This was the last picture taken of me before I gave birth to my daughter May 2016.
One of the most frequent questions I receive these days is, “How did you manage your thyroid while pregnant?” This is a poignant question because pregnancy and post-partum is infamous for sending the thyroid awry whether or not you have Hashimoto’s disease.
my back story…
I was diagnosed with Hashimoto’s at age 19 (10 years ago) and have been on some form of thyroid hormone replacement since then. In our community, we tend towards anti-medication but in the case of many autoimmune diseases, supporting the body through medication AND dietary and lifestyle changes is a true holistic approach.
My body requires supplemental hormone because the disease has significantly destroyed my thyroid prior to diagnosis and dietary changes. Once thyroid tissue is destroyed through autoimmunity or radiation, it will not produce the necessary thyroid hormone required for optimal metabolic function. This requires supplement through medication and it is incredibly important to adhere to your doctor’s advice regarding medication while pregnant.
A quick note on which thyroid medication I take:
I am one of the rare people who has a severe autoimmune attack to porcine thyroid hormone (Armour, Naturethroid, for example). In fact, the last time I took it, I launched into a 12-month long flare that ended during pregnancy. You will also likely find autoimmune disease remission during pregnancy as the immune system down regulates to protect the body from seeing your baby as an invader.
Instead, I do best on a synthetic combination of T4 (Tirosint) and T3 (liothyronine). Yes, I’ve tried compounded medication with a functional practitioner and my numbers do not stabilize well. No, I have not tried and will not try to go off my medication. Tirosint is a great option for those of you looking for additive-free synthetic thyroid medication. Ask your insurance if they will cover it.
My story with infertility is long, and I won’t be talking about it here. Instead, let’s start with conception to keep this focused.
I went into pregnancy in the middle of that autoimmune flare mentioned above. Women with Hashimoto’s do have an increased risk of pregnancies not being carried to term (I don’t like the word “miscarriage”). As a woman with Hashimoto’s, I knew I needed to be an educated self-advocate during pregnancy and beyond.
I did not let these statistics scare me though. Sure I had my moments of worry like most moms, but I trusted and supported and loved my body extra during this time. When I needed to calm my mind, I used prayer, meditation and journaling to comfort me.
I am sharing with you the process I put into place the moment I found out I was pregnant in August 2015 to best ensure a healthy mom and a healthy baby.
GET TESTED AS SOON AS YOU TEST POSITIVE
I found out I was pregnant in Hawaii on our way from moving from Chicago to Austin. I didn’t have an OBGYN in Austin let alone a general practitioner.
The day I found out I was pregnant, I called my health insurance company from our Kauai Airbnb to get the number of a gynecology group in Austin under our plan. I knew they may not be the perfect fit, but I needed to establish care as soon as possible so I could get my thyroid tested immediately.
But what if I don’t have diagnosed Hashimoto’s? Should I still get my thyroid tested?
My answer as a thyroid patient is YES. If you have suspected Hashimoto’s or hypothyroidism or have a family history, get your thyroid tested early in the first trimester. There is absolutely no risk to you to get this done but it can be risky to NOT know what your thyroid is doing in those formative weeks.
In fact, some thyroid experts advocate thyroid testing for every pregnant woman.
The office requested I only schedule my first appointment between 8 to 10 weeks pregnant, but I had done enough research on early pregnancy and Hashimoto’s to know I needed to get in sooner.
I was able to schedule my first appointment for 6 weeks. I would have preferred 5 weeks but they did not have availability. I requested a blood thyroid panel including TSH, free T4, free T3. I even got to see my baby as a little dot on a quick ultrasound (and hear her heart beat) during that appointment.
Backing up, I had a full panel done around the time of conception and knew my TSH, T3, and T4 were normal even though my antibodies were high from the flare. Just four weeks later at 6 weeks pregnant, my TSH increased from 1.0 to 9.0 and my T3 and T4 dropped.
The increased demand on your thyroid during the first trimester is no joke. If you have a damaged thyroid due to Hashimoto’s, your thyroid may not be able to keep up with this increase demand. Test early, test often, and test fully.
Test early, test often, and test fully.
We increased my thyroid dosage by about 50% to stabilize my numbers. At this time, I was only on T4 and not T3. In fact, during pregnancy, I could not find a practitioner to prescribe me T3 since it has not been studied in pregnant women. You may have a different experience with that depending on your practitioner. I got on T3 within a few weeks of giving birth. Even without supplemental T3, I was able to keep my T3 in the 50% range and had bounds of energy throughout pregnancy.
FIND THE RIGHT PRACTITIONER
Many thyroid patients will agree that finding the right practitioner, one knowledgeable in full thyroid panels and optimal levels (not just “in range” levels) is a necessity. Pregnant women especially must feel they are in good care with their medical team. Your OBGYN, midwife or general practitioner will likely be the one in charge of monitoring your thyroid while pregnant.
You’ll likely encounter a physician who doesn’t believe in testing T3. I did several times (endocrinologists are notoriously the worst about this ironically). I essentially “fired” those physicians but not before providing information on why testing T3 is so important for their thyroid patients. This topic is worthy of more than just a quick paragraph here.
Rather than having an endocrinologist follow my thyroid throughout pregnancy, I trusted my gynecologist. We worked together to establish a plan of care that included frequent testing, monitoring of symptoms, and extra care to ensure that Grace was growing adequately. Since mothers with unmanaged Hashimoto’s can have babies with low weight as well as an increased risk of pre-term labor, we wanted to monitor closely.
How I Self-Advocate with Physicians
Whenever I move to a new city or visit a new doctor, I am very clear about a few things. I tell them I am a seasoned thyroid patient, I know how to read my lab numbers, and I know when I need a change in medication. I have lived this and researched it for a decade, and I would like to be treated that way.
The only physicians who have responded negatively to this are endocrinologists so I refuse to see them anymore. Am I being harsh about endocrinologists? It may seem that way. But over ten years, I’ve had the exact (it’s eery) same experience with over a dozen of them. It angers me to see so many thyroid patients often poorly managed by these specialists.
Being this upfront may not be easy, especially in a world where we believe medical practitioners are above us. Remember, no one knows you better. Trust yourself, your experiences and your intuition. Your doctor is your teammate not your boss.
MONITOR & ADJUST FREQUENTLY
My doctor felt most comfortable testing my thyroid every 4 to 6 weeks throughout pregnancy to ensure stabilization. I informed her at my first appointment at 6 weeks that I tend to have a volatile thyroid that struggles with stress and hormonal changes (so prevalent in pregnancy and post-partum!)
This is another instance of self-advocacy in the hierarchical medical model. Speak up for yourself. Don’t be complacent with your physician. You know your body way better than they do. They know textbooks, they know previous patients. They do not know you. Help them get to know you.
Thankfully, I only had to adjust my medicine once during pregnancy in the first trimester and was able to maintain that dosage throughout. Your doctor needs to be well-informed on the thyroid ranges for pregnant women as they do differ from non-pregnant women. For example, the TSH range is quite a bit tighter than for non-pregnant women, and it also changes slightly the first to the second trimester.
Most providers will want your TSH below 2.5 for the first trimester and below 3.0 for the second and third trimester. My TSH stayed around 2.0 throughout my pregnancy, about twice as high as when non-pregnant. I was not concerned with this number after researching the increased demand on the thyroid. It makes sense my pituitary was sending out a “produce more thyroid hormone” signal to my thyroid.
That being said, be aware of your hypothyroid symptoms even if your numbers are in range, especially if they are at the higher end of the range. For example, I could barely walk up the stairs my first trimester. This symptom (what I call “stair fatigue”) is a classic hypothyroid symptom for me. I knew I needed to give the increased dosage a couple weeks to kick in before my symptoms would reside though. Once the meds kicked in, my fatigue quickly dissipated.
It’s important to know your body in this way. Get a sense of what it feels like to be hypothyroid and to feel well. Note those hypothyroid symptoms so that if and when they appear, you can get yourself to your doctor for testing.
SUPPORT YOUR THYROID WITH DIET & LIFESTYLE
I started the autoimmune protocol in 2014, about 18 months before getting pregnant. In fact, it was key in helping me reverse my infertility diagnosis. I didn’t use pregnancy as an excuse to go wild on cravings though. If there’s ever a time in your life to treat your body with respect, it’s during pregnancy and post-partum.
The nutritional and energy demands of a woman’s body during this time are astounding. I made a pact with myself to stick as closely to the principles of the autoimmune protocol as possible during pregnancy and post-partum. Note that I said the principles of the protocol and not the elimination phase of the protocol.
For me, this meant including foods I knew I tolerated well such as soaked organic white rice cooked in broth, dark chocolate, seed spices and treats like store-bought coconut milk ice cream. This allowed me to focus on nutrient density while still having fun with food and listening to my body.
I would be lying if I said I ate “perfectly healthy” my entire pregnancy. I am not a diet perfectionist by any means. My food choices stem from my intuition, my mood, the social setting and frankly what’s in my fridge. While I ate dark chocolate most days, I also never skipped a meal. I had three balanced meals each day that included protein (a must!), leafy greens (folate!), starchy veggies (glucose!) and fats like avocado or coconut. I wish I still ate like that post-partum!
I personally do not believe in attempting low carb and ketogenic diets during pregnancy. I only mention this because they are trending hard right now. I am so happy for all the people these diets heal and bring happiness. If you naturally eat low carb (and you’re being honest with yourself about it being natural), then continue to listen to your body.
But if you are truly craving sweet potatoes, dried mango or a bowl of freakin’ cereal, then YOU get to decide if you eat that or not. Not a diet guru. In fact, I had gluten-free cereal several times during pregnancy. I also distinctly recall eating a bowl of rice with coconut aminos at 3 am because I woke up craving it and was starving (2nd trimester hungry, if you know what I mean).
My pregnant body craved SPECIFIC foods like citrus, mango, berries and sweet potatoes. And I don’t blame this on being a “sugar-burner” (so many opinions on that terminology, by the way). These are common food cravings for pregnant women for good reason – our bodies demand all of that folate, vitamin C and glucose they’re asking for. WE’RE BUILDING A HUMAN. Be easy on yourself but also treat your body with respect and let that be reflected on your plate, with your sleep, your stress management, your movement and your relationships.
It is my goal one day to provide a more inclusive guide of managing autoimmune disease during pregnancy. Until then, I hope this article provided you with some helpful, actionable information to protect your thyroid health during pregnancy.
Hypothyroid Mom is an excellent resource for additional information on fertility and pregnancy. Dana Trentini is also the author of Your Healthy Pregnancy with Thyroid Disease. You can also order your own full thyroid panel with a coupon code on her website.
Looking for post-partum support? I found Dr. Jolene Brighten’s book Healing the Body Naturally After Childbirth helpful.
Disclaimer: I am not a medical practitioner, and I will not be able to answer specific questions regarding your health state. I am here for emotional support and to provide hope. The information in this article is based on my personal experience and research.