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I’ve helped many women become pregnant after they’ve “failed” several rounds of in vitro fertilization (IVF). It didn’t take any fancy equipment, painful procedures, or expensive medications. It just took looking at these women like they were more than ovaries and uteruses.

Many of these women had undiagnosed hypothyroidism. Once we discovered and corrected for this, they were quickly able to become pregnant – and stay pregnant.

Optimizing thyroid health is also important for minimizing the risk of miscarriage, ensuring good development of a baby’s brain, and helping mom survive the postpartum period.

What’s the Thyroid?

The thyroid is a butterfly-shaped gland that sits at the front of the neck. It helps regulate energy levels, metabolism, menstruation, fertility, and so much more.

How is Thyroid Hormone Made?

When the brain senses a drop in thyroid hormone levels in the blood, it sends a signal to the thyroid gland, letting the thyroid know it’s time to make more hormone. This signal is called TSH, or thyroid stimulating hormone.

Once the thyroid receives the TSH signal, it then responds in turn by making thyroid hormones T3 and T4.

T3, the active form of the hormone, is produced in small amounts. T4, the inactive form of the hormone, is made in larger amounts (about 4 times as much as T3). As the body needs more T3 to fuel its functions it turns the T4 into T3. (Think of it this way: T4 is like a grenade with the pin engaged. Once you remove the pin, it becomes T3, and it can do some serious work!)

Thyroid Problems

Thyroid problems can result in over-functioning of thyroid hormone (called hypERthyroidism) or in under-functioning of the gland (called hypOthyroidism). Hypothyroidism is much more common in Americans and can be caused by nutritional deficiencies, infections, injury to the thyroid after surgery or trauma, radiation, and even environmental toxicity. The most common cause of hypothyroidism in America, however, is autoimmune disease. Autoimmune hypothyroidism – known as Hashimoto’s – accounts for roughly 90% of hypothyroidism in Americans!

Hashimoto’s and other autoimmune diseases are more common in women – especially in pregnant and postpartum mamas. For this reason, it’s important to screen a woman’s thyroid health before she conceives, throughout her pregnancy, and again in the postpartum period.

What are the Signs of Hypothyroidism?

Because the thyroid controls so many functions in the body, the signs of hypothyroidism can crop up in just about any system. Common symptoms include:

  • Fatigue
  • Brain fog or poor memory
  • Depression, anxiety, and mood imbalances
  • Constipation
  • Difficulty losing weight or unexplained weight gain
  • Dry skin and/or brittle nails
  • Thinning hair or shortening of eyebrows
  • Feeling cold all the time
  • Carpal tunnel or other nerve irritation
  • Heavy or irregular periods
  • Infertility
  • High cholesterol levels
  • Puffiness of the face, shins, or tongue, or looking much older than you actually are

Thyroid Health and Fertility

Thyroid health has a huge impact on menstruation, ovulation, and fertility. For this reason, I encourage every woman to get her thyroid levels checked before she becomes pregnant. Having a TSH of 2.5 or less will make it much easier to conceive, and keeping it there through the first trimester will significantly lower the risk of miscarriage. Even if women doing IVF, having optimal thyroid health improves the chances of the IVF working. Keeping TSH at 3 or less during the second and third trimesters further helps ensure a healthy baby.

Mom’s Thyroid Influences Baby’s Health

Optimizing a pregnant mother’s thyroid function not only decreases her chance of a miscarriage but it also helps ensure the healthy development of her baby’s brain. If a mom has uncontrolled Hashimoto’s during pregnancy, the antibodies associated with the disease can wreak havoc on her baby. Women with active autoimmune diseases during pregnancy are more likely to deliver babies with learning disabilities and autism diagnosed in childhood. 

Thyroid Health and Postpartum

It’s possible for Hashimoto’s to present in the postpartum period – even in women who had healthy thyroids through pregnancy. In fact, my practice is full of exhausted, depressed moms who have been told by their other doctors, “Your TSH looks fine, there’s nothing wrong with you, motherhood is just really hard sometimes,” when in fact their thyroid antibodies were through the roof and they had a real disease with very real symptoms.

These women unnecessarily feel that they are crazy, weak, or not good enough for having such a hard time with motherhood. Many of them are placed on anti-depressants when what they really need is a little love for their thyroids!

Comprehensive testing and careful consideration of a woman’s symptoms are imperative. There is absolutely no reason a woman should suffer because her doctor didn’t have two extra minutes to talk with her and check a few more boxes on a lab test order form!




For more information about Postpartum Thyroiditis see Dr. Krumbeck’s article: Postpartum depression or postpartum thyroiditis?

Baseline Screening for Hypothyroidism / Hashimoto’s:

This is the minimum thyroid screening I recommend to my patients. All of these tests are available through any commercial laboratory, and can be checked from a simple blood draw:

  • TSH
  • Free T3
  • Free T4
  • Thyroid Peroxidase Antibodies (TPOAb)
  • Thyroglobulin Antibodies (TgAb)
  • Reverse T3

Sadly, most conventional physicians only check TSH and never actually assess the levels of hormone produced by the actual gland. This can result in the under diagnosis of thyroid disorders. (Yes, I see normal TSH’s all the time with abnormal results on the other tests!)

Due to better outreach on this issue, some doctors are now expanding their scope of ordering to include TSH, free T3, and free T4, but even this “expanded” test panel can miss Hashimoto’s. In several women I’ve seen these tests be perfectly normal but in the meantime their antibody levels were through the roof!

It’s entirely possible to have Hashimoto’s and still have a “normal thyroid panel.” (Indeed, this is yet another example of how a naturopathic physician can catch problems missed entirely by an endocrinologist!)

American Mamas (and Children) Deserve Better Care

Catching and treating thyroid imbalances can help a woman conceive, stay pregnant, deliver a healthy baby, and survive the postpartum period. It can also help her child avoid learning disabilities and autism later in life.

In some cases medication (pharmaceutical T3 and/or T4 hormone) may be necessary, but often times thyroid health can improve through eating a nutritionally-dense diet (iodine, selenium, and zinc are essential!), supplementing vitamin D3, strictly avoiding gluten (note: get tested for celiac disease first! Even if you “have no symptoms!”), and steering clear of thyroid-toxic chemicals like chlorine, bromide, and even the fluoride added to municipal drinking water. (A good quality water filter should be in every household!)

Another important factor for optimizing thyroid health is stress reduction. Refusing to check work e-mails after 5pm, taking a hot bath, paying somebody else to clean the house, getting 7-9 hours of sleep per night, and going on vacation are all great ways to support healthy hormones.

 




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Erica Zelfand
Erica Zelfand
Dr. Erica Zelfand (aka "Dr. Z") is a family physician, medical writer, and teacher.After graduating from medical school and finishing a family practice residency at NUNM, Dr. Z completed post-doctoral training in pediatrics under the tutelage of the esteemed Paul Thomas, MD. She is also adjunct faculty at NUNM's school of medicine.Dr. Z is the co-founder of Natura Integrative Medicine in Portland, Oregon, where she sees patients of all ages in a welcoming, unhurried setting. She is deeply committed to a patient-centered, root-cause-oriented, nature-honoring approach to healing.Dr. Z is also passionate about returning unbiased scientific inquiry and proven natural therapies to their rightful place in medicine.

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