Underactive thyroid and pregnancy

[cumbria81]

I was diagnosd with an underactive thyroid last year and have been taking thyroxine. I have never had any of the usual symptoms (I don't have a weight problem and rarely feel tired) so the diagnosis was a bit of a surprise.

However, I am now thinking about ttc and know that hypothyroidism can cause problems in pregnancy. I've been doing some googling (always dangerous!) and it's quite scary - miscarriage, birth defects etc.

Has anyone with an underactive thyroid been pregnant and what were your experiences?

many thanks!

Thanks all, for the advice. I'll go back and talk to another GP.

Hello, sorry for ressurecting an old thread but I need some advice. I'm in my 12 week today. Been on Thyroxine for 15 years and for the last 5-6 my dose has been 50mcg.

I found out I was pregnant on wk5 and went to the GP on wk7. He mumbled something about thyroid but not enough to get me to do blood tests. Had some blood tests at my MW booking in appointment (at wk10) and they asked loads of thyroid questions then - but I haven't heard anything since. And no-one has mentioned anything about upping my dose.

We had a scan at 10 weeks as well and it all seemed fine in terms of growth and heartbeat. But I'm really really worried now because my glands are doing funny things and I still haven't heard anything about my thyroxine dose from the blood tests and all I hear is "as soon as you are pregnant, the dose has to go up by 50mcg". That's double my dose! Do I just self-medicate and go for two pills a day?

I can't sleep for worrying about it. Does anyone have any advice please?

Have you had your TSH tested? What was the result? You should be being monitored by regular blood tests during your pregnancy. My consultant has said to keep my TSH below 1.5 while I'm pregnancy. So far, that has meant me going up from 125mcg to 150mcg.

If your GP and midwife aren't being helpful then you need to make a fuss. You need your TSH (and possibly T3 and T4) checked at least every trimester. You then need to follow up and get the results. Make a nuisance of yourself!

print this out go back to your GP/midwife and demand treatment
you may only need a 25 mcg increase

At diagnosis of pregnancy, immediately increase the levothyroxine dose and check TSH and FT4 levels while waiting for referral to a specialist:

* The dose should be increased usually by adding at least 25?50 micrograms levothyroxine; the size of the initial increase in dose will depend on the dose the woman is already taking and the TSH and FT4 concentrations. A 30?50% increase in dosage may be required. If there is any uncertainty about what dose to prescribe, seek immediate specialist advice so that there is no delay in the woman receiving an adequate dose of levothyroxine.
* Check TSH and FT4 levels every 4 weeks until stabilized, aiming for a TSH concentration in the low-normal range (0.4?2.0 mU/L) and an FT4 concentration in the upper reference range.

Thanks for your reply!

I had bloods taken at my booking-in appointment (Monday before last) and they said they'd test my TSH then. Haven't had the results from that yet. But as I'm in week 12 now and that was the only blood test I've had so far, I'm panicking. I don't even know who to call as the tests were done at the hospital and I still haven't met the midwife who will be looking after me. I've got an appointment with the Obstetrician at week 16, presumably because of the thyroid but again, no contact.

Right.I'd better spring into action!

Nice to see so many of us with thyroid probs who have not had any issues with conceiving. I was always really worried it would be hard to conceive, have been on thyroxine since I was 22 and am now 36. But as long as your thyroid is 'normal' you should be fine. It took me 3 months of not using contraception and not really paying much attention to 'fertile days! That's despite having a cycle that can vary between 28 days and 45 but is usually around 32-35.

11.2 weeks so far, scan on Monday. So I was worried that I couldn't conceive and am now just worried about scan! But conception wasn't a problem.

Good luck! Make sure you know the discrepancy between what your doc might see as 'normal' levels and what any informed thyroid patient sees as normal. Charity Thyroid UK is good for info on this.

Fascinating thread, I wonder if anyone could tell me what they think of my results - I'm concerned.

History:
Lost my first baby at 20 weeks in October. TSH measured as part of the many bloods on the day I delivered her, it was 6.7. GP insisted that this was only a touch out of the normal range which they quoted as up to 5.5 so they wouldn't medicate. As I was no longer pregnant I let it go, too much else going on right then.

A month after the pregnancy loss they tested again and found:
TSH 2.3, FT4 16.1, FT3 5.1

I then conceived got a BFP in early December so bloods re done at 5-6 weeks pregnant: TSH 3.6

Still no treatment.

I'm under consultant care due to my loss last year and saw him last week for 16 week scan and he was concerned that my thyroid hadn't been checked again. So they tested it: TSH 4.6, FT4 13.9

I got the results today from the GP receptionist who said that the doctor had noted "normal, no action needed" next to the results. I don't agree so am going to try and get an appointment tomorrow.

Is it right that I quote the TSH 0.4-2.0, and FT4 16+ as the pregnancy ranges? Given that they've never really diagnosed me properly, just fobbed me off three times? Would I be sensible to request a trial of thyroxine?

I'm really scared to see my TSH levels climbing and my FT4 falling. The levels are getting close to what they were when I lost my first baby. She was 20 weeks and I'm 17+4 now. Yet they don't seem at all bothered!

Thanks

I recommend you ask to see an endocrinologist asap
In preg tsh should ideally be under 2
Good luck

spilttheteaagain, I'm really sorry to hear about the loss of your first baby. Have you ever been treated for thyroid or did these problem show up during your pregnancy for the first time?

Thanks mpops, the first thyroid test I ever had was on the day I delivered her so it was completely undetected/ untreated throughout the pregnancy. Given that my results were all lovely and normal between pregnancies I'm half inclined to think it's pregnancy that causes the hypo type readings. Also they've tested me for the anti thyroid antibodies and I got a borderline result, so lots of being borderline, nothing definitive!

I will try and see a GP tomorrow and I will not be fobbed off! If I'm getting nowhere then as Eldon says I'll ask for a referral or phone my obstetric consultant I guess.

Good luck at the doctor's. Don't go anywhere until they refer you to an endocrinologist, like Eldon said. I talked to my GP about my concerns today and he said that most GPs have no idea how to treat thyroid during pregnancy. He admitted that to me openly, which I really appreciated. They just follow guidelines for dosage when you are not pregnant but when things need adjusting, they have no specialist training to deal with that. So get yourself seen as soon as possible. Let us know how it goes.

split, I'm so sorry to hear about your loss. I hope it goes well with the GP tomorrow. I know that a few mnetters have gone privately to an endocrinologist to get things moving faster. Is that something you could do?

mpops, I think it is dreadful that your GP is being so rubbish about this. Ok, he isn't specially trained to deal with it but he should know where to get the information for a patient who needs it. After all, it is easily enough found on the internet! I hope you get your results soon and they put your mind at ease.

Just got a call from the GP saying my TSH is at 2.2. He said that was ok at 11 weeks. Is it? He's increasing my dose from 50 to 75mcg.

Hello there I have had a underactive thyriod since I was 16 im now 34. I can say that its not a problem so long as you get checked regular. Also I would advise if you feel tired, slow thinking maybe even cold hands/feet there are many more on the list as well. Its worth just going to the docs and asking for an extra test. They should not turn you away. Im now 37 weeks pregnant my thyroid was a little low (on 150mg)got to see the consultant at week 39. I had my DS 5 yrs ago and had no problems. This pregnancy has not been a problem either until now where the level is a little low. Getting both T3 and T4 functions tested next week. Dont let it put you off having a baby it seems to be a common problem having a underactive thyroid I know of 4 people who have it besides me. Just get your thyroid maintained and at a good level and you should be fine.

Sorry one more thing to add if you have to take Iron suppliments if you become pregnant take them in the evening as the iron blocks the thyroxine. So take thyroxine AM and Iron PM.

Just wanted to say, thank you for the advice yesterday. I saw the GP today and he ummed and ahhed for a bit and the upshot is he has given me a prescription for 25mg for the next two weeks and he will be phoning my antenatal consultant on Monday to get his opinion before issuing a longer prescription. He will also arrange a referral to an endocrine specialist but wanted to discuss with my AN consultant who would be best (half way between two major hospitals, my GP knows the specialist at the hospital my consultant is not at, but wondered whether better to get all care done at the same place!)

So I think that's a fairly sensible plan for now.

mpops that's a slightly odd message from your GP - it's fine, but up your dose? I suspect what he means is it's nothing to worry about as it's not ridiculously high and the slight extra dose should keep everything under control.

Thanks for the tip about iron scruffy

Your very welcome. Get that thyroid sorted and the dose right and you should be on track for getting ready for a baby! I was told once your on your correct dose and its stable you are just like every other healthy person by one GP. Im not sure he was right still have days where you feel like poo but dont know if thats the thyroid or just an off day?! Good luck listen to your body if in doubt see GP to get it checked.

This thread is amazing! I have a question. After being diagnosed with hypothyroid a year and a half ago, gaining 4 stone and having finally stabliting this past year on 100 mcg of levo (and losing most the weight gained) my DH would like to TTC this summer.

My GP is awful (say the least) after there temp GP helping and supporting me through my thyroid problems she is now gone and without fail my "old and registered" GP gives me the wrong dose every month and refuses blood tests under 6 months.

Little nervous to go and ask for a referral or just tell her I am TTC. I have thought about going with the info from that link.. How should I approach this with my GP and since I am already on 100mcg how far can I go up.

collen - can you see a different GP? or change surgery?

Not sure what link you were referring to in your post, but here's one to some info from the NHS on what should happen when TTC & pg

I just thought I'd add in my experience of hypothyroidism and pregnancy. I'm currently 33 weeks with DC3 and have conceived all three children in the first month of trying.

I have not had any problems in any of my pregnancies and my dose of thyroxine (100mcg) has stayed the same throughout the full 6 years from conception of first through to fairly imminent birth of third.

Maybe I'm just lucky but I thought it would cheer anyone who suffers from hypothyroidism and is hoping to conceive a baby!

Hi Bessie- my gp is the only female at the surgery, they tend to give her all female clients but tbh sometimes I think she could really care less. Nothing but bad experiences with her. Might try the other GPs but they are all men (small village, one surgery). I guess a lot of people go to men GPs.

Hello, I don't have as much experience as some ladies on the thread but I was diagnosed last year with a slight/subclinical under active thyroid, TSH was around 3.2 so the GP referred me an endo because we had planned to ttc in the next few months, he decided to wait for the time being as my TSH went down spontaneously (no other thyroid related issues antibodies etc all fine) but then I got pregnant unexpectedly so he put me on the lowest does 25mg just in case and my TSH was 1.1. I had a MMC but it had nothing to do with my thyroid and now am pregnant again - he upped my dose to 25/50 on alternate days and my TSH was at 1.4, the mw at my hospital also referred me to the endo clinic and I have an appt next week to check my levels etc.
I guess I don't have a serious problem - my endo is being cautious and really keeping on the minimum dose as long as all is OK but I have had no problems conceiving (first or second cycle and bam :)

I read that the main danger is in the first 12 weeks as the baby's thyroid is not yet developed and he relies completely on the mother's thyroid for all hormone levels after that it's not as serious as he/she starts producing their own but obviously you should be monitored throughout your pregnancy.

If I were you try to get a referral or go see a reproductive endo as it can't hurt and better sort out these things before you get pregnant. From my personal experience I noticed that a lot of drs in the UK are more towards waiting to see rather than pre-planning, I decided not to put added pressure on myself (worrying is part of pregnancy anyway why add to it ;) and did all the test before ttc - toxo - have had cats for years and guess what not immune to it so have to be extra careful now, thyroid, cmv, immunity to chicken pox & rubella (important as I work with young children and ooops! turned out I wasn't immune so had to get vaccinated)

Good luck!

so pleased to find this thread.. i was diagnosed with hashimotos disease (underactive) after having my first child.. was underweight before pregnancy but put on 3 stone and was miserable and utterly exhausted. my thyroid levels have been stable for about 7 months now and we are wanting to try for another baby but i am so scared. I had a miscarriage before my daughter and haven't had a period for 19months, still struggling to shift the weight that i put on with first pregnancy and estrogen levels really high. doctor says if i lose weight it will help greatly.. thats not the part that worries me, its when i do get pregnant.. scared of having another miscarriage and also how to get through pregnancy knowing about thyroid problem, with my daughter had horrific pregnancy which ended being hospitalised then caesarean, have app. with ob next week. anybody else had prblems with delivery with underactive thyroid? is it safer to have caeasarean or vbac? help!!!!

Hi mummybearroque,

Sorry to hear about your dreadful experiences.

There are lots of internet resources about TTC and pregnancy with an underactive thyroid.

When TTC with positive thyroid antibodies they can cause "immune issues" so you might need to take steroids and have other immune treatments.

Here's a list of webpages about TTC with an underactive thyorid and monitoring TSH levels in pregnancy:

www.fertilityfriends.co.uk/forum/index.php?topic=256702.0

www.bellaonline.com/articles/art21171.asp

www.endo-society.org/guidelines/final/upload/Clinical-Guideline-Management-of-Thyroid-Dysfunction-during-Pregnancy-Postpartum.pdf

thischangedmypractice.com/2011/03/14/management-of-maternal-thyroid-disease-in-pregnancy/

www.cks.nhs.uk/hypothyroidism/management/scenario_preconception_or_pregnant/preexisting_overt_hypothyroidism

There's also another recent thread on Mumsnet about hypothyroidism in pregnancy:

www.mumsnet.com/Talk/pregnancy/1163901-Underactive-thyroid

Good luck!

Hi confused 2011! thank you so much for webpages, you are a godsend!!
didnt realise how much information was available on the internet!!!