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
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.
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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.