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Pregnancy and Thyroid Health

Pregnancy is a time when we expect a lot of hormonal changes – but not every woman is aware of the changes that can occur in her thyroid function – and what that can mean for both her health, and the health of her baby.

A Brief Introduction to your Thyroid

Your thyroid is a hormone-producing gland, located at the front of the neck. It produces thyroid hormones (T4 and T3) that regulate our metabolic rate – our ability to make energy in our cells.

Thyroid Hormone Changes in Pregnancy

During pregnancy the body has a significant increase in metabolic activity – a lot of energy is required to make a baby! As such, the need for thyroid hormone increases. Women need approximately 40% more thyroid hormones during pregnancy to sustain the increases in energy needed for a healthy pregnancy.

Many women with thyroid disease are not immediately identified in pregnancy, as many of the symptoms of hypothyroidism (low thyroid function) are the same as symptoms of pregnancy. Weight gain, depression, fatigue, constipation and dry skin are all common in pregnancy and are also signs of an under-performing thyroid gland.

If you know prior to pregnancy that you have an underactive thyroid (half of people with hypothyroidism don’t know it), then increasing your thyroid medication soon after a positive pregnancy test is recommended. An increase in the medication dose of 25-40% is suggested for most women.

An underactive thyroid, challenged by the increased energy demands in pregnancy, may also be exacerbated by the increased clearance of iodide by the kidneys in pregnancy (all those increased trips to the bathroom have consequences as well!) Many prenatal supplements still do not contain adequate amounts of iodine to address this issue, worsening an already delicate hormone balance in pregnancy.

Consequences of Thyroid Disease in Pregnancy

Hypothyroidism in pregnancy is a serious health concern. Recurrent miscarriages have been found in women with even mild and asymptomatic thyroid disease. Increases in fetal death, birth defects, premature birth, low birth weights, placental abruption and intellectual disability have all been linked to hypothyroidism in pregnancy, especially in early pregnancy.

Hypothyroid is not the only thyroid concern that is problematic in pregnancy. The presence of autoimmune antibodies against the thyroid (TPO or anti-TG) can also increase the chances of miscarriage – in some studies doubling the risk of an early miscarriage.

Thyroid Testing in Pregnancy and Pre-Conception

Unfortunately, thyroid testing is not standard care for women who are trying to conceive, or who are pregnant. It is not even standard for women who have experienced an early miscarriage, in spite of the association of hypothyroidism and autoimmune thyroid antibodies and miscarriage.The demand for thyroid hormone in pregnancy increases most in the first half of pregnancy – especially in the first 6-12 weeks. This means we need to be testing women sooner – ideally before pregnancy, and certainly after a positive pregnancy test. Most experts believe that testing should be done before 9 weeks gestation – within the first month after a positive pregnancy test.

More comprehensive thyroid testing should also be offered to women trying to conceive, or who are pregnant. A simple TSH is not enough to fully assess the thyroid – autoimmune antibodies, T3 and T4 levels should also be tested.

And please keep in mind, the lab ranges for “normal” on thyroid testing are not the same as those that are optimal for pregnancy. Even mild or asymptomatic hypothyroidism, or any elevation in thyroid antibodies, can increase risk for an unsuccessful pregnancy.

If your doctor is unwilling to run these tests for you, speak to your Naturopathic Doctor. They can advocate for you, or run the tests to ensure you are getting the optimal support you need both before, and during, pregnancy.

The risks of not identifying a thyroid condition in pregnancy are significant. Don’t let a lack of knowledge, a lack of testing, or a lack of an appropriate diagnosis impact your pregnancy. Speak up, get the testing, and have a healthy, happy pregnancy.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Select References

Alexander EK, Mandel SJ – Diagnosis and Treatment of Thyroid Disease During Pregnancy. Endocrinology: Adult and Pediatric 7th Ed, 2016. Chapter 84; 1478-1499.

 

 

 

Understanding Hashimoto’s Thyroiditis

Hypothyroidism is a common condition impacting women, with women between 5-8 times more likely to develop this condition than men. The most common cause of hypothyroidism in Canada and the US is Hashimoto’s thyroiditis.

What is Hashimoto’s Thyroiditis

Hashimoto’s thyroiditis is an autoimmune condition in which the body’s own immune cells attack and destroy the thyroid gland resulting in decreased thyroid function (hypothyroidism). Hashimoto’s most often impacts young and middle aged women (20’s to 50’s) and can lead to permanent damage of the thyroid gland and lifelong hypothyroidism.

Symptoms of Hashimoto’s Thyroiditis

Hashimoto’s thyroiditis in it’s early stages is often silent with few to no symptoms. Some people experience a sense of fatigue or not feeling their best, but often do not seek medical care for these common symptoms.Winter hat

The symptoms of Hashimoto’s are indistinguishable from other forms of hypothyroidism:

  • Weight gain
  • Fatigue
  • Swelling
  • Muscle weakness
  • Constipation
  • Cold intolerance
  • Dry skin
  • Dry or brittle hair
  • Hair loss
  • Firm or nodular thyroid gland on palpation

Diagnosing Hashimoto’s Thyroiditis

All hypothyroidism is diagnosed using a thyroid stimulating hormone (TSH) level. TSH is produced in the pituitary gland and tells the thyroid gland to make thyroid hormones. If the TSH is too high, that means the thyroid is not working effectively and a diagnosis of hypothyroidism can be made.

In Hashimoto’s thyroiditis anti-thyroid antibodies (antithyroid peroxidase, antithyroglobulin) are commonly present. However they are rarely tested, despite the majority of hypothyroid cases being autoimmune in origin.

In my Naturopathic practice I always test for anti-thyroid antibodies to confirm Hashimoto’s and to monitor treatment.

Hashimoto’s and Autoimmunity

An autoimmune condition is any condition where the body’s immune system begins to attack the body’s own tissues rather than the viruses and bacteria it is designed to fight. Hashimoto’s thyroiditis occurs when the immune system attacks the thyroid gland. It is not in essence a thyroid condition, but an immune condition where the thyroid is the unfortunate victim.

Once a person develops one form of autoimmune condition they are more likely to develop others. The incidence of Hashimoto’s is higher in people with pre-existing autoimmune conditions such as celiac disease, rheumatoid arthritis, psoriasis, vitiligo and lupus.

Conventional Treatment of Hashimoto’s

Thyroid medicationConventional treatment of Hashimoto’s thyroiditis does not differ significantly from treatment of other forms of hypothyroidism. The main treatment is L-thyroxine (T4) taken daily in the morning. This T4 is then converted in the body to the active thyroid hormone, T3.

There are controversies regarding this treatment for Hashimoto’s thyroiditis. Studies have shown that combined use of T4 and T3 results in better relief of hypothyroid symptoms than T4 alone. This is accomplished by using a dessicated thyroid extract, prescribed to you by your Medical Doctor, endocrinologist or Naturopathic Doctor.

Another controversy in the treatment of Hashimoto’s is the lack of treatment targeted at the immune system. The use of L-thyroxine does not prevent or treat the inflammation and autoimmune destruction of the thyroid nor does it lower anti-thyroid antibodies.

Naturopathic Treatment of Hashimoto’s Thyroiditis

An experienced Naturopathic Doctor can be an amazing ally in the treatment of Hashimoto’s. Your ND can personalize a protocol that will address the root cause of your Hashimoto’s – an overactive immune system.

In Ontario your ND may be able to prescribe dessicated thyroid, provided they have obtained additional education and a license to prescribe.

Nutritional supplements, such as selenomethionine, may also be used to decrease autoimmune thyroid antibodies. Dietary support such as gluten avoidance, immunoglobulin food sensitivity testing, celiac testing, detoxification support, gut healing protocols and more can also be used to support the immune system and decrease over-reactivity.
More information on the Naturopathic treatment of Hashimoto’s Thyroiditis can be found in the following articles: Hashimoto’s and Gluten, Naturopathic Treatment of Hashimoto’s Thyroiditis, Hashimoto’s and Fertility.  You can also book an appointment with Dr. Lisa Watson, ND and get started on healing your Hashimoto’s now.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.