Possible Hypothyroid

[dimpmal]

Hi I have given my blood tests on 02/11/15 and thyroid function test results are :
- TSH slightly elevated. Suggest repeat in 6 to 12 months.
- Time to exclude developing hypothyroidism.

TSH : 5.39 mU/L and Free T4 11.3 pmol/L.

The reason I gave my blood tests to identify the reason for not able to conceive for 6 months. But I have just came to know that I am now 4 weeks pregnant. I have recently met my GP and asked him to prescribe medicines for Thyroid as my TSH is slightly elevated. But he has suggested not to worry and did not prescribe any medicines.

I am now worried as I am pregnant. I already have 3 yr old daughter and I had hypothyroid in 2009 before my first daughter was born.

As my GP is not willing to provide any medication can you please suggest if I need to worry and see another doctor?

Thanks

[dimpmal]

Barb135 and Super_sally888,

We have seen Endocrinologist consultant in private hospital today and explained everything to him. He has agreed with my India doctor and prescribed 50mcg Thyroxin. I will take it from tomorrow.

Do I need to avoid any specific foods while taking these medicines? I hope I can still take Pregnacare multivitamins. Please correct me if I am wrong.

Thanks for your support and help.

Thanks.

[dimpmal]

Thanks Super_sally888. I have managed to get an appointment with Endocrinologist for 8th Dec which is the earliest appointment I could get. My GP has agreed to give a referral letter.

Thanks

[Super_sally888]

Hi,

The ideal range for FT4 in pregnancy is upper 1/3 of the range, not the bottom (as advised by my endocrinologist).  TSh should be in the 1 - 2 range, but is less important than ft3 and Ft4 being at appropriate levels.

Given the importance of thyroid hormone to your baby you definitely should try to get in with the midwife earlier, and or see another dr.  Given you past history and your results, you should be on medication.

Please do this as soon as you can.

[Super_sally888]

Hi,

the usual advise for patients with hypothyroid is to immediately increase medication dose as soon as they know they are pregnant.  thereafter doses are usually increased monthly, if required (and with monitoring) - I have had 2 pregnancies with hypothyroid.

During pregnancy target FT4 is in the upper 1/3 of the range, as advised by my endocrinologist.

Considering you are not on medication and you are low thyroid, and that thyroid hormone is important for your developing baby, I would try to find a dr that will prescribe you the medication and do everything possible to advance your appointment.

[Barb135]

I can't tell you what to do; the decision must be between you, your husband and your doctor.  

Have you ruled out going to the private hospitals because of the cost?  Is there any way you can step up the appointment with the midwife?  

Since your family doctor in India has agreed that you should start on thyroxine, have you taken his recommendation to your GP in U.K?  Can you get the thyroxine tablets?

It's a dilemma, because the longer you wait, the greater the risk to your baby, but you will need a cooperative doctor/midwife who will test and be willing to increase the thyroxine throughout your pregnancy as needed, because 25 mcg probably won't be enough by the end of your pregnancy. Many women need increased dosages as the pregnancy progresses.  

From that standpoint, waiting until Dec 7 to see the endocrinologist might be your best option, though I'm not telling you that's what I think you should do.

The availability of the thyroxine tablets would be the first consideration.  Your GP has already denied a prescription, so the endocrinologist would be the next option, since the appointment with the midwife isn't until late December.  

Your thyroid is still producing hormones, at this time.  Are you having symptoms of hypothyroidism?

[dimpmal]

We have seen our GP this morning and asked him to prescribe medication for hypothyroidism. But he has not agreed with us and he again said that I don’t have hypothyroidism.  However he has agreed to give a referral letter to see the private consultant. He has also mentioned that when we see the midwife for the first antenatal appointment midwife can suggest what to do with thyroid.

Meanwhile I have contacted couple of private hospitals in my area and to my surprise Endocrinologist consultant is same in both the private hospitals and the first appointment we can get is 7th Dec with the fee £250.

Our first midwife appointment is 23rd Dec. GP also said we can repeat the  blood test one week before going to midwife.

We are originally from India and we have sent these test results to our family doctor (Gynaecologist) back in India. As you suggested our family doctor has also suggested taking 25mg thyroxine tablets.

Please suggest what we should do now. Should we see the private consultant on 7th Dec or get the blood test redone in NHS and wait until midwife appointment on 23rd Dec. I am now 6 weeks pregnant. I will be in 10th week by 23rd Dec.

Thanks for your help.

[Barb135]

I'm sorry... you're right - your FT4 "is" in range, but it's very low in range - too low, plus your TSH is over range.  In 6 months, you will be in late stage of pregnancy and too little thyroid hormone during pregnancy hinders growth and development of baby.

I'm glad you have asked for second opinion.  I hope your gp, will give referral. Let me know how it goes.

[dimpmal]

Thanks Barb135. Sorry if my earlier post has confused you. My FT4 is 11.3 pmol/L and the reference range is 9.0 - 21.0 U. Is FT4 not normal? I  have contacted private hospital to get blood tests done but they need GP referral. I am now trying to get GP referral. Thanks a lot for your help.

This is the actual wordings from my test:

-TSH slightly elevated. Suggest repeat in 6 months
- time to exclude developing hypothyroidism

Test     Abn    Value      Units    Range            Status
TSH      +        5.39       mU/L   (0.35-5.00 U)   NK
Free T4           11.3       pmol/L  (9.0-21.0)        NK


Thanks

[Barb135]

Your FT4 is actually below the reference range.  I'm not sure how your doctor can justify "not" treating you, since your TSH is also above range...

I did not realize that you were in U.K. - that can make things a bit more difficult, due to the stringent guidelines of the NHS; however, since your TSH is over range and your FT4 is below the bottom range, perhaps if you take that report to your hospital, along with proof that you had to have treatment during your prior pregnancy, that would help...

At the very least, can you go to a different doctor?  What about an obstetrician?   It's important that you be treated as soon as possible.

[dimpmal]

Thanks Barb135.We are trying to get other tests done as you mentioned. Unfortunately here in the UK thyroid tests in private hospitals are very expensive. BTW you asked about reference range for the Free T4 which is 9.0 - 21.0 U.

Thanks

[dimpmal]

Thanks a lot Barb135.

[Barb135]

What is the reference range for the Free T4?  Ranges vary from lab to lab and have to come from your own report... Your TSH is over the reference range and indicates that you may need to be on replacement thyroid medication...

You also need to have Free T3 tested, since that's the hormone that's used by every cell in the body...

Adequate thyroid hormones are necessary for the proper growth and development of a fetus.  Many women need higher levels when they are pregnant...

If your GP will not prescribe medication, then yes, you should see another doctor, particularly, since you had to take medication when you were pregnant previously...

You should ask to be tested for thyroid antibodies to determine if you have Hashimoto's, which is an autoimmune thyroid condition.  The tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  You need them both, as some of us with Hashimoto's have one or the other and some of us have them both.