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!

Hi everyone,

I'm a doctor but thanks so much for all of the info you've given me with the links. I really knew nothing about what to do with my T4 dose and monitoring etc. My GP is totally unhelpful and wanted to know why I had asked him to up my dose - doh - because I'm pregnant - and then prescribed me a measly 28 days supply. Git. Also said he had no intention of referring me back to the endocrinologist I saw previously as he'd leave that entirely at the discretion of the obstetric team - but my local hospital doesn't even do booking appts till 12/40!

I'm totally paranoid about risk of miscarriage (am 5+1 weeks today) and seriously thinking of taking some selenium as my TPO was positive 2 yrs ago. Think I'll take matters into my own hands and speak with my old endocrinologist next week and see what he suggests.

Sorry for the rant, ladies but really glad to know it's not just me who's going through this mental torture.

I had a miscarriage at 10 weeks (a few days ago). All guidance says don't blame yourself and I know I am just unlucky 1 in 5 (or 4 - depends what you read). But I looked into reasons for miscarriage on line anyway because obviously want to be more successful next time we ttc. Came across link to hormones and thought hmm I wonder about my thyroid problem so researched further.

I had no idea that hypothyroidism could affect pregnancy and TSH etc needed to be monitored. Went to doc at 5 weeks preg. and nothing mentioned at all. Booking appt came through the post - appts at 12 weeks and scan at 14. Of course it could have had nothing to do with the miscarriage but my husband and I are still cross that this was missed.

We want to make sure we get this right this time. I have always been so trusting of doctors. Obviously the GP is the gateway to the experts but I do feel this should have been picked up. Any advice?? Read all the messages above. I really don't feel I want to trust the doc to treat me alone next time. Should I request endo or....not sure???

Daisy32, just catching up with old threads as I have been away. So sorry to hear about your MC, and don't blame yourself, as first trimester miscarriages are rarely something we can prevent. For the future you could ask your GP to send you to see an endocrinologist who specialises in thyroid and pregnancy, or a fertility specialist who specialises in immune issues, as you'll probably be advised to take steroids and clexane injections (not too painful!) as well as having your TSH levels monitored while trying to conceive and during the pregnancy. It's more about making sure the baby develops properly, particularly the brain, rather than preventing early miscarriages.

Love your idea about GPs being "gateways to the experts". I think the phrase is gateKEEPERS, ie they are there to STOP you being seen by specialists unless they think you need to be, whereas in Europe the public can usually make appointments directly with specialists without seeing their GP first.

fifitrixabelle I had a similar problem to you trying to see an endocrinologist. Finally managed it on the NHS at 14 weeks!!! Only to be told by the endocrinologist that the crucial time for T4 management is the first trimester. Luckily I was able to get TSH/T4 tests done by my GP and midwife and got my TSH level down below 2.0 early on in the pregnancy. Definitely agree you should speak to your old endocrinologist next week. Should you also be on steroids and clexane due to your previous positive TPO result?

Just want to thank everyone for sharing your experiences. I booked an appointment with my "could care less" GP to discuss my thyroid and TTC. This thread has given me some great printable info to take with me.

Hi Ladies, I have kind of scrambled into this thread whilst looking for answers, I have been ttc for the past 2 years and last year had a misc at 5 weeks so doc was looking into it and sent me for bloods, turns out I have hypothyroidism and have for the past 9 days been on levothyroxine 25 mcg,
My last af was on 4th June (sorry tmi) and haven't had one since, would it be the meds making it disappear? I did a pg test and it said neg.
My doc was a bit vague about meds and what to expect, I don't know whether I should continue ttc or give up for a while and let things sort themselves out.

I feel better for typing all of that, I haven't discussed any of this with my family only my hubby and he's knows less than me! :-)

I don't know the answer to your question but it is not good enough for your GP to be vague with answers, is there another GP at the practice you can ask to see?

I myself am hypothyroid and currently 35 weeks with dc2. I take a dose of 175mcg of levothyroxine which has been increased to 200mcg whilst pregnant.

I think if you have been ttc for 2 years and suffered a miscarriage then your GP needs to be doing tests for both you and your dh to see if there is any underlying problem although I know it can just take a long time for some people to conceive.

Miscarriage is heartbreaking (I had one myself last year at 9 weeks), but it shows you have been able to get pregnant which in itself is a good sign. I have been told by GP and consultant that having hypothyroidism shouldn't prevent you getting pregnant and continuing with a healthy pregnancy especially if you are being monitored throughout for changes in your levels. I hope you get the answers to your question soon and good luck for the future.

Sorry for the long ramble.

my thyroid levels all over the place in first trimester was overactive then went to underactive staying on the 200 dose the doctor aske if i had actually stopped taking it as was so low I hadnt and the only thing I was doing was taking prenatal vitamin at same time the iron can cancel it out. So the tiredntess I felt in first trimester I put down to pregnancy was actually low thyroixine levels showed up on blood test as had none in body i take the prenatal at night thyoxine in morning and fine now and its ok. and no problem getting pregnant happened first month of tryingxx

Thanks for this thread, I am ttc but I was slightly overdosed since the spring, so my new GP has lowered the dosage. Sounds like I need to check the actual figures from her - I hate the idea that piddling around with my thyroxine might affect my chances of conceiving, or maintaining pregnancy :(

pregnant any idea how far apart your thyroxine & multivit need to be? I take my thyroxine at around 645 when I wake up & my multivit with breakfast at 8. I did try taking my multivit later in the day, but I just kept forgetting!

tiger defo get the actual figures from your Dr. If you search through this thread you should find a link to some NHS guidance about TTC & what your levels should be - it seems very few Drs are aware of it!

Thornelius and Tigers, definitely get your full results on a printout from your GP and insist to be referred to an endocrinologist. GPs often don't know much about thyroid dysfunction and tend to rely on the internet, guesswork and general guidance. TTC aside, it's really important to get the dosage right and to be monitored properly until you find out what works for you. I was diagnosed 18 years ago and I'm now 29 weeks pregnant, under consultant care. It's going well but they're keeping a close eye on it.

Also, if you're taking iron/pregnancy tablets and thyroxine, make sure you take them at totally different times of the day. I take my thyroxine in the morning and my pregnancy meds in the evening with my dinner, so the iron doesn't affect the thyroxine being absorbed.

Hi All. Wondering whether any of you can give me advice. I was diagnosed with Hasimoto's Disease a few months ago. Am now on 100mcg thyroxine per day. I've just found out I'm pregnant (about 4 weeks) and having read that the level of thyroxine in early pregnancy can be quite important I went straight to my GP. Unfortunately had to see a new GP and he couldn't have been less interested! Basically told me I didn't have to think about it until after my midwife's appointment at 10 weeks when I would probably be referred to a consultant who would decide whether to increase my meds. I'm very uncomfortable with this because my last TSH level was 4.9 and I've read should be nearer 2 in pregnancy. Also I fear that leaving it til 10 weeks I will have missed the crucial period if it is indeed important to get the levels right in the first trimester. I've read the NHS advice about increasing by 25mcg when first pregnant and told him about it but he just dismissed it. He wasn't even going to send me for a blood test until I insisted! Am I being silly or should I persist?

Hi Jessie - I've had a really similar experience today and am stressing about it. I am four - five weeks pregnant and have been on 75mg of thyroxine since the birth of my last child about two years ago. My doctor today said she'd get me a blood test but the results will take a week, no need to up the dose immediately (although she said she couldn't stop me if I wanted to) and didn't want to test for T4 but said she'd ask the lab (when I pushed it) but said they might not do it?

I talked about the NHS article I've seen mentioned here but she wasn't really interested. She didn't seem knowledgeable at all and told me that it wasn't a problem at this point of pregnancy and that I will only need testing every 8 weeks after this because they wouldn't be able to see the results of any increased medication quicker than that anyway. I thought that the point was more the way my body is changing in that time frame though.

Anyway - no help at all but as stressed as you!

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

Persist persist persist and speak to the Obstetric Physicians at your EPU/pregnancy assessment unit. I only say this from experience-my GP told me it was no big deal that my TSH was 7.4 last week. I was not satisfied (having read the NHS summary linked to below) and did all the asking myself. I had an immediate appointment with a consultant and immediate medication!

Thank you theidsalright, I won't get my TSH result back until next monday which is a bit crap. One thing I don't know is how I know if I'm overt or Subclinical (or something else?) and if that makes any difference?

I have a underactive thyroid very underactive and it wasnt a problem gettin pregnant (happened first time) and I have had some problems but not related to thyroid I have always thought as long as you have the meds your thyroid is fine shouldnt have problems. Having said that you do need to have it checked more and if goes under can affect babies development my doctor said but as long as you take your med keep eye on levels should be finexx

oh the iron and tyroid yes take apart i didnt and i went bit underactive cause of it

rolling my understanding (I'm not a medic) is that sub-clinical hyperthyroidism in a woman who is not pregnant (i.e. TSH between 4-10) would not be a problem really but in a pregnant woman IS a problem that can affect baby's development/make you more likely to miscarry etc. That was what freaked me out (past history) and made me very pushy indeed and go over my GP's head! TSH >10 is overt hyperthyroidism. The NHS paper linked to above is a very good summary.

Rolling - it is stressful isn't it? Seems that the advice from theidsalright to persist was absolutely right. My GP wanted to send me away with no tests or anything and let me wait until 10 weeks but I insisted on having a blood test. Its a good job I did because he telephoned me last night to say that my levels are raised and that he thinks he needs to put my thyroxine up by 25mcg! If I had taken his advice and gone away quietly I wouldn't have known my levels were raised. He has also now said he has referred me to an obstetrician - so am wondering whether he had second thoughts. Its depressing that we need to take control of these situations instead of the GP taking the lead - but persistence certainly pays off. I'm keeping everything crossed that my levels are now OK and won't have a negative impact.

Thanks everyone, it's hard knowing that your doctor might not be giving you the right advice isn't it. It's one thing when it's your own health (not that that's ok) but really another when it's your future baby.

I'm surprised that the correct information on this isn't more well known because hypothyroidism is really common?

I had my blood test today but won't get the results back until Monday. I also am hoping they'll test for T4 but need to wait to find out. I dropped off a copy of the referenced article with my doctor but don't know if she'll get it or read it - or if she'll think I'm being a hypochondriac. In the meantime I've raised my dosage by 25 (was originally on 75).

bessie 26 sorry for late reply just checked thread In regards to taking prenatal vitamin and thyroxine apart I take the thyroxine in the morning and the prenatal vit in the night. So they are well apart if I forget my throxine and have to have it at night I dont have the prenatal only because I think the thyroxine is more important but ideally I like to make sure I have both if possible.

Hello, I have been following this thread quite closely - thank you all for asking your questions and for patiently responding to them even if that meant repeating stuff that you've said earlier.
I have hypothyroidism - after reading the NHS Clinical Knowledge link I realized I don't know what type I have. I reached out to my GP to ask if I can have a blood test and she refused saying that I was tested in July (TSH only - was in normal range) and being pregnant now does not make a difference. I also sent her the link but I doubt she's read it - the clinic never acknowledge emails.
My next step is to book an appointment with my GP and be more insistent for a blood test or a referral to an endocrinologist. Please note I am in my 7th week of pregnancy and have a mid-wife appointment on Sept 20 - ie, 9th week.

Once again, thank you for your advice and information - I will update you on how my appt with GP goes. I am also trying not to panic or get stressed about this even though that can be quite hard to do.

womanlytales, being pregnant does make a difference! There are very clear guidelines. You should print this out and take it to your GP: www.cks.nhs.uk/hypothyroidism/management/scenario_preconception_or_pregnant/preexisting_overt_hypothyroidism. I've had blood tests every 4 weeks throughout my pregnancy to ensure the levels are always correct and that the dose I was on was fine (it was increased as per the guidelines).

Good luck!

Hi I am 6w4d, I m/c last year, I have an underactive thyroid and hashimotos and have had a lot of support from my endo this year. As soon as i got my bfp i called my endo my TSH was 3.48 (he is a saint listened to all my full on drama queen worries) and he said to bump my thyroxine from 75mg up to 100mg straight away and go back for another check in 3 weeks its now 1.1, he said catching my TSH early is good and will not effect baby.

He told my he would prescribe me 200mg selenium daily as i have hashimoto's and it will help the antibodies.

Also my specialist told me because I have an underactive thyroid I also need a pregnancy vitamin with Iodine as it is important for the baby to get iodine as women with thyroid problems are lacking this vitamin, my dr prescribed me Femibion, I checked it is also available in the uk. It is expensive though.

I have leant so much in the last year thanks to my endo, the TSH needs to be between 0.5-1.5 for the whole of your pregnancy and ideally you should not TTC until your TSH has been stable at this level for at least 10-12 months (I know this seems like an eternity when ttc but your health is so important) I wish my thyroid was better controlled before i fell pregnant as I feel i will spend the rest of my pregnancy worrying what was my baby missing out on in the first few weeks.

Ok,I'm a bit worried now.
I was diagnosed with an underactive thyroid 3 years ago as my body did not ovulate and I was tired constantly. I was borderline underactive and put onto 25mcg a day. Was never actually ttc, yet I fell pregnant in March 2011 and found out 8 weeks later. I had no symptoms/morning sickness at all.I was told by my GP to stay on 25mcg, even though my annual check (in Feb) the reading was 'ok'. I am now under consultant care at the hospital.
I've had 2 blood checks - in June the reading was 2.5 and in August it was 2.8.
I was told in August that my readings were slightly high at 2.8 and that the Consultant would be happier if my readings were 2.5 - so I am now on 50mcg a day 'to make the levels fall a bit'. My appetite is odd and I seem to have put on about 1.5stones (which for me is v good, as exercise has reduced loads)
I have to wait to mid september for my next appt with consultant and find out readings from blood test taken a couple of weeks ago.
I'm slightly concerned after reading these posts that I maybe overlooked here - and that the target of 2.5 is really high???
With 14 weeks to go I do have a smallish pregnant bump( I am 5ft2)
So, has my condition not been managed well ??