid was more unstable and I needed to increase my does from 125-150, then again to 175mcg. This all happened by about 15-16 weeks which when I researched it was the most usual time for it to need increasing.

It was stable thereafter and I managed to arrange a homebirth after the final scan showed no expected problems. Just a shame I ended up being induced for very post dates! So although it may mean consultant care during the pregnancy, there is no reason it will mean a consultant birth (though I had to fight my case quite hard and thankfully had a good MW on my side too).

Best of luck!

Thanks for the advice - it's very reassuring to no that I'm not the only mum to be with an under active thyroid !

Good luck all and brightonbleach I'm sure your baby will be fine - my mum is hypothyroid and was when she had me but I didn't develop mine until I was 35 !!!

I have hashimoto's diagnosed after coming off the pill and TTC #1. TSH stabilied at 50mcg a day but quickly got pregnant, and TSH went up very quickly (by 8 weeks) to around 13..... and dose eventually upped to 150mcg. After the pregnancy dose settled on 100mcg, and in 2nd pregnancy moved straight up to 125mcg and was stable the whole way through. Have done the same this time (am 11 weeks) waiting for result of blood test. Hospital want me to have consultant care but I refused because the endo clinic takes hours but the compromise is that I have monthly blood tests at the GP. At 8 weeks TSH was 0.7 and T4 22.7 (T4 slightly too high) hence the further test at 10 weeks.

So, going back to your original questions:

1. If you are TTC best for tsh to be below 2 (although normally up to 4 is ok) was told by consultant fertility can be compromised otherwise, so go to GP now and get TSH checked.

1. As soon as you have a confirmed pregnancy go to GP - I made the mistake of not doing this last time (didn't go until 7 weeks) and ended up not being not being offered nuchal scan on NHS as "I was too late and they were fully booked".

1. You should be able to go to GP on whatever day you want.

1. Personally I would want a thyroid test done monthly during pregnancy at least until 6 months.