Autoimmune disorders such as Hashimoto’s thyroiditis, Lupus, Celiac disease and Diabetes have all been shown to have a potentially negative impact on both fertility and pregnancy outcomes showing higher rates of infertility, miscarriage and preterm deliveries. Due to the potentially negative outcomes, it is important for women of reproductive age to be properly assessed for potential autoimmune conditions before trying to conceive. This is particularly relevant when it comes to Hashimoto’s thyroiditis as it often goes undiagnosed.
Hashimoto’s thyroiditis is the most common cause of hypothyroidism or underactive thyroid function. It is very common and affects up to 4% of the population. Hypothyroidism is a condition in which the thyroid doesn’t make enough thyroid hormone either T4 or its active form T3. Some of the symptoms of hypothyroidism include weight gain, mental fog, dry skin/hair/nails, constipation, difficulty regulating temperature (generally presents with feeling cold) and fatigue. When we look at thyroid function there are 5 lab values of relevance.
1. Thyroid stimulating hormone (TSH) – this is a hormone that comes from the pituitary and tells the thyroid to make thyroxine (T4)
2. Thyroxine (T4) is a hormone made by the thyroid
3. Triiodothyronine (T3) is a thyroid hormone that is made through the conversion of T4. T3 is the hormone that works actively in our cells.
4. Thyroid peroxidase antibodies (TPO). These are antibodies that can be a sign of Hashimoto’s thyroiditis. You can also see TPO antibodies in a condition called Graves’ disease. This is also an autoimmune disease and the most common cause of hyperthyroidism. Hyperthyroidism is a condition in which the thyroid makes too much of certain thyroid hormones.
5. Thyroglobulin antibodies (Tg). These antibodies can also be a sign of Hashimoto’s disease. Most people with Hashimoto’s disease have high levels of both Tg and TPO antibodies.
TSH tells the thyroid to make T4. Then T4 goes out into circulation and converts into T3. T3 is active in our cells and regulates several processes in the body including metabolism and temperature regulation. Once T4 and T3 reaches a level where the cells are happy, feedback is given to the pituitary to slow down the production of TSH. If not enough T4/T3 is getting into the cells, we will see the TSH levels increasing on our lab work.
A combination of looking at all five of these lab values is needed to properly determine if a patient has Hashimoto’s and to determine if treatment is working.
When it comes to pregnancy if a woman has elevated antibodies, even with other thyroid labs values being normal, it can still have a negative impact for reproductive outcomes.
How can we lower elevated antibodies?
Research has shown some patients with Hashimoto’s are sensitive to a protein called gluten. If you have a gluten sensitivity (gluten is found in grains including wheat, rye, spelt and barley) this can promote inflammation in the body and therefore contribute to thyroid symptoms. Gluten has a similar appearance to thyroid tissue so in some cases, when the immune system starts attacking gluten, it also will attack the thyroid tissue. The same mechanism can happen with corn. For anyone who has seen elevated antibodies it is a great idea to start by eliminating both gluten and corn from their diet for at least three months. Repeat the antibody testing after three months to see if numbers have improved. For some patients, I find it helpful for them to follow a modified paleo diet to reduce overall inflammatory load. This involves focusing the diet on lean proteins, healthy fats, lots of fruits and vegetables and limiting any processed or packaged foods, sugars and grains.
The oil of an Indian seed called black cumin has research showing it can help lower TSH as well as antibodies. It also works to help reduce inflammation – a very useful oil when it comes to supporting patients with Hashimoto’s.
Curcumin, which is an extract from a spice called turmeric, also has some great research promoting a healthy immune balance by changing the body’s response to inflammation. Over time it can shift the immune system function to reduce its attack on itself.
Omega 3 fatty acids, predominantly derived from fish, help our bodies to promote a healthy response to inflammation. Most people in North America are deficient in omega 3s which can promote pain and inflammation in the body. Fish oil can also help improve the signalling of thyroid hormone within cells. As the feedback loop improves, we will see a natural lowering of TSH levels.
For patients that have elevated TSH levels it is recommended that, along with diet changes, they also use a thyroid medication such as levothyroxine. Ideally, this will result in their lab values normalizing and antibody levels coming down. For other patients though, being on a thyroid medication may normalize their TSH, T4 and T3, but their immune system can still present elevated antibodies showing it is still actively fighting itself.
Regulating thyroid function or other autoimmune conditions is essential to conceiving and being able to maintain a healthy pregnancy. If you suspect you have any thyroid related symptoms, have your blood tests run with your health professional so you can work to optimize these levels before your pregnancy. Once you do have a positive pregnancy test you should continue to monitor your blood levels especially during the early stages of pregnancy. This is a time where we can see a lot of fluctuation and adjusting medication levels may be needed.
Autoimmune conditions such as Hashimoto’s thyroiditis can be complex to manage, so please seek the care of your health professional for support.
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