In this episode, Dr. Eric Osansky welcomes thyroid patient advocate, speaker, and bestselling author Rachel Hill to discuss her book, The Positive Thyroid Pregnancy Book. Drawing from both her personal experiences and years of supporting thyroid patients, Rachel shares practical guidance for navigating fertility, pregnancy, and postpartum health while managing hypothyroidism and Hashimoto’s thyroiditis. While her focus is primarily on hypothyroidism, much of the conversation applies to anyone dealing with thyroid or autoimmune thyroid conditions.
Together, they explore some of the biggest challenges thyroid patients face when trying to conceive, including infertility, miscarriage risk, thyroid antibody management, medication considerations, and optimizing thyroid hormone levels. Rachel also discusses the importance of tracking thyroid labs throughout pregnancy, reducing thyroid antibodies before conception when possible, supporting gut and immune health, balancing blood sugar, addressing nutrient deficiencies, and understanding the role of hormones, diet, exercise, and environmental toxins in fertility and pregnancy outcomes.
The conversation concludes with practical advice on prenatal supplements, postpartum thyroid health, building a supportive healthcare team, and advocating for yourself throughout the entire pregnancy journey. If you want a clearer understanding of how to prepare for a healthy pregnancy while managing a thyroid condition, you’ll get a lot out of this episode.
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Dr. Eric Osansky:
I am super excited to chat with Rachel Hill, who is the multi award-winning thyroid advocate, speaker, and best-selling author behind The Invisible Hypothyroidism and four thyroid patient books. In this conversation, we will be talking about her book The Positive Thyroid Pregnancy Book. Rachel, thank you so much for joining us.
Rachel Hill:
Thank you so much for having me on. I’m really excited to discuss a really important topic today.
Dr. Eric:
Same here. You’ve written a number of different books. The question I’m about to ask is, why did you write The Positive Thyroid Pregnancy Book? I assume it’s your own experience, but there is also not a lot of information out there when it comes to thyroid and pregnancy. Were those two of the biggest motivating factors? Maybe there were other reasons, too.
Rachel:
I’d say you hit the nail on the head there. I have one called The Patient Expert about navigating a new diagnosis. One about relationships with your spouse, friends, and family. For me, writing has to come from an organic place. It’s often a representation of where I am in my own thyroid journey.
I now have two sons who are six and four. When I went through my own pregnancies, it was an overwhelming time of not knowing where to turn for this information. I think there are one or two books out there. They can be quite clinical. They are written by doctors, brilliant doctors, but they are not easy for someone who is perhaps brain fogged, fatigued, with these typical thyroid symptoms. It’s not easy for us to digest. They can be really long books.
I wanted to create something that had all of the essential information but without all the fluff and jargon. Just the need-to-know information that we thyroid patients can go ahead and implement.
My work is always there to be utilized alongside your doctor, functional medicine practitioner, chiropractor, whomever you’re working with. I want thyroid patients to feel empowered to know what they can do specifically and what questions to ask in the doctor’s office. How to advocate not only for themselves but for their unborn child when they are pregnant.
Writing The Positive Thyroid Pregnancy Book is something I pieced together over 3-4 years of going through a couple of pregnancies that were incredibly different. One with a thyroid condition well managed, and the other one was the complete opposite. It gave me a lot of personal experience to use as well that will hopefully not only help the thyroid patients but give them validation for what it is we go through.
I really wanted to put some difficult experiences into something useful. It was important to me that it was a positive book to read, hence the name. When you Google “hypothyroidism pregnancy,” thyroid in general and pregnancy, fertility, it’s doom and gloom. At least when I was Googling, “chances of miscarriage,” you end up going down this terrible black hole. It’s not positive information that comes up.
When we get to the truth of it, thyroid patients can have children. We just need to know this crucial information in order to help support ourselves with the best chances of getting there. That’s why I created it.
Dr. Eric:
Wonderful. Glad you did create the book as well as your other books. Let’s start by discussing some of the biggest challenges women with thyroid conditions experience when they are trying to have a healthy pregnancy. If you want to tie it into some of your own experiences, I’m sure you have seen a lot of different experiences from other women who were pregnant with hypothyroidism/Hashimoto’s.
Rachel:
The single biggest struggle that we have is falling pregnant. A lot of people don’t realize how important their thyroid gland is for their fertility.
Second to that is being able to hold onto the pregnancy. I experienced a miscarriage as my first pregnancy, which was a trigger for me feeling like, “Okay, I need to understand more of what I can do, more of what is going on,” and delving into that research. I found so much that thyroid patients don’t know. It’s not easily accessible, or at least it wasn’t before I wrote this book.
Understanding the T4 synthetic medications, like levothyroxine or Synthroid, they work for a lot of people, but they don’t work for everyone. When I say “work,” we’re not just talking about getting your thyroid test results normal. We are talking about actual symptoms and your quality of life and whether your thyroid test results are optimal as opposed to normal, fine, or in range, all these phrases we all hear. That alone can be the biggest step we can make to combating fertility struggles, pregnancy loss.
It’s such a simple thing, yet a lot of us don’t know to ask those questions to get a copy of our own test results and look at them and understand them. When it comes to the biggest issues that we face, that pregnancy loss, falling pregnant, they’re often the biggest ones. It’s just about how we can then navigate that and understand what we can ask to overcome those.
Dr. Eric:
Thyroid hormone replacement, I’m glad you brought that up because a lot of women are on levothyroxine. Some women do fine with it, and some don’t. You need to convert that T4 into T3. That’s a big problem.
Do you have a preference? It is individual, but I don’t know if you personally take levothyroxine or if you like desiccated thyroid. Is desiccated thyroid safe to take during pregnancy? There is also some debate. If you ask conventional medical doctors, they would say no, that you need to be on levothyroxine. I’d love to know your thoughts about what is safe, what is optimal during pregnancy when it comes to thyroid hormone replacement.
Rachel:
I always say there is no one best thyroid medication. It’s the one that works best for each person. When we say that it works best for you, we are looking at optimal thyroid hormone levels as well as symptom relief and overall quality of life.
For me, I am currently on Armour Thyroid plus a small amount, 25mcg, of levothyroxine on the side. This is not very conventional. It was something that I was almost hesitant to share when I first made that switch because a lot of people are very opinionated on thyroid medication options.
When I was diagnosed almost 11 years ago now, I was started on levothyroxine. I felt awful. I was gaining more symptoms, gaining weight. My mental health was down the drain. I then explored the route of natural desiccated thyroid medications. I started off self-sourcing that from Thailand because here in the UK, it’s incredibly hard to get, if not impossible, through our national health care system.
When I knew, and this is something I talk about a lot in the book, that I wanted to start a family, it was important for me to move from self-sourcing medication to having it prescribed. It was never something I wanted to do long-term. It was more a stopgap to get my health back enough that I could function at work.
This is something we don’t hear a lot about. There are thyroid patients who are not optimally treated where it impacts their work life, relationships, absolutely everything. Once I was well enough to be able to digest and understand this thyroid research, I could find a private doctor here in the UK to prescribe.
I have been on Armour Thyroid up to seven years. Levothyroxine was added in after my first pregnancy. The Armour Thyroid was no longer optimizing all my levels on its own. My free T3 was great. TSH was fine. But my free T4 was quite low. We tweaked and tried things, and adding that small amount of T4 in is what got me to my happy place, where I am optimally treated now.
Going forward, that has to be closely and consistently checked in with, moderated. Needs can change over time.
Through my first pregnancy, I was just on Armour Thyroid. Textbook pregnancy, very easy, very straightforward, no major issues. Second pregnancy came along. By this point, I was on both Armour and levothyroxine. My levels would drop very quickly. I think it happened three or four times by the time I was six months pregnant. The Armour didn’t need adjusting until I was about seven months pregnant. The levothyroxine was all over the place. That was a lot harder to keep on top of.
For that reason, as well as many of the guidelines I referenced during the book as well, I am a big advocate of women having their thyroid levels tested every 4-6 weeks throughout pregnancy. We all react so differently. Each pregnancy can be individual. Each woman is individual. Each thyroid condition is individual. You never really know how your body is going to react.
I am an example of a woman who had two very different reactions and needs in terms of those thyroid medication adjustments. Obviously, for people who are just on levothyroxine alone, they do often find they need that medication increase almost as soon as they find out they are pregnant. That need increases.
In terms of medication options, I am a big advocate of each person finding what works for them, in their pregnancy as well. You will find more conventional doctors are not as keen on using T3 medications. They will argue that it doesn’t pass through to the baby, that T4 is what’s needed for the baby to grow.
I would argue that T3 is important for Mom to feel well, that Mom also has to have energy, good mental health, and be able to focus and feel well throughout her pregnancy. I am not a fan of the one size fits all that we often see in the thyroid world.
It is worth knowing that you might get pushback from certain doctors if you aren’t someone who does well on levothyroxine. Ultimately, if you feel like you need T3 medication, it’s important to get stabilized on that before falling pregnant. You want to get stable and settled on that before a pregnancy. Once you are pregnant, it’s much less likely that a doctor will suddenly change your thyroid medication.
There are a lot of things to consider. Ultimately, we want to find what works for each person in order for you to feel well and grow a happy, healthy baby and have a happy, healthy pregnancy.
Dr. Eric:
Agreed. When it comes to testing, what do you recommend testing? Just TSH, free T4, free T3? Anything else?
Rachel:
Thyroid antibodies. Being a thyroid advocate for Hashimoto’s and hypothyroidism, there are antibodies. TG and TPO are the two that can be really helpful. Before getting pregnant, checking if you have Hashimoto’s, which over 90% of those with hypothyroidism do. If possible, trying to reduce those thyroid antibodies.
Unfortunately, there is no one magical thing that works for everyone with that. We often have to try different things. Some people are really stubborn. If you’re able to reduce those before you fall pregnant again, that can help with fertility. Monitoring them throughout pregnancy can be helpful. Checking them every month is probably not necessary. A couple times throughout your pregnancy is fine.
What most people find, and I had this as well, is Hashimoto’s and thyroid antibodies often go really low, if not down to zero, when you’re pregnant. There is a change that happens, Th1 to Th2, that happens when you’re pregnant. This often puts a lot of health conditions into remission. They flare back up when you’re post-partum. That’s normal. As I talked about in the book, knowing how to prepare for yourself and not getting angry at your body when that happens. Since it’s expected to happen, knowing what to do is often the best way forward.
Throughout the pregnancy, TSH, free T3, free T4, absolutely should be checked all the way through. Aiming for them to be optimal as opposed to just within range will support your pregnancy as much as possible.
Dr. Eric:
Any reason to look at reverse T3 before or during pregnancy?
Rachel:
I am more mixed on this one. It can be helpful in showing up if there are other stresses going on in the body. When you’re pregnant, I would hope or promote that people do things to keep that low anyway. Pregnancy is a stressor. Seeing that rise throughout pregnancy wouldn’t be surprising.
I like to focus on what we can do instead of the things we can’t control. Anyone who has gone through pregnancy will tell you there is a lot you can’t control. It’s not about wanting to control everything. It’s about understanding what is reasonably in your control that you can do that won’t add further stress at the same time.
Dr. Eric:
Makes sense. With the antibodies, you mentioned that if you can, you want to try to lower and normalize them before pregnancy. As you mentioned, with immune shifts, they might normalize during pregnancy anyway. If someone has elevated TG and/or TPO antibodies and are trying to conceive, even if they are not successful in lowering or normalizing them prior to conceiving, they could still conceive and have a healthy pregnancy, correct?
Rachel:
Yeah. The thing with wanting to lower them is your risks of miscarriage are higher if you have high thyroid antibody levels. I always recommend, if you can give it time, to give it 6-12 months to try to lower them through various things.
We know selenium supplementation can help. Vitamin D has been shown as well. I am not a fan of supplementing with things we don’t necessarily need. We don’t want to give ourselves problems by having really high levels of Vitamin D, for example. That won’t help. If you are doing blood tests and can see there is room to top that up, and we are already low in it, that can help.
In terms of diet, going gluten-free, that reduced my thyroid antibodies. It didn’t even measure past a certain number. It said more than 1,300 for my TPO. I got them all the way down to 40 just by going gluten-free.
Blood sugar balancing. Reducing alcohol. Going dairy-free can help. Gluten is the biggest one. Optimizing your thyroid hormone levels alone can help with thyroid antibody levels. Improving your gut health. Keeping your nervous system and adrenals in check. There are so many things you can try. I often describe it like a big jigsaw puzzle. There are often a few different pieces that we can slot in, and that gives us results.
As I said before, there is no cookie cutter approach of what can help reduce thyroid antibody levels. It’s some sort of trial and error and some digging into what triggered your thyroid condition in the first place. That can often unearth areas we can work on and improve as well. Naturally, when you’re feeling less stressed, those thyroid antibodies tend to drop down anyway.
Look at reducing them before pregnancy. It gives us a better chance of holding onto a pregnancy and falling pregnant in the first place and having that healthier pregnancy throughout those nine months.
We do have to appreciate that a lot of people spend years trying to lower them, and they haven’t found anything that has worked either. Women hear all about this biological clock. As much as I do want to promote that women can also have a career and do other things, that we are not just here to produce children, we do need to be aware of the biological clock if we want to optimize our fertility.
It does drop off from as early as 28 years old. For a lot of people, they are not having children in their 20s, so if they get into their 30s and may want to delay it longer for the sake of trying to reduce thyroid antibody levels, there has to be a balance struck between what is reasonable and when perhaps it is time to go forward and see if it still happens for you.
I talk about this in the book. There is no perfect time. Your thyroid health is just one side of it. There are other parts in your life that you are weighing when it is time to start or expand your family. It’s a really personal decision. We have to figure out what makes the most sense for us.
Dr. Eric:
When trying to prevent miscarriages, having healthy thyroid hormone levels, doing your best to lower thyroid antibodies. Anything else that women can do, like optimizing sex hormones or any other tips you can give to prevent miscarriages from happening?
Rachel:
There is a phrase we hear a lot, estrogen dominance, in our community. Whether that is strictly a health issue within its own right is hotly debated. I was someone who did have high levels of estrogen throughout my cycle when I shouldn’t have. My skin was so oily, my hair was falling out, I had frequent migraines. At the time, I was working with a functional medicine practitioner. Whether people debate that is a real thing or not, what she did with me in terms of improving, it is embarrassing. People don’t talk about it. Things like your gut health, bowel movements, it certainly helped me, and it improved my fertility.
I went from not regularly ovulating. My cycles were 10 days long, then 40 days, then 20 days, all over the place. Working on supporting that natural flow of hormones, where your estrogen is building up for the first half of the cycle, and then progesterone is taking front and center. Working so we are seeing more of that natural shape, the curves we want to see, definitely helped me regulate my cycles.
Instead of focusing on just estrogen or progesterone being a certain number, which is tricky because they fluctuate throughout the month, so it’s hard to know where that should be. Focusing more on having regular healthy menstrual cycles, aiming for that 30-40-day regular cycle, getting to know what is normal for you will reflect what your hormones are doing for you than zoning in on a specific hormone.
When I’d gone from these irregular cycles to seeing them being 28-30 days every month, being able to pinpoint when my body is ovulating, once you understand your cycles, and you can take a basal body temperature reading to help with this, there are many other ways that you can track your cycle. It helps you with your fertility.
People don’t understand that you’re only actually fertile for a few days each month. That alone can help you pinpoint the window that you are going to be fertile that month and hopefully get you on the journey to becoming a parent.
I am hesitant to zone in on specific hormones. Working with a practitioner who knows how to help you get to the point of understanding your cycles and where possible regulating them more and understanding the flow, that can be incredibly helpful. That is where I stand with those things.
Dr. Eric:
I don’t know if you have the answer to this, but are you aware of any research about exposure to endocrine disrupting chemicals? We are exposed to a lot of toxicants and microplastics. I’m sure they affect fertility, but I don’t know if increasing miscarriage rates has been researched.
Rachel:
Not super specifically. When they talk about endocrine disruptors, that can impact your hormones and your thyroid and cycles. I would suspect there is a link in that way. I think there is. Space to talk about this stuff and give people tips on how to maybe reduce exposure in certain ways. I wouldn’t want people to stress so much that that stress is impacting their fertility or a chance for pregnancy.
There is that balance. I talk about this balance in terms of diet and exercise. You don’t want to ignore that stuff completely, but there is a balance that we want to find where it is helping us instead of hindering us.
Dr. Eric:
Let’s talk more about diet. You mentioned gluten-free. Of course, you want to eat whole, healthy foods as much as you can. There are diets like AIP. A lot of people with autoimmunity follow a carnivore diet. There is debate on how much protein you should have in general. If you could touch upon some of these topics. There is no perfect diet that fits everyone.
Do you recommend a certain amount of protein for women who are pregnant? When it comes to diets, are there concerns about restrictive diets? I recommend AIP a lot. It’s restrictive, but it’s also nutrient-dense. We could make that argument with carnivore. Are there any concerns you have about any of these diets? If you could talk about protein and fat needs for pregnant women.
Rachel:
Like you said, I don’t recommend any one diet for everyone. We have to find what works for us. We react differently to different foods, especially thyroid patients. Gluten, dairy, they are the big ones. Eggs, all grains, soy. That could be anything from a digestive issue to something more subtle, like headaches or fatigue, which could take a while to pinpoint down to food.
When it comes to diets like the AIP diet, you probably have more to say as a practitioner on this than I do. I understand it to be more of a temporary diet that you would do for a certain amount of time to reduce inflammation, to help give the gut time to heal, to get back to a good place, to identify trigger foods. If foods are causing digestive complaints, headaches, skin rashes.
In terms of an example, with AIP, when you’re pregnant, you probably want to be eating a lot of whole foods, a lot of variety. Those sort of restrictive diets would be done before you’re pregnant and/or trying to conceive. I talk in the book about having this 6-12-month period of getting all your ducks in a row, getting your health in as best a place as possible, so you can go into pregnancy with your mind and body prepared for it and with as good a chance as possible of having a positive experience.
With those more restrictive diets, they are not recommended once you become pregnant. By all means, if you do need to do those for a certain amount of time to reduce your thyroid antibodies and give your gut time to heal. Gut health is such a big part of this thyroid jigsaw puzzle for so many of us. That can be helpful.
Fiber and protein needs. I don’t follow a specific amount. Here in the UK, they currently recommend 30g of fiber a day, which I don’t think is that much. When you see it in front of you, there is room to improve that.
When it comes to protein, national recommendations aren’t a thing over here. What I do know, and what a functional medicine practitioner told me years ago, which completely changed my approach to food and feeling satiated, blood sugar balance, when building a plate of food, aim for it to be 1/3 protein, 1/3 carbs, 1/3 healthy fats. If you can increase protein and healthy fats on your plate, great, but do not have more than 1/3 of carbs on your plate as you’re looking at it. That then more or less creates a meal.
You can do it with your snacks as well. If you are going to have an apple, you probably want to have olives or nuts alongside as well. That will give you more energy to keep you going for longer, stay focused, keep the headaches and fatigue at bay. You will hopefully also look after your gut and address things like constipation. You are more likely to have constipation and brain fog and fatigue.
Sometimes, making these principles safe to look at when you’re building a plate of food can be one of the best ways forward. What people who are already tired or brain fogged don’t need are complicated changes to their day to day. I am a big fan of making these really easy to look at and form day to day instead of things being another roadblock. That is my approach to things like protein, healthy fats, and fiber, not just through pregnancy or trying to conceive.
There are some easy dietary changes you can make day to day. We know about reducing ultra processed foods. We know most of us are not eating anywhere near enough fiber. With simple changes like swapping out regular white basmati rice for brown whole grain rice, or the same with pasta. Over here, we have a lot of lentil pasta. Really easy swaps, naturally gluten free for people who can’t have gluten. They can make such a positive impact on your gut health, bowel issues, fatigue, headaches. A big advocate.
We are not drinking enough water for the most part. It’s such a common thing. It’s free. People forget it all the time. It’s one of the biggest ways you can improve your mental focus and energy. People don’t realize how dehydrated they are.
Dr. Eric:
Agreed. What about exercise? Too much, too little during pregnancy when dealing with a thyroid condition?
Rachel:
One thing I learned was to listen to my body to figure out not only what was working and not working throughout each stage of pregnancy but also day to day. Your hormones are fluctuating so much. One week your body will go through a lot of growth to grow the placenta. The baby goes through a rapid period of growth. You’re more tired and hungry. Sometimes, we don’t only need to consider what is working for us in terms of a trimester or pregnancy in general. It can fluctuate day to day.
I would have an aim of going swimming twice a week. I went to a prenatal yoga class once a week. I walked every day. As pregnancy progressed, the walks became shorter and shorter because of pain setting in when you get more pregnant. I used to do salsa dance classes. I couldn’t keep them up because my center of gravity was changing as the belly grows. I almost tumbled and fell over a few times. I had to pause it after pregnancy.
There are things we can do in terms of keeping an eye on day to day. One day, you might be able to go for a 30-minute walk. The next day, you can only manage five minutes. Maybe keeping a log of these things. Is this more of an overall trend? Do I need to get my iron checked? So many people who are pregnant and thyroid patients all have low iron levels, which can make exercise hard. Or is it just my body is doing a lot more growth this week? Am I not sleeping well? Getting to know your body can be so important.
If you’re exercising while pregnant and having heart palpitations, dizziness, back pain, long lasting fatigue, thyroid flares, which is a period of your thyroid symptoms flaring up, those are signs that the current exercise may not be working for you. It could be too strenuous. It could be that you’re doing too much. It could be the time of day. When I was pregnant, I felt best late afternoon, so that was when I would get my exercise in or go swimming. All these things are really important.
As long as you are keeping your body moving throughout pregnancy, that will do so much more for your health rather than writing all exercise off or pushing and doing too much. Yoga, walking, swimming, all of those are perfectly safe for most pregnant people. If you were lifting weights or doing strength training before pregnancy, that is often okay to continue during most of pregnancy.
You are more likely to injure yourself once you’re pregnant because of the hormone relaxing. It relaxes a lot of your body and joints. We have to keep things like that in mind. Ultimately, when your energy is going up and down, you just need to check in and tune in with your own body and listen to what is and isn’t working.
Some exercise is better than nothing. If you’re having a hard day, some simple yoga stretches or a walk around the garden can still be beneficial for your physical and mental health.
Dr. Eric:
You spoke a little bit about the immune system. We chatted about how the antibodies might normalize during pregnancy because of Th1/Th2 balance. Also, a lot of women do experience post-partum thyroiditis. Is there anything women can do not to completely prevent post-partum thyroiditis from developing but minimize it?
Rachel:
In terms of post-partum thyroiditis, it is most often triggered by that immune change, as far as I can understand. Continuing through pregnancy the things that might keep your Hashimoto’s under control if you have been lucky to get to that point can help. Things like learning to regulate our nervous system, looking after our adrenal health, things like that can go quite a long way. Not just for managing or trying to avoid post-partum thyroiditis, but also the thyroid crash that happens when you’re post-partum.
If you have practices in place that help you feel calm and the opposite of fight or flight nailed down pre-pregnancy, hopefully throughout pregnancy, post-partum, those things alone can go a long way to helping you get your health back to a more stable place.
I personally had my functional medicine practitioner on speed dial. When I’m post-partum, my thyroid antibodies will probably go crazy. I imagine things like iron will drop after giving birth. I had all these ideas. My thyroid levels will go up and down. I had her ready to contact.
I was actually pleasantly surprised when I had everything tested six weeks post-partum that everything had settled nicely on its own. It wasn’t until I was six months post-partum that things started to go awry.
When I spoke to her, she said I probably did quite a good job of trying to do things to support keeping my body in a place where it feels safe throughout pregnancy and post-partum. Once that bundle of joy is here, and they are keeping you up throughout the night, and they are screaming during the day, your body turns to what is more familiar. That regulation of feeling like you have things down day to day tends to change. She says she sees it more at that six-month mark.
I had a conversation with Dr. Izabella Wentz about this as well. She said the same thing. It seems really common. I would say it’s helpful to have that plan in mind. What can I do to promote this during pregnancy and post-partum?
If things do go pear-shaped, you can only do so much. Pregnancy and giving birth is such a huge stressor on our body that we have to be kind to ourselves and remember we can only do so much. That’s okay. Give yourself grace. Know what those next steps are going to be. That alone can give your body a lot of comfort and knowing that you have thought ahead, and there is a plan if you need it.
Dr. Eric:
How about supplementation during pregnancy? I assume you recommend a prenatal vitamin. Do you recommend anything else? Does it depend on the person? Are there any essentials for supplementation?
Rachel:
A good quality multivitamin that delivers all of those key nutrients that your body needs when you are growing a pregnancy, including omega-3 fatty acids and DHEA. They often get missed out. Those are important for mom and baby throughout pregnancy. That is usually where we start.
From there, a lot of people often need extra iron. We don’t want to be supplementing iron if we don’t need it. A lot of people have high levels and don’t have a clue. Throughout pregnancy, you want to be running everything through your providers.
I recommend having more of a health care team throughout pregnancy. You might have a primary care doctor. You might have a functional medicine practitioner, a naturopath, something like that, alongside. Here in the UK, we have midwives as well. It can be helpful to have this team to bounce all of these ideas off of different people who have different inputs and specialties and the ability to test different things.
When you are looking at iron, vitamin D, make sure to test before you take.
Folate. Methyl folate specifically. You want methylated folate because a lot of people don’t do anything with regular folate. Those are important.
It’s more important to be supplementing the right things when you are optimizing your fertility. You don’t want to fall pregnant and realize your iron is quite low. That can take ages to build back up in your blood. That can take months to get to an optimal place.
Things like Vitamin D as well. Zinc. You need healthy iron, Vitamin D, and zinc to have good fertility. This goes for men as well.
In terms of supplementation, I fully recommend people get a full workup when they are thinking about starting a family and improving that before conceiving. When you fall pregnant, it’s about keeping up with what your body really needs.
Testing your thyroid levels throughout pregnancy. Key vitamin levels like Vitamin D, B12, iron, ferritin. That can be checked in probably every few months to keep a close eye on it.
If you are particularly fatigued, check those things sooner. It’s easy for doctors to write off tiredness and brain fog as normal pregnancy symptoms, but it could be low thyroid, low vitamin levels. We benefit a lot from being clued in on this. This is why I want to empower other thyroid patients to know what to ask for, so those things aren’t being missed.
Dr. Eric:
You brought up a few important points. Omega-3 fatty acids. If it’s not in the prenatal, and women are not eating fish on a regular basis, there is a good chance she is not getting enough. You need EPA and DHEA for the brain health of the baby.
You mentioned methylated folate because a lot of these prenatals still have folic acid. That’s important.
Iron, you don’t want to be low on iron. You want to be careful because too much iron can cause oxidative stress.
What you briefly mentioned is the importance of the male. We are focusing on the female during this conversation, but that is another conversation, too. Sometimes, when women have problems conceiving, it’s not always related to the woman. It could be the health of the man.
You want to do everything you can to prepare for a healthy pregnancy on both sides. Eat a healthy diet and optimize nutrients and reduce toxic load. Same thing with the endocrine disrupting chemicals. A lot of what relates to women when preparing for a healthy pregnancy probably also relates to men, too. Would you agree?
Rachel:
Definitely. It’s 50% from both, isn’t it? It’s equally as important. That’s something we are only starting to understand more now. I saw some interesting research that said that conditions such as morning sickness and preeclampsia could be linked to the sperm quality. If you are having a horrible time with morning sickness, you probably need to have a word with your partner about what he did to his sperm.
The omega-3 fatty acids, zinc, especially, really important for sperm quality. And Vitamin D. Here in the UK, it is estimated that as many as 90% of us are low in Vitamin D because we don’t get a lot of sunshine unfortunately. A lot of people don’t have a clue. A lot of people don’t realize.
It’s easy to write tiredness off or feeling like you lack focus and that mental clarity. It’s easy to write that off as having a busy life or not sleeping well or getting older. It’s important to ask these questions and get these things checked out if you are thinking about starting or expanding your family. It is something that can be simply treated that avoids issues and heartbreak further down the line.
I touch on this briefly in the book. It is more from a female point of view. There are things that men can do as well to improve their sperm quality, so we can mitigate any issues that might come from there.
Dr. Eric:
You already sort of answered this question I was going to ask about working with a team. You mentioned your primary but maybe a functional medicine doctor and a midwife. When it comes to women who are thinking about doing a home birth, if they had the right team in place, is that something that is safe to do for someone with hypothyroidism?
Rachel:
The short answer is yes. The longer answer is we are still different. It depends on how your pregnancy is going. When you are pregnant, you will be classified as low risk or high risk for other issues or complications coming up during birth.
For me personally, I chose to give birth at a hospital but in the midwife-led unit. They don’t monitor you with a lot of equipment. It’s monitoring you based on the signs you are giving. It is offering the environment you would have if you were having a home birth but with that added security of knowing there are medical professionals there. There are midwives, not doctors. That is where I felt most calm. If things do take a turn, because we can’t be in control of everything, at least I am next door to the hospital if I need it.
In the same way, being able to be in a room that was dimly lit. We were able to play calming music. We were able to be in control of the environment. I felt that was going to give me the best chance possible of having a straightforward birth that wouldn’t require intervention. If things aren’t progressing well because your oxytocin can’t pick up and keep progressing labor at a different speed. That was important for me.
For other people considering a similar birth, a home birth can be possible. It will depend on your situation. If your doctor classifies you as high risk, because your thyroid condition is hard to stabilize or something comes up in your pregnancy like preeclampsia or someone who can have an issue with their liver, lots of things can crop up. Your doctor might be less comfortable with you giving birth outside a medical setting. Then that will definitely play a part.
Having a thyroid condition doesn’t automatically mean you will have more complications or you are high risk, especially if you are being closely monitored. You are monitoring and optimizing your thyroid levels. As long as all those things are in place, for the vast majority of people, they don’t need an involved birth plan.
Dr. Eric:
We covered a lot. You go into greater detail in your book. For more information, check that out.
Before we wrap up, there are a lot of things I could have asked you. Anything you really wanted to talk about that I didn’t ask you? Any final words of wisdom?
Rachel:
I think we have covered all the key areas. My #1 piece of advice for anyone in their thyroid journey is continue to be your own thyroid health advocate. Continue to ask questions. Learn through resources like this podcast and books. However best it is you can take in that information. Continue to advocate for yourself, and learn what you can ask in the doctor’s office. Learn what you can do yourself.
Whether you are pregnant or way past that stage in your thyroid journey, learning how to advocate for yourself is crucial. It will make the difference between whether you have good quality of life or whether you struggle. Having optimal thyroid treatment and a good set of practitioners, and how active you are in your own health care. That alone is the #1 thing we can do, and that is the key message in everything I do.
Dr. Eric:
Where can people learn more about you, Rachel?
Rachel:
You can find me online under TheInvisibleHypothyroidism.com. That is my blog where I started 11 years ago. I have around 500 articles and blogs on there now, covering all aspects of living with thyroid disease.
I am active on Facebook and Instagram. I have four books on Amazon. My Substack newsletter is something I am really passionate about at the moment. I am continuing to focus on particular topics that I think thyroid patients need to know more about. It’s a weekly roundup. I include thyroid research, developments, interesting podcast episodes that thyroid patients would find interesting. I collate that in a weekly broadcast. I also focus on particular topics, so we can keep learning together.
What is so great about existing in this thyroid sphere is that we are constantly learning more and more stuff. There is always more we can do or share with others. Come and find me. Join the community. We have a lot to learn from one another.
Dr. Eric:
Thanks so much. This was a great conversation. Really appreciate everything you do for women with thyroid conditions. Check out Rachel’s book on pregnancy and her other books as well. Thank you so much for this conversation, Rachel.
Rachel:
Thank you so much for having me.
***
Dr. Eric:
That was an excellent conversation with Rachel Hill, discussing how to have a positive thyroid pregnancy. Preparing for a healthy pregnancy. She definitely goes into greater detail in her book. Of course, you want to eat healthy, reduce stress. You want to take 6-12 months prior to conception to optimize your health, according to her.
Quite frankly, there are things you can’t do during pregnancy, such as detoxify. I would agree that at least six months prior to conception, do what you can to optimize your health. If you aren’t eating healthy, you don’t want to wait until you’re pregnant. You want to try to eat as healthy as you can prior to conceiving.
Same thing with reducing stress, getting sufficient sleep, reducing your toxic burden is huge. Once you’re pregnant, you can’t do things to detoxify. You can do a lot when you’re not pregnant. If you’re drinking water out of plastic bottles now, now is the time to stop, not when you’re pregnant. That could also affect conception and fertility.
She also mentioned the male. The male could also be preparing. I know a lot of men may not want to change their diet and do these other things, like avoiding endocrine disrupting chemicals. All these things can be helpful.
Thyroid medication. She personally took Armour Thyroid. I will talk about antithyroid medication. Preparing for a healthy pregnancy relates to both hyper and hypothyroidism. With thyroid medication, obviously Armour doesn’t relate to hyperthyroidism. I thought it was important to have this conversation because some women are under the impression that they have to take levothyroxine, that it’s not safe to take Armour, NP thyroid.
I can’t give recommendations. I am not recommending for women to switch from Synthroid to Armour. This is ultimately between you and your health care practitioner. My point is if you speak with an endocrinologist, they are probably not going to speak highly about Armour or NP thyroid. You probably will need to speak with another practitioner who is willing to prescribe these.
Antithyroid medication. I am not a huge fan of antithyroid meds, but there is a time and place for them. You want healthy thyroid hormone levels during pregnancy. If you have low thyroid hormone, it makes sense to take thyroid hormone replacement, even if you don’t want to take it. Something you should consider for the health of your baby.
Same thing if you have elevated thyroid hormones. I know you don’t want your baby exposed to PTU, which will be prescribed during the first trimester, not methimazole or carbimazole. In a perfect world, you wouldn’t take it. If you are hyper, especially moderately to severely hyper, you want to do something. Unmanaged hyperthyroidism isn’t a good thing.
Lowering thyroid antibodies prior to conceiving. She mentioned how you want to try to do that. That ties into what I will discuss next, which is preventing miscarriages from occurring.
We also had a conversation about how because of the immune system shifts during pregnancy, the antibodies might normalize during a first trimester because many people with Hashimoto’s are what’s called Th1 dominant. Many people with Graves’ are Th2 dominant. A lot of times, you get the switch from Th1 to Th2 dominant during the first trimester.
If someone has Hashimoto’s, the immune system will calm down, and the antibodies may lower or normalize as a result. With Graves’, sometimes the opposite happens, where things flare up. It’s not perfect. Some people with Hashimoto’s may flare, and some people with Graves’, it may calm down. There is still a lot we don’t know.
When it comes to preventing miscarriages, having healthy thyroid hormones is important. Healthy thyroid hormone is more important for conceiving in the first place. Not to say that it can’t play a role in having a miscarriage, but she did mention the antibodies. I have seen this, too, not just with Hashimoto’s antibodies, but Graves’ antibodies, having elevated TSIs doesn’t mean you will get a miscarriage, but it increases the risk. You could still have a healthy pregnancy with elevated thyroid antibodies, but there is an increased risk factor.
She spoke about estrogen dominance. Keep in mind that estrogen dominance doesn’t just mean high estrogen. It could mean low progesterone. That is a big reason for miscarriages, women having low progesterone. When we think of low progesterone, one reason is adrenals. You need healthy adrenals to have healthy progesterone.
There are also the endocrine disrupting chemicals that I mentioned and other toxins and toxicants. You can’t avoid everything, but when it comes to cleaners, cosmetics in your home, you could use as many natural cleaners and cosmetics. Drinking water out of plastic bottles, if you are doing that, if you are buying plastic water bottles by the case, I definitely would recommend taking a break from those. Ideally, a permanent break, at least on a day in, day out basis. Definitely could affect fertility and potentially can play a role with miscarriage.
As we discussed, neither one of us has done the research. I don’t know what research is out there when it comes to endocrine disrupting chemicals and miscarriages. It wouldn’t be a surprise if that could be a possible factor.
Preventing post-partum thyroiditis. There is no perfect thing you can do. One thing is at least according to the research, supplementing with selenium. I think it’s 200mcg. I am not sure. I’d have to double check. You also want to be careful because you may have selenium in your prenatal. Usually, it’s not a lot. You might have 50mcg. If you supplement with 200mcg, that is 250mcg. You do want to be careful about selenium toxicity.
I have another episode where I spoke about this. I think I interviewed someone a few years ago. It might have been Dr. Betty Murray who brought this up, too. She spoke about post-partum thyroiditis. Selenium could potentially prevent that from happening.
We also spoke about diet during pregnancy, like AIP, carnivore. It sounded like she recommended following these diets prior to getting pregnant. You may be restricting too many foods. If you are eating a wide variety of meat and vegetables and fruits, it’s not like you need to eat grains and legumes. Eggs are nutrient dense. It’s nice if you like eggs and could eat eggs. They are nutrient dense, extra source of protein. Maybe follow a paleo type diet.
If you are carnivore, you are not having plant-based foods. If you are getting a lot of nutrients through meat and animal-based protein, you don’t have to eat veggies and fruits. Another reason why you should speak with a practitioner.
Supplements during pregnancy. Definitely want to make sure you are getting enough omegas and natural folate like methyl folate, not synthetic folate. You want to test for iron and Vitamin D.
We didn’t mention iodine. I can’t believe I forgot to ask her about iodine in a multivitamin. My perspective is you want to make sure you have enough iodine. You don’t want to take separate iodine supplements, but iodine is important for the health of the baby. Most prenatals will have iodine though. I am not saying to take extra iodine. I don’t think there is a prenatal out there that doesn’t have iodine; that is because it is important. If there is a prenatal without iodine, I am not sure if I would recommend taking that one. It is up to you. You don’t want to be iodine deficient. Especially if you have hyperthyroidism, even if you have Hashimoto’s, there is concerns with iodine. Prenatal, definitely take one with iodine.
In general, talking about hyperthyroidism and pregnancy. Like I said, there is a lot of overlap. The difference is the symptom management aspect between hyperthyroidism and hypothyroidism. If your thyroid hormone levels are low, you might want to consider thyroid hormone replacement for the sake of the baby.
With hyperthyroidism, if you have elevated thyroid hormone, that is not good. You are not really supposed to take bugleweed or higher doses of L-carnitine. Unfortunately, I don’t have a perfect solution when it comes to the symptom management aspect of hyperthyroidism.
When it comes to Graves’ and Hashimoto’s and pregnancy, you will still do things to find and remove triggers and support the gut. But there are restrictions. You might not be able to do everything you can while pregnant that you can when you’re not, like certain herbs.
Really important topic. I think I covered this a number of years ago in a solo episode, but I wanted to get someone who is more of an expert than myself, so I did. Rachel wrote a book on pregnancy. Definitely check it out if you are thinking about conceiving or are currently pregnant.
Thanks again for tuning in. Hope you found this episode to be valuable. Look forward to catching you in the next one.
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