Dr. Izabella Wentz, PharmD

Thyroid Pharmacist

Hashimoto's & Pregnancy

Hashimoto’s and Pregnancy

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This guest post was originally posted in February of 2015, based on personal experience provided by Dana Trentini, Hypothyroid Mom.  I have since developed new articles and resources for Hashimoto’s that might be helpful for you. For the latest information on pregnancy, please visit the following:

 

6 Things You Need To Know

Many of you have asked me about pregnancy and Hashimoto’s. I’m so excited to have Dana Trentini “Hypothyroid Mom” share her expertise through a guest blog post.

~ Your Thyroid Pharmacist, Izabella Wentz, PharmD ~

Hashimoto’s And Pregnancy: 6 Things You Need To Know

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My name is Dana Trentini. I am a hypothyroidism sufferer and founder of the thyroid advocacy blog Hypothyroid Mom.

Who knew that little butterfly-shaped thyroid gland at the base of my neck had the power to take the life of my unborn baby?

My Ivy League medical school trained and top awarded doctors in New York City did not know enough about the dangers of hypothyroidism in pregnancy. Under their care, my TSH soared far above the recommended reference range for pregnancy endangering the life of my fetus, and I miscarried.

How could I have trusted my doctors unquestioningly and not taken my health into my hands?

1. Get Thyroid Testing Before Trying to Conceive

The goal is to get as thyroid healthy as possible before trying to conceive. TSH is often the only test run for the diagnosis and treatment of thyroid conditions, but this one test does not give a full picture of thyroid health. Insist on a full thyroid panel that includes at a minimum Free T4, Free T3, Reverse T3, Thyroid Peroxidase Antibodies, and Thyroglobulin Antibodies.

Some people with Hashimoto’s test negative for thyroid antibodies because their overall immune health is so weak they do not produce enough antibodies. I’ve tested negative for antibodies several times. Now I’ve insisted on a thyroid ultrasound. Given that Hashimoto’s is one of the leading causes of hypothyroidism worldwide, I won’t stop until I know one way or another.

According to the Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum:

RECOMMENDATION 15 – Treated hypothyroid patients (receiving thyroid hormone replacement medication) who are planning pregnancy should have their dose adjusted by their provider to optimize serum TSH values to <2.5 μIU/mL preconception. Lower preconception TSH values (within the nonpregnant reference range) reduce the risk of TSH elevation during the first trimester.

2. Identify and Treat the Root Causes

There are several possible underlying causes for Hashimoto’s that need to be tested and treated including nutrient deficiencies, adrenal dysfunction, abnormal sex hormone levels, poor iron levels, food intolerances and sensitivities especially to gluten, heavy metal toxicity, bacteria and viral infections, Candida, blood sugar imbalance, and leaky gut. Thanks to Dr. Izabella Wentz’s new book “Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause,” Hashimoto’s sufferers have the information they need to take control of their health.

3. Speak to Your Doctor about Immunological Fertility Testing

If you are optimally treated for your thyroid condition, you’ve identified and treated the root causes, you’ve charted your fertility cycles, but you’re still struggling to conceive or experiencing recurrent miscarriages, speak with your doctor about immunological fertility testing.

When a person has an untreated autoimmune condition like Hashimoto’s they are more vulnerable to develop other autoimmune conditions. Once the immune system has made the mistake of attacking one part of the body, it is more likely to attack others including reproductive tissue and even the implanted embryo. There are 3 major immunological fertility tests:

  • Antiphospholipid Antibodies
  • Natural Killer Cells
  • Antinuclear Antibodies

4. Confirm Your Pregnancy as Soon as Possible

Do NOT wait for a missed period to test for pregnancy and do NOT wait for your first pre-natal visit with your OB/GYN to test your thyroid. In the first 12 weeks of pregnancy, the fetus relies completely on the mother to provide thyroid hormones for its growth and development. Your goal is to confirm your pregnancy as early as possible.

Most OB/GYN practitioners do not schedule the first prenatal visit until 8 weeks pregnancy. Do NOT wait this long to have your thyroid tested. Contact your doctor immediately for thyroid testing as soon as you confirm your pregnancy.

According to the American Thyroid Association:

RECOMMENDATION 14 – There exists great inter-individual variability regarding the increased amount of thyroid treatment necessary to maintain a normal TSH throughout pregnancy, with some women requiring only 10%–20% increased dosing, while others may require as much as an 80% increase.

5. Ensure Thyroid Testing Throughout Pregnancy

Insist on regular monitoring of your thyroid levels. Don’t just accept “your thyroid is normal” from your doctor. Get a copy of your lab results and check for yourself.

According to the American Thyroid Association:

RECOMMENDATION 2 – Trimester-specific reference ranges for TSH are recommended: first trimester, 0.1–2.5 μIU/mL; second trimester, 0.2–3.0 μIU/mL; third trimester, 0.3–3.0 μIU/mL.

RECOMMENDATION 16 – In pregnant patients with treated hypothyroidism, maternal serum TSH should be monitored approximately every 4 weeks during the first half of pregnancy because further dose adjustments are often required.

RECOMMENDATION 17 – In pregnant patients with treated hypothyroidism, maternal TSH should be checked at least once between 26 and 32 weeks gestation.

6. Listen to Your Body

Your body whispers warnings that something is wrong. Listen to it. We are more than lab numbers. The best thyroid doctors are the ones that listen to you and your symptoms.

Hashimoto’s can come with swings up and down in TSH. Know the symptoms of hypothyroidism and hyperthyroidism and watch for signs. You know your body better than anyone. Listen to your instincts.

I didn’t listen to my body, and I paid a heavy price.

I will live with that regret the rest of my life.

PS. You can also download a free Thyroid Diet Guide, 10 Thyroid friendly recipes, and the Nutrient Depletions and Digestion chapter for free by going to www.thyroidpharmacist.com/gift. You will also receive occasional updates about new research, resources, giveaways and helpful information.

For future updates, make sure to follow us on Facebook!

References

Stagnaro-Green A, Abalovich M, Alexander E et al. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Thyroid. 2011;21(10):1081-1125. doi:10.1089/thy.2011.0087.

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Disclaimer: The information contained herein is for informational purposes only and should not be construed as medical advice. Please consult your physician for any health problems and before making any medical or lifestyle changes.

Lifestyle changes can result in improved thyroid function and/or an increased absorption of thyroid hormone medications, leading to a lower required dose and possible symptoms of hyperthyroidism at a dose that was previously stable. Please discuss lifestyle changes with your physician and ensure that your thyroid function is monitored every 6-8 weeks while making lifestyle changes. Symptoms of overmedication include, but are not limited to: rapid or irregular heartbeat, nervousness, irritability or mood swings, muscle weakness or tremors, diarrhea, menstrual irregularities, hair loss, weight loss, insomnia, chest pain, and excessive sweating. Do not start, change, increase, decrease or discontinue your medications without consulting with your physician.

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Comments

  1. What about iodine in pregancy with hashimoto?
    Shoud it be suplemented or not? I felt much wors when a few monts ago I took multivitamins with iodine.
    The second question: my FT3 and FT4 is heigh (5,35 and 18,56) but my TSH is still rising. I just have found out I am pregnant and I have TSH 4,5 …
    Why, if FT3 and FT4 is heigh?
    Reply

  2. Hi Agnes- Please work with your doctor to control your thyroid levels during pregnancy. Iodine has been helpful in preventing birth defects when taken during pregnancy. It may also help to take Selenium. Wishing you all the best!
    Reply

    • Hi, which dose of selenium is optimal during pregnancy? 200mcg? I feel good when taking this dosage, but haven´t found enough recommendation…:)

      Reply

      • Hi Josefina, I always recommend speaking with your practitioner/OB before taking supplements in pregnancy. Generally, 200mcg is what is contained in most prenatal vitamins. So if you are taking an individual supplement as well be aware and check with your practitioner.

        Reply

  3. I was diagnosed with Hashimoto’s at 32 after I had two early term miscarriages. My TSH level was fixed using synthroid and I went on to have two beautiful and bright children. I was told this was permanent but feel encouraged after reading Root Cause that it may not be. I have a list of questions for my endocrinologist now.
    Quick question for you- Hubby and I just started trying for baby #3 so I have been taking prenatals. I have been using Baby and Me by Megafood. Is that a good brand? I see others listed in Root Cause and thought maybe I should be switching although I have no known complaints about Megafood as I used it for both kids. Thanks for keeping us informed!
    Reply

    • Jennifer- I would encourage you to reread chapter 19 on page 328. Not everyone will need every single supplement! In fact, I believe that most nutrients should come from the diet, this is why I always list food sources for most of the nutrients, vitamins, minerals and probiotics that are depleted in Hashimoto’s in the book and on the blog. However, some may require/prefer supplements and the supplements on the website are a resource for those that do. I recommend getting tested for deficiencies to determine your need for a supplement as instructed in the book and blog. I also don’t recommend starting multiple supplements all at once. I recommend starting one at a time and then adding another a week or so later once it has been confirmed that the first supplement is not causing any harm.I do have a full supplements chapter in my book.

      Reply

  4. How soon after I deliver should I have my levels checked? After my first child my thyroid went crazy (I was already diagnosed and being treated for over 10 yrs prior). I want to avoid having my thyroid go wacko this time. My Dr said 2 wks after delivery but I thought I read something about testing ASAP.
    Reply

    • Jen- Your body whispers warnings that something is wrong. Listen to it. We are more than lab numbers. The best thyroid doctors are the ones that listen to you and your symptoms.

      Hashimoto’s can come with swings up and down in TSH. Know the symptoms of hypothyroidism and hyperthyroidism and watch for signs. You know your body better than anyone. Listen to your instincts.

      Reply

  5. How does Hashimoto’s disease affect childbirth? I mean the labor itself? As long as levels are good and there is adequate medication, is anything different?
    Reply

  6. thank you so much for all of the information on your site. I’m at a complete loss and could use advice. I’m almost 6 weeks pregnant and was diagnosed with Hashimotos hypothyroidism 19 years ago. I was treated up until about 5 years ago when I slowly reduced levoxyl with the help of an acupuncturist and MD. Since then my thyroid tests including TSH, T3, T4, thyroglobulin antibody and thyroid peroxidase AB have been completely normal. About 2 months ago prior to finding out I was pregnant tests were perfectly normal. I found about my pregnancy at 4 weeks and went to an OBGYN who tested only TSH which came back at 5.61 obviously high. He tried to prescribe synthroid but I went to an endocrinologist for a 2nd testing 4 days later and TSH was at 1.9 (perfect for 1st trimester). All other tests mentioned above were done as well and everything is perfect. Well, my OBGYN just called to tell me that someone’s test must be faulty and I’m causing extreme harm to my fetus, he mentioned mental retardation, deformities, etc. I tried to speak with endocrinologist today but have not yet been successful however I scheduled a follow up appointment tomorrow with additional testing. I’m looking for any insight or advice to help navigate this path as I’m at a complete loss and now extremely stressed. Please help. Thank you.

    Reply

  7. Hello, what about antibodies and pregnancy? As i remember good in Thyroid Secret was mentioned that antibodies like tpo or tg should be as lower as possible – and even should be 1 or 0! Is it true? Thank you!

    Reply

  8. Hi all. I’m 26 and have Hashimots. In the past 5 years I’ve had two miscarriages. The second one, we were not trying to get pregnant and it was a pleasant surprise. Before hand I was not on thyroid medicine so as soon as I found out I was pregnant (first missed period) I checked my thyroid levels, which were at 84. DR said I was supposed to be under 2 but they immediately put me on thyroid meds and after 4 weeks my levels were normal, a couple days later I found out the baby stopped growing at 7 weeks. Do you think this was due to the high level of my thyroid? We are now TTC and I just pray it doesn’t take forever because I want a baby so bad. Does anyone recommend and ways that will help?

    Reply

  9. Do you think that hyperemesies is related to hashimotos or hypothyroidism? I had 2 children prionto being diagnosed with hashimotos. Both pregnancies I had hyperemesies and was hospitalized several times for dehydration. Now that I have my hashimotos under control I’m contemplating having a third child but scared that I will have hyperemesies and that the panic attacks/anxiety from the hashimotos will come back worse than before. Any advice or knowledge on this would be very helpful!

    Reply

  10. Hi!
    I am hoping you can put my nerves at ease. I am currently 6 weeks 5 days pregnant and just got put on .05MCG Levothyroxine today. My TSH is 5.67 my t3 free is 2.2pg/ml and t4 free is 0.8 ng/dl and my TPO AB is 214.9 iu/ml. I’m just concerned that my baby may not be developing correctly or that I may loose him/her and I’m not getting any clarification or even a diagnosis from the nurse practitioner that took the tests. I was just told through a health message system what my levels are and told that there is a prescription waiting for me. So I feel in the dark and scared for my unborn baby.
    Thank you in advance!
    Sam

    Reply

  11. Hi Dr. Izabella,

    I just ordered your book and I’m looking forward to reading it! With regards to TPO antibodies, mine have reduced from 287 to 167 after three months of Levothyroxine, zinc, selenium and a subtantial reduction in dairy and gluten (TSH has always been under 2 and I don’t have any symptoms). Is it likely that I will one day have zero TPO antibodies if I continue to follow this regime? Or will I still be destined to develop Hashimoto’s down the road?

    Reply

    • Linda – thank you for your support! I’m looking forward to hearing your progress on this page. Make sure to take the book slow, take notes, highlight, and establish a baseline when making changes. Here is some information which you may find interesting as well.

      Three things MUST be present in order for autoimmunity to occur…

      1. Genetic predisposition
      2. Environmental triggers
      3. Intestinal permeability (leaky gut)

      Developing autoimmunity is like a three-legged stool, all of these factors must be present for autoimmunity to occur! When you remove one of these, you can prevent or stop autoimmune disease. While we can’t change genes, if we know the trigger, we can remove it and we can heal the gut.

      REVERSING AUTOIMMUNITY? AND THE PERFECT STORM
      https://thyroidpharmacist.com/articles/reversing-autoimmunity-and-the-perfect-storm/

      IS HASHIMOTO’S HYPOTHYROIDISM GENETIC?
      https://thyroidpharmacist.com/articles/is-hashimotos-genetic

      Reply

  12. Hi Dr Izabella,
    I’ve read your book Hashimoto’s Protocol and started on the plan about 2 weeks ago, I feel GREAT!!!!! I am a Mexican mom currently living in Mexico, so it hasn’t been easy to find a good endocrinologist/functional Dr than can help me out more than I hope for.
    I found out I had Hashimoto’s about 2 years ago because I was feeling exhausted and had one missed period, I ran some lab tests and confirmed it, but my thyroid is working just fine(I checked my thyroid every 3 months and everything was perfect, so I didn’t take any levothyroxine or anything) I had baby #1 a year ago (unplanned) and even in my pregnancy my thyroid worked fine, the only thing that my ob/gyn ordered was to take 5mcg of prednisone(I didn’t know anything about Hashimoto’s at the time, only that I had it) and 25mcg of levothyroxine even when my labtests were fine; TSH, t3,t4 etc. He told me this was to prevent a miscarriage. Pregnancy went OK. After I delivered, I digged into what was prednisone and I don’t want to take it in my next pregnancies. What would you recommend to take in the next pregnancies that won’t harm my immune system? Do you agree on taking levothyroxine even when my thyroid levels are ok, but just have the ATP antibodies? Can I still have a good pregnancy without prednisone and just levothyroxine? Is there anything else (supplements) than can help just have peace of mind that I won’t miscarriage? I’m planning on reversing Hashimoto’s but in the mean time I would love to have another baby, so I’m in the middle, not knowing what to do. I hope you can help me out here. Thank you so much!

    Gloria

    Reply

  14. I was diagnosed with hashimotos 5 years ago, but have gone into remission (no autoantibodies, thyroid levels in (low) normal ranges. I am now 7 weeks pregnant and my TSH is at 3.3 and my Free T3 and Free T4 are within normal range, but lower half of the reference range. My autoantibodies continue to be negative. My doctor thinks I should get on thyroid hormone because I’m above the 2.5 threshold for TSH.

    My question is: if I start a microdose of thyroid hormone, will my own thyroid hormone turn off and potentially put my baby at MORE risk with wonky numbers? I’m not sure if taking the thyroid hormone will bump up my levels or possibly cause some extreme roller coastering if my thyroid shuts off. It’s tricky. Does anyone know if you have to have a certain amount of exogenous thyroid hormone for the thyroid to shut off? Will a microdose bump it up? I’m nervous to start taking it, but I could lose either way.

    Reply

  15. Hi Dr. Wenz,

    I’m 6 weeks pregnant and I’m taking 65 mcg of Nature Thyroid. My free T3 is normal, but my TSH is 5.
    I asked to increase the dose of the Thyroid medicine, but my doctor refused.
    I miscarried last year, so I’m very scared of losing this one.
    Please advice!

    Thanks a lot for your help!

    Shanya

    Reply

  16. Thank you so much for taking the time out to write this blog! My fiancé and I have 2 girls, but my hormones were off the charts so bad with our youngest (who is 2 now) that when she was 3 months old I was severely nauseous, and couldn’t walk. Went to my OBGYN and they tested my TSH, which was 508!!! It was so high, they called me the next morning, panicked. I felt about dead. My mom did experience a dip in her thyroid after menopause, so I do believe I have a slight Hashimoto which was spiked young from my tough pregnancy with her. I wonder why OBGYNS don’t monitor thyroid throughout pregnancies? I don’t remember them ever checking the entire time. Although I did get my thyroid checked 6 years prior, and my doctor at the time said everything was perfect. So idk. We are wanting to try for baby #3 in a couple of months….just scared because I feel absolutely awful, horrible and extremely sick my entire pregnancies. Do you know if that is normal with a Hashimotos-Thyroiditis? Thank you so much for writing this, it is a huge help!

    Reply

  17. Can you please recommend a functional medicine doctor in Denver or Colorado Springs who
    understands pregnancy with thyroid disease and MTHFR gene mutation. Thank you!

    Reply

  18. My THS levels are normal. Expect Thyroglobulin Antibodies at 200 right now with no medication. I had a miscarriage about a year ago, the numbers were at 465 back then. I have been doing supplements and gluten, dairy free. Since the numbers are going down should I be concerned and should I see an endocrinologist before trying to get pregnant again? Thank you

    Reply

    • Maritza – thank you for reaching out and sharing your journey! I am happy to hear you are taking charge of your health and seeing results! <3 I recommend that you discuss this with your trusted clinician who’s care you are under. <3

      Reply

  19. I was just diagnosed with Hashimoto’s after two consecutive miscarriages. I am 29 years old and do not have any children yet. My TSH level was 3.274 and my TPO Antibodies was 75. My doctor put me on 125mcg of Tirosint. I have also eliminated gluten, soy, and dairy. I will go back in after 6 weeks to check my levels again. She advised me to wait 6 months before trying again to get pregnant. I am heartbroken. I understand the importance of waiting until my levels are under control, but is it actually going to take 6 months for my levels to be normalized?

    Reply

  20. Hi, I have hashimotos and am 29 weeks pregnant. I have anemia where I’ve been prescribed iron to help. I ask my OB to check my free T3, free T4, and TSH. She said my T3 was low but I can’t see those results. She said my TSH was normal so based on guidelines not to increase my lyvothyroxine dose (25mcg). I noticed in March TSH was at 1.080 and now .666. Is this good management? Should I be asking for more? Thank you

    Reply

    • Sarah, congratulations! <3 Most people feel best with a TSH of around 1 or lower and with a Free T4 and Free T3 in the upper half of the range. It is expected that your TSH will be very suppressed when optimal on NDT medication. How much thyroid replacement therapy is needed is unique and different for each person, so it's important to work with a functional medicine practitioner or a doctor, who can closely monitor your dosage and your progress. Every six weeks is usually a good schedule for testing your thyroid hormones. Here is a research article which might help further:
      TOP 10 THYROID TESTS FOR DIAGNOSIS
      https://thyroidpharmacist.com/articles/top-6-thyroid-tests/

      Reply

  21. Hello Izabella! Thank you for the informative article. I am concerned that I might have some thyroid issue which has caused two recurrent miscarriages. Around 1.5 years ago I had my thyroid hormones tested, I believe the doctor said my TSH was slightly elevated, (4.5) and my T4 was normal, due to COVID there was a significant delay in any treatment and follow up being offered. I began to feel better and didn’t think much of it. However, recently since trying to get pregnant, I have experienced 2 recurrent miscarriages and have been thinking about the route cause of it. I am concerned that my miscarriages are being caused by a thyroid problem. In the latest one, I was informed that my progesterone had dropped far lower than what was expected (5.5ng/ml, and anything above 20ng/ml would have been ideal.) I am hoping to work on getting adequate iodine and selenium in my diet and since that test 1.5 years ago, my diet has majorly improved and so has my fatigue. Besides this, I am not too sure where to start, do you have any specific advice/guidance for me? Many thanks!

    Reply

    • MrsK – thank you for reaching out.❤️ I’m so sorry of your losses. My heart goes out to you. When trying to conceive, I always recommend testing and getting your thyroid levels in a range, with TSH 2.5 or lower, before conceiving. Once you do become pregnant, make sure you get tested right away, as you might need to increase your medication. Our need for thyroid hormone increases as soon as we become pregnant, so it’s important to get tested more frequently during pregnancy, and get those levels in an optimal range. Here is an article that you might find helpful as well: https://thyroidpharmacist.com/articles/pregnancy-announcement/

      Reply

  22. Are there recommendations for optimal FT4 and FT3 ranges during pregnancy trimesters? Everywhere else we talk about how useless TSH is by itself, but the pregnancy articles only talk about TSH.

    Reply

  23. Hi Dr. Wentz, I have had Hashimoto’s since I was in elementary school, and had a miscarriage this summer at 7 weeks. I believe that was due to insufficient thyroid hormone production, and should have trusted my instinct to find a new practitioner asap when my midwife wouldn’t test immediately upon confirming the pregnancy. Anyway, I am pregnant again and my new midwife is willing to test every two weeks. However, my TSH was 2.1 prior to pregnancy and then jumped to 3.36 within that two weeks. What damage could have occurred during that time? Everything I have read is vague. The ATA and AACE recommend a TSH below 2.5 for the first trimester when the fetus cannot make its own hormones, and less than that can cause insufficient neurological development. But what does that mean? And does that happen immediately, if your TSH is above 2.5 for even one day? One week? Everyone I have spoken to has said me testing every two weeks is unusual. But if thyroid hormones are that important for fetal development, how come I can’t find any statistics about actual outcomes? Do you have any insight? Maybe I’m just not looking in the right places?

    Reply

  24. i have hashimoto’s hypothyroidism. i fell pregnant very late in life and had a miraculous healthy pregnancy. then my baby died during full-term labour. one of the possible causes suggested by the indeterminate post mortem of my daughter and her placenta was my thyroid – which i had fought to be tested through the pregnancy, but on the NHS (i’m in the UK) they only test routinely for TSH. my antibody levels were tested once.

    since my daughter Indigo’s death i’ve been desperately trying to conceive, as the need to have a child has become a very different thing now than it was before. i’ve had to give up on the idea of using my own eggs – yet another loss – as it’s just too late, and i’m about to try IVF with donor eggs. i hope that if i’m pregnant again my care will be very different this time (closer to how it should have been last time), and have just spoken to an obstetrician about it and other things – but would welcome any additional suggestions.

    prior to my pregnancy i was taking 75micrograms of levothyroxine. then more during my pregnancy, but it wasn’t stabilising after the pregnancy. i have recently been taking 100micrograms mon-fri and 125micrograms sat&sun, but i saw a reproductive endocrinologist last year who recommended that my TSH should be below 3 and it’s marginally over, so i’ve just switched the dosage on weekdays/weekends.

    Reply

  25. Hello, just learned I have Hashimoto’s Hypothyroidism. My midwife sent me your HASHIMOTO’S PROTOCOL book. I find it quite interesting. I would love to do the 90 day protocol with your supplements you advise in the book. My question is, is it safe to do your 90 Day Protocol while pregnant? Will doing the liver Detox harm our baby?

    Reply

    • Alyssa – thank you for following. Thyroid medications are Pregnancy Category A, which means that they are considered to be safe medications for use during pregnancy. Being on a correct dose of thyroid medication can actually help women conceive, as well as prevent miscarriage. If you get pregnant while taking thyroid hormones, be sure to see your doctor ASAP to test your levels. You will very likely need to increase your dose, as pregnancy increases the requirement of thyroid hormones.

      Reply

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