Hashimoto disease and pregnancy

Hypothyroidism sufferers may be wondering, what does this mean for me and my baby? This article will give you the information you need to stay healthy during your pregnancy.

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What role do thyroid hormones play in pregnancy?

The thyroid is a butterfly-shaped gland that sits at the base of your neck. It produces thyroid hormones which play a role in a variety of bodily functions like metabolism, regulating your gut health, sleep, cholesterol, reproductive health…and the list goes on.

Given its role in regulating ovulation and menstruation, poor thyroid function may lead to fertility problems. Hypothyroidism have not only been implicated in anovulation (failure to ovulate), it has also been shown to influence progesterone production, oestrogen metabolism, circulating levels of sex hormone‐binding globulin, granulosa cells (which surround and supply nutrients to developing egg in the ovary), as well as the eggs themselves [1].

What is Hashimoto’s disease?

Hashimoto’s or Hashimoto’s thyroiditis was first recognised by a Japanese physician, Hakari Hashimoto, and was formally recognised as an autoimmune condition in the 1950s.

In a nutshell, Hashimoto’s is an autoimmune condition in which our immune system forms antibodies against the thyroid gland and over time gradually destroys it. Most cases of Hashimoto’s disease unfold as a gradual attack on the thyroid gland, with blood levels of TSH and symptoms of hypothyroidism slowly escalating. Hashimoto’s often manifests as a “poly-endocrine autoimmune pattern”. This means that in addition to having antithyroid antibodies, it is not uncommon for Hashimoto’s patients to have antibodies to other tissues or enzymes as well. The most common are transglutaminase (Celiac disease), the cerebellum (neurological disorders), intrinsic factor (pernicious anaemia) and glutamic acid decarboxylase (anxiety/panic attacks and late onset type 1 diabetes).

Who gets Hashimoto’s disease?

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Hashimoto’s thyroiditis is at least 8 times more common in women than men. Although the disease may occur in teens or young women, it more often appears between ages 40 and 60 [2]. Your chance of developing Hashimoto’s disease increases if other family members have Hashimoto’s thyroiditis.

What are the symptoms of Hashimoto’s disease?

Hashimoto’s disease is a slow process and signs and symptoms during the first stages of the disorder often go unnoticed[3]. However, as the disease progresses many subclinical symptoms will start to appear:

Goitre, one of the first and most obvious sign of thyroid disease [4]
Fatigue and extreme tiredness
Unexplained weight gain
Increased sensitivity to cold
Constipation
Depression and lack of motivation
Morning headaches that wear off as the day progresses
Thinning of hair on scalp or excessive hair loss
Dryness of skin
Mental sluggishness
Puffy face
Prolonged and excessive menstrual bleeding

What causes Hashimoto’s disease

There are many things that may be causing or contributing to Hashimoto’s disease. Usually, it is not just one thing but rather a cascade of several endocrine and immunological pathways which create the perfect storm for a multifactorial endocrine disease.

There are 6 key areas we will investigate:

Genetics: there are genetic factors that may prevent the body from synthesizing necessary hormones or detoxifying harmful substances that may be toxic to the immune system as well as the thyroid gland.

Gut Health is a crucial part of the Hashimoto’s disease puzzle. Ongoing stressors such as medications, gluten, lectins and even stress can cause an imbalanced gut flora which can lead to increased gut permeability and trigger inflammation and an autoimmune reaction [5].

Nutrition: Nutrient deficiencies may play a part in the development of Hashimoto’s and hypothyroidism. Nutrients like selenium, zinc, vitamin D and tyrosine influence thyroid function and essential fatty acids modulate inflammation [6] [7] [8].

Environmental toxins: Past or ongoing exposures to toxins such as heavy metals, mercury, arsenic, cadmium, as well as solvents, plastics, and even pesticides can put tremendous stress on our bodies detoxification systems as well as being directly harmful to our nervous and endocrine system [9].

Infection: Research suggests association between bacterial and viral infections and just about every autoimmune condition [10]. Epstein Barr or Yersina enetrocolitica can create a situation called molecular mimicry in which the immune system, attempting to fight pathogens, mistakenly identifies our own tissues as the foreign invader and mounts an attack on it.

Stress: Chronic stress elevates cortisol levels and disrupts other hormone levels in the body, including the thyroid. Our practitioners can help you develop a stress reduction plan which might include improving sleep, practicing restorative yoga, meditation, more outdoor time, exercise, and mindfulness [11].

How does Hashimoto’s disease affect women?

As mentioned above, women are much more likely than men to get Hashimoto’s disease. Most problems happen when women develop hypothyroidism as it directly modifies their reproductive system:

Poor thyroid function may lead to heavier and irregular menstrual cycles.
Irregular menstrual cycles can make it harder to get pregnant. Studies show that almost half of women with hypothyroidism , due to Hashimoto’s disease, had problems getting pregnant [12].
Untreated or inappropriately treated Hashimoto’s disease can lead to poor pregnancy outcomes and complications.

How does Hashimoto’s disease affect pregnancy?

Pregnancy places profound physiological demands on the thyroid gland, which as a result, increases in size and ramps up production of the two key thyroid hormones (T4 and T3). This explains why the prevalence of thyroid disorders, such as Hashimoto’s disease, are increased during pregnancy, leading to negative implications for the long-term health of both the mother and child [13].

Does Hashimoto’s cause miscarriage?

Evidence is still inconclusive, however there is growing awareness that pregnant women with both hypothyroidism and thyroid autoimmunity have a greater risk of miscarriages during their 1st and 2nd trimester [14].

Does Hashimoto’s cause birth defects?

People with untreated hypothyroidism, due to Hashimoto’s, may have a higher risk of having a child with birth defects. Checking thyroid levels prior to conception and monitoring thyroid levels during pregnancy may help to ensure the appropriate intervention is taken to avoid these complications. Find out how we can assess your thyroid function with the use of our comprehensive functional tests here.

Hyperthyroidism in pregnancy effects on baby

Hyperthyroidism is much less common during pregnancy, approximately 2 out 1000 pregnancies are affected. Overactive thyroid function has been linked with low birth weight, preeclampsia, premature birth and very rarely hyperemesis gravidarum (severe nausea and vomiting) [15].

Can you have a normal pregnancy with hypothyroidism?

Yes, although untreated maternal hypothyroidism and subclinical hypothyroidism can result in adverse pregnancy outcomes, all of this can be ameliorated by personalised lifestyle and dietary changes alongside appropriate medication [16].

Getting pregnant with Hashimoto’s

As mentioned above, Hashimoto’s thyroiditis is associated with a higher risk of fertility issues including miscarriage and preterm birth. The good news is some research has proven those risks go down if the condition is diagnosed early and treated properly [17].

How can I get pregnant with Hashimoto’s?

At the London Clinic of Nutrition, we work under the functional medicine framework and we will investigate the root cause of your thyroid condition. We will create a personalised treatment plan based on your lifestyle, genetics, history and your lab work.

Within this personalised approach we support our patients’ health by optimising the following key factors:

Support your detoxification pathways
Eliminate excess sugar and gluten.
Address nutritional deficiencies.
Sleep and stress management.
Monitor your thyroid hormones often.

Treatment

In order to treat all causes of Hashimoto’s disease, it’s important to bring the immune system back into balance. Here are some of our general guidelines on how to reset the immune system, however if you have Hashimoto’s, we strongly recommend that you consult a knowledgeable practitioner who understands immunology and endocrinology and is up to date with the latest nutritional and botanical protocols for treating autoimmune disease.

Remove autoimmune triggers such as gluten, lectin, excess iodine, stress, leaky gut, environmental toxins, and infectious pathogens.
Rebalance the immune system with addressing Vitamin D deficiency and including pre and probiotic foods.
Reduce inflammation by implementing a phytonutrient and omega 3 rich diet.

How is Hypothyroidism from Hashimoto’s disease treated during pregnancy?

At the London Clinic of Nutrition, we combine industry-leading nutrition and functional medicine expertise, alongside the latest in-house testing, so we can attend to all your health needs in one trip. We are renowned for treating the ‘untreatable’. Our qualified and registered practitioners will work with you closely to create a personalised approach.

After birth

Can I breastfeed if I take medicine to treat Hashimoto’s disease?

According to NIDDK, certain beta-blockers and thyroid hormone medications are safe to use while breastfeeding because only a small amount gets transferred into breast milk. However, in the case of antithyroid drugs, your doctor will most likely limit your dose [18]. It is always best to consult your medical practitioner for advice regarding your medication.