Hypothyroidism and miscarriage

[MogTheForgetfulCat]

I was diagnosed with an underactive thyroid when DS2 (2) was about 12 or 13 months. Take 50mcg of levothyroxine daily. I have long felt that this dose is not enough (still more tired than I should be, irritable, low energy levels and cold), and have nagged my GP, but she keeps trying to insist I am depressed (I'm not) and says that my blood tests are within normal limits or refuses to test again.

Had m/c at 7+5 last summer. Didn't think much of it - am mid-30s and know the statistics. Also, the pg just didn't 'feel' right from the start iyswim. Pg again in Jan, felt v different - strong symptoms, a good feeling etc. Had brown bleeding at 6+5, went to EPU and had scan, showing baby right size for dates with a good, strong heartbeat. More bleeding intermittently, went for scan yesterday at 9+2 and was told no heartbeat. Again, baby showed the right size for dates, so had obviously happened v recently. Am devastsated and now just sitting here waiting to miscarry naturally in an attempt to avoid ERPC

I know, statistically, that 2 m/c's is not seen as a big deal, especially as I am blessed with 2 gorgeous DSs. But I have been doing a bit of digging on the internet and it seems that there is quite a lot of info re: thyroxine dosage being increased during pregnancy. I did have a blood test as soon as I knew I was pg, but when I phoned for the results was told it was normal. This was the receptionist telling me this not the GP - last test was also 'normal' although GP later admitted that TSH was 'on the high side'. I understand TSH should be 2 or under in pregnancy? I need to go back to her and go through the results in more detail, I think...

What do I do now? Can I ask GP for referral to an endocrinologist in the event that I want to TTC again? Have PMI through work, so that would probably cover it. Or just ask for closer monitoring from her next time? Or am I being precious about this? I am trying not to be and I know that the hypothyroidism may not be the answer or the whole answer, but it seems pretty questionable that I have only experienced m/c since being diagnosed. Also, I understand that seeing a foetus at nearly 7 weeks with a good heartbeat and then something going wrong is farily unusual?

Anyone got any advice/ideas/experiences to share? Feeling v desperate and sad right now...

sorry to hear of your mc

useful links here

your TSH should be under 2 and as soon as you get pg your dose should be increased

the normal range unfortunately goes beyond 2

I would go see your GP and ask for your exact results - for all prior tests
Then ask for an endocrinologist referral

If GP is difficult then I would change GP

I am dreadfully sorry for you losing your babies.

i used to be hyper and now hypo - on 4th baby and had two miscarriages whilst i was undiagnosed hyper.

yes true about the tsh during pregnancy and the range is so wide for normal blood results but it really varies from person to person - i am on 100mcg a day... and this went up during my last pregnancy. A friend of mine (not pg) is 125 a day? so go figure...

yes you should ask to be referred to an endocrinologist - you should be reviewed anyway after a pregnancy

I am and 15 weeks pregnant but have not yet been referred back to my endocrinologist but i have been referred to a foetal medicine specialist for my care - most of my care is done by midwife though as having a homebirth but becuase of the thyroid issue i see him too.

No, you are not being precious, you are being sensible to be cautous before TTC again.

My absolute best wishes to you and do take care of yourself.

Thanks so much for these quick responses - and for the v useful links, EldonAve. Head still in a mess, and unsure about TTc again, but v good to know I can go back to GP armed with concrete info, and from a reputable source. Thanks again!

Tartyhighheels (love it) - very best wishes for your pregnancy!

Sorry, another question... On the day of a blood test, should thyroid meds be taken as usual - I take mine first thing in the morning, and GP says this should be taken as normal on day of test. But I read elsewhere on the internet (can't find it now) that you shouldn't as it could give a false result? Can see the argument of both sides, so a bit confused - any ideas?

various sources say don't take them until after the test
delaying taking them until later in the day isn't going to do you any harm

hi

so sorry to hear of your MC i am hypo too and was on 50mg but the GP lowered it to 25mg a while back. i have had 5 early MC/CP's since being diagnosed 2.5 years ago but the GP takes no notice of the thyroid hormone link whenever i speak to him (he is a ridiculous man though)

i think it is worth making sure you get a second opinion on your thyroid levels as what is 'normal' for you may be too high or low for someone else! so if your levels are naturally on the higher end of their normal limits then the lower end would be underactive for you IYSWIM

good luck if you do decide to TTC again

PandaEis - I urge you to change GP if at all possible

the mc hypo link is well established

OP - Change GP - and PandaEis too.

When TTC (and when pregnant) TSH should be around 1 thats the target - your dose needs to be increased in 25mcg increments every 6 weeks until your TSH is 1.

Get it tested first thing in morning - ALWAYS at same time of day as TSH fluctuates during day and is higher in morning than afternoon, and don't take your dose until after the test. Don't take any multivit containing iron within a few hours of the medication and that can make the dose less effective.

Reason for delay is that the dose enters blood stream straightaway and does affect the T4 result (although shouldn't affect TSH) so better on the day of test to take later. Ignore GP - just don't miss a day, take it with you and take it straightaway after test.

If you have PMI go and see endo immediately - if you are in London I see Dr Vanderpump (based at RF but private in SJ&SE) and I recommend him, he's really lovely. He recommended increasing dose as soon as I had positive test (after what happened in my first pregnancy was normal at 5 weeks (TSH 0.87) but no dose increase and by 8 weeks TSH already up to 13.8!!!. In this pregnancy increased dose as soon as I knew - 100mcg to 125mcg and at 12 weeks TSH was up to 2.24 and he increased it slightly again.

Also NEVER EVER get result from receptionist (unless they give you exact numbers - speak to GP and get exact number - and start questioning if getting close to 2).

MumNWLondon - belated thanks for this very useful info. Have not yet seen GP - she rang me when the papers from the EPU were sent through to her, and we discussed matters briefly, but I was too upset to go into detail, and need to have a proper face-to-face with her and get all the info and ask for the referral. Not in London, so can't see your man, but hope will find someone else who knows what the hell he is talking about, unlike my GP.

Am trying not to be , but utterly failing. Miscarriage has not yet started, and the waiting is pretty hard to take, but have an irrational fear that if I go for the ERPC it will somehow be botched and the decision about whether to try for another DC will be taken out of my hands. So will go and see her when it is all over

Thanks again for the info, it's much appreciated.

Mog

Sorry to hear about what you are going through. I'm sure you can find endo who knows what s/he is talking about near you - best to get details of all private endos in area and call their private secretaries and find out if they have experience of treating women with underactive thyroids who are TTC or pregnant. Some endo specialise in diabetes so need to find one that has an interest in thyroids!

Your work PMI should cover any of it but just needs to be carefully worded ie not mention fertility/miscarriage - just that you have underactive thyroid and are being referred for treatment. When you do see endo need to discuss with him action plan for when you get pregnant again - eg a letter from him to GP suggesting dose rise as soon as you know you are pregnant so you don't waste time.

In the meantime you need to find more sympathetic GP - from what you have said you were symptomatic with a dose of 50mcg (my sister was symptomatic with a TSH of 4 which is inside "normal" range - GP said it was tiredness from having 2 kids! - but when her TSH was 1 she felt great.) No reason to suffer symptoms. Also my endo said harder to get pregnant with elevated TSH even if still in normal range.

Also with your history now need to make sure what when you do get pregnant again you are v carefully monitored at the start etc. The m/c might be to do with something else but you need to eliminate this.....

Thanks again, Am now wondering if your sister has same GP as me, as that's exactly what mine said - "Of course you are tired, you have 2 small children"! I was sobbing in despair, trying to explain to her how different it was from that sort of tiredness, which I would naturally expect to have. Like banging my head against a blardy brick wall... Think TSH from blood test in Sept 09 was 3.9, so clearly too high for me, even if in normal range. Will get print-outs of all blood tests to date, though.

Am thinking of sticking with same GP, as if I put the wind up her about this, she may be a lot more careful next time re: monitoring etc. But will certainly think about changing if I continue to be unhappy.

Thanks for tips re: finding the right endo - will follow up on that. All really helpful, thanks so much!

I had a mc when my meds were still being assessed (was on 100mcg at the time, but final dose ended up being 175mcg) I didn't realise until I was pg with DD the next year that hyperthyroidism could be a cause of mc, and I'm pretty angry I wasn't told this by my GP - I would have waited before TTC if I'd been aware of the risks.