Recently, I interviewed Jenny, our thyroid health audit participant, who shares her journey with Hashimoto’s and secondary infertility, two challenges that often go hand in hand but are rarely talked about together. In this episode we discussed how addressing root causes, not just lab numbers—can open new possibilities for healing and conception, and more. If you would prefer to listen to the interview you can access it by Clicking Here.
Dr. Eric Osansky:
Welcome to another Save My Thyroid audit. I am very excited to chat with Jenny here. She will talk a little bit about her health journey. How are you doing today, Jenny?
Jenny:
I’m doing well, thank you. Appreciate the opportunity to meet with you.
Dr. Eric:
Thank you as well for doing this. We were chatting a little bit before this, and you filled out the application I have everybody do, so I can get an idea of your health challenges.
You were recently diagnosed with Hashimoto’s. The biggest challenge is dealing with infertility. Can you give a little bit of that background? When were you diagnosed with Hashimoto’s? As far as the infertility, you received IVF as well, so if you could talk about that.
Jenny:
Certainly. My spouse and I are navigating secondary infertility. We were able to have one child naturally. We went to try to have a second child and were not able to. After a while of trying, I had reached out to my OB to get some potential bloodwork done. They look at your ovarian reserve, your TSH, and something else.
At that point, my TSH was in the normal range, but from my understanding, it was higher than what they wanted to see for somebody who was trying to conceive or pregnant. From what I learned, that range may not be the most accurate range in terms of TSH functioning.
At that point, I was put on levothyroxine. I took that with hopes that maybe that would be the magic thing to get my TSH down, and then I could get pregnant. Unfortunately, that didn’t happen.
We eventually got referred to a reproductive endocrinologist. At that point, we did a lot of bloodwork. Within that wasn’t a full thyroid panel, but it did include TSH again and TPO antibodies, which were high. That was a little over a year ago.
No one told me, “You have Hashimoto’s.” No one said there was any concern with my thyroid. They just said something like, “There has been a little damage to your thyroid. That’s all. It’s unlikely that your thyroid is impacting your ability to conceive.”
We continued to do interventions. We did several IUIs. They were unsuccessful. We went to do IVF as well. That was unsuccessful. That’s another topic, and it was really devastating. We realized we must be missing something. Something was off.
I had done a lot of research on thyroid through this process. Was it worth introducing supplements, working to get rid of toxins, changing my diet, stress management. As you can imagine, it’s really hard when you’re doing IVF. “Don’t be stressed,” but it’s one of the most stressful things ever.
I met with an endocrinologist this summer. Pretty off the bat, she was like, “You have Hashimoto’s, mild hypothyroidism.” I also have a family history of this. My dad has Hashimoto’s. My paternal grandmother. I don’t know if she was diagnosed with Hashimoto’s, but there were issues with her thyroid. She had a goiter, so I’m pretty sure she had Hashimoto’s.
Then I went into a deeper dive. I have to figure this out. What can I do to support my thyroid? Consulting with some of your work, some other folks and their work as well.
Dr. Eric:
When you did your research, is that how you came across me? Did you come across my website or book?
Jenny:
I came across your book and website around the time I did that initial bloodwork with my OB. They were talking about thyroid. I was like, “Okay.” My mission is to have a baby. I have to do everything I can. My dad pointed me in your direction. He has an extensive library of thyroid books and resources.
Dr. Eric:
Glad he found me and referred you to me.
When they first tested TSH, sounded like it was within the lab range but higher than optimal. They didn’t look at thyroid hormones. They just put you on levothyroxine based on the TSH alone. Eventually, they retested the TSH. It sounds like they still didn’t do a full thyroid panel, just TSH and TPO antibodies. Then they saw the TPO antibodies were high. Do you know if they tested the TG antibodies, which are also associated with Hashimoto’s?
Jenny:
No, I don’t have any bloodwork for that. I haven’t had a full panel done. I had asked my endocrinologist about that and was met with just looking at the TSH and TPO antibodies. They didn’t feel like we needed to test T3 or T4.
From some of my more recent research, and maybe this is a question with you, I am hoping to do a bit more advocacy for myself to try to get a full panel done. I feel like that would be helpful, even if they are not considering it on their side of things, just for me to have an understanding of where I’m at and with a strong desire to reduce my antibodies.
Dr. Eric:
When it comes to testing TG antibodies, I could understand why they’re not doing it. It won’t change their approach. They will give thyroid hormone replacement regardless, the levothyroxine.
I think it is crazy for them not to look at thyroid hormones just because maybe you’re taking the levothyroxine, which is T4, but T4 has to convert into T3. It’s not always reflected with the TSH. The T4 influences the TSH more. For all we know, the T3 might be on the lower side, even if the TSH is looking better with levothyroxine. T3, being the active form of thyroid hormone, if that is on the lower side, that definitely can affect conception.
If you can’t get it through your doctors, I would pay out of pocket. I realize you have already spent who knows how much money on the IVF. Depending on where you go, if you go to some walk-in labs, they might charge you over $100. If you shop around, you can get it for like $30-40, TSH, free T3, free T4. Not a full thyroid panel with antibodies, but at least a look at the thyroid hormones.
Make sure that T3 is optimal. I do see a lot of people with Hashimoto’s where that T3 is on the lower side. Definitely want to look into that.
Like I said, the TG antibodies, for the sake of what they do, I could understand not testing. Actually, on the podcast, I interviewed a few healthcare practitioners who talked about fertility. Based on my own research, too, when you have low thyroid, that could affect conception. The antibodies could also increase the likelihood of having a miscarriage. It doesn’t mean that you will have a miscarriage, so it’s nice to get those antibodies tested to see.
Maybe you just have TPO antibodies, and TG antibodies look fine. If that’s the case, you won’t need to retest those again necessarily. If they’re both high, and the goal is to eventually normalize them, which is my goal when working with someone, then I would say it’s a good idea to retest. But test it first, since you haven’t tested it at all yet.
The priority would be T3 and T4. Then same thing. If you had to, you could pay out of pocket for the TG antibodies as well. It’s unfortunate that most doctors, including endocrinologists, will just look at TSH. Some will do a TSH and T4. As I just mentioned, you do want to make sure you are converting T4 to T3.
You might have heard of reverse T3, which sometimes can be helpful, too. Like I said, I realize you have already spent a lot of money. Reverse T3, some people really think highly of it. Everybody with Hashimoto’s should get reverse T3, they say. I do try to include it.
To me, it wouldn’t be the priority. When we prioritize the blood test, TSH and thyroid hormones are the priority. Antibodies are important. Reverse T3, kind of on the back end. If you can get that done, great. If you can’t get that done, usually we could look at the other numbers and get a good idea of what’s going on.
Jenny:
If my T3 is lower, the recommendation would be to shift what medication I am on?
Dr. Eric:
Yes. If you are having a problem converting T4 to T3, ultimately, you want to try to address the cause of the problem. While doing that, you might choose to take T3.
There are a few different options. They probably would recommend synthetic T3, something like Cytomel. There is also desiccated thyroid. A lot of doctors aren’t big fans of that, especially during pregnancy. Things like Armour or NP Thyroid, which have T3, T4 as well as T1 and T2, which are less well known. They would probably recommend synthetic T3.
Another option is compounded thyroid hormone. You go to a compound pharmacy and get T4 and T3.
You would want to address the cause of the problem, too. Approximately 60% of the conversion from T4 to T3 takes place in the liver. Another 20% takes place in the gut.
Sounds like you have already done some good things for your health, like working on diet. Stress also could affect that conversion. Having higher cortisol could impact the conversion of T4 to T3. If you have to take the T3 to help with the conception, that is fine. You want to ideally identify the cause of the conversion problem and then address it.
Jenny:
Certainly. That’s where I feel like I’m so close yet so far away at the same time with figuring out the root cause. My TPO antibodies went up by 400 over the last year. I thought I was doing all the stuff I needed to do to help support my thyroid. Granted, I was under a high level of stress. I was taking a lot of medication for infertility reasons. They were working to reduce inflammation, but I still had a lot of inflammation happening because of all of that.
I was really disheartened when I asked to get my TPO antibodies rechecked recently and saw they had increased by 400. I was so hoping the opposite.
Dr. Eric:
It can be challenging to lower and normalize the antibodies. It’s not uncommon for them to rollercoaster back and forth, which can make it challenging. Let’s say you test antibodies again in a few months. If they decrease greatly, again, sometimes can be misleading. Obviously, that’s what we ultimately want to see.
It sounds like something might be missing. Diet and lifestyle, very important. It’s a piece of the puzzle. If you have my book Hashimoto’s Triggers, there are a lot of triggers. Food is one. Stress is one. There are a lot more, too. It could sometimes take some extensive detective work, depending on the person. That’s the next question: Have you done any functional medicine testing at all?
Jenny:
No, I haven’t done any functional medicine testing. I’m interested in that. I was in such an urgency to have a child and wanting children close together and got pushed in a variety of directions into the more medical route. I do feel like that would be beneficial for me, and I’m hoping to do that.
On my own, I have really worked on foods I’m eating or not eating. One big thing has been balancing my blood sugar. I was always super hangry, and that has gotten a lot better.
I am taking a lot of supplements. Some of that is good; some of it is frustrating. I don’t want to move through my life taking this many supplements. Some of them I don’t even know if they are doing anything or not. Either they were recommended for infertility reasons or suggested in some thyroid resources I found.
I’ve had gut issues throughout my life. They’re a lot better now. I don’t experience that as frequently. I feel like I’ve had a lot of growth there.
I have no idea how my liver is doing. I know the liver functioning is important, and there can be a lot of buildup there. I wonder about that.
I feel like I’m going off from your initial question now about functional medicine. Here I am telling you all the things I am trying to do so far. I’ll stop here.
Dr. Eric:
No, that’s okay. Getting back to the liver. When you do a basic blood test, like a comprehensive metabolic panel or hepatic panel, they are looking at liver enzymes, AST, ALT, sometimes GGT. That doesn’t really look at the function of the liver.
If those levels are low, that is what you want. If they’re higher, that means there is some type of damage. I see that more with my hyper patients when they are taking antithyroid medication for example. The levothyroxine wouldn’t do that.
That doesn’t tell us how you’re detoxifying, what your toxic burden is. There is really not a great test to look at our toxic burden. You can do testing to look at heavy metals. You can do other tests to look at other types of environmental toxins.
In that respect, I would say definitely do as much as you can to minimize your exposure to environmental toxins. Even without knowing levels of heavy metals and other environmental toxins, they might do liver detox, and that is hugely harmful. Sometimes, it can cause certain side effects, like die-off effects.
The supplements, I definitely recommend supplements, but that is one reason I do testing. There are some general supplements, like omega-3 fatty acids, probiotics. Depends on the person. We want to do testing to see what imbalances someone has. My guess is you probably had at least some blood testing, like Vitamin D. I’d be surprised if they didn’t look at Vitamin D levels.
Jenny:
I did have Vitamin D. That’s fine. Vitamin D, iron, B12, magnesium.
Dr. Eric:
How did your iron look? Another challenge is hair loss, which could be related to the thyroid but also nutrient deficiencies. I don’t know if you remember your iron numbers. Like the thyroid, they might be within the lab range but outside of the optimal range.
Jenny:
I don’t have the specific numbers in mind, but I believe it was fine, within the lab range. I also had some resource that I was consulting, more functional medicine. It seemed like it fell in that range, so that wasn’t a concern.
My B12 was really high.
Dr. Eric:
I assume you’re not a vegetarian, that you eat meat?
Jenny:
Yeah, I do.
Dr. Eric:
If you ate a meal higher in B12, whether it was beef or something else the night before. If you are taking a B12 supplement, you probably are taking a prenatal? This has not only folate but B12.
Jenny:
Yes.
Dr. Eric:
I usually don’t get too concerned when I see B12 high. It is common on a blood test. When that is low, that could be an issue. When it’s high, it’s usually because you are getting exposed to it either through the diet or supplementation.
There is another marker called methylmalonic acid, which is a better indicator of B12 status. Usually not tested by most doctors. That might be something to look into if you’re concerned about that.
With diet and lifestyle, what you’re doing as far as trying to eat a whole, healthy foods diet.
The stress is huge. I know you’re doing things to manage your stress. I would continue on an everyday basis. That doesn’t mean that you have to spend an hour per day on stress management. Consistency is important. Just because some people will maybe do yoga 2-3 times a week, and that’s it. You really want to be in the routine of stress handling.
How is your sleep at night?
Jenny:
My sleep is generally okay. That’s one of the areas that I’m more recently focusing on. I have to acknowledge, I didn’t sleep as great last night because I was nervous about this conversation and being recorded. I kept waking up thinking about what I was going to say. Generally, I can fall asleep fine.
I do think with balancing my blood sugar, at least a piece of it has supported me in waking up not as groggy. I don’t know for sure. I think just energy-wise, I am feeling better.
I do have a Fitbit that tracks my sleep. I always have a very high level of light sleep and not much deep sleep.
Dr. Eric:
Okay. A lot of light sleep and not enough deep sleep. That’s something to work on. You haven’t had your adrenals tested, I assume?
Jenny:
No.
Dr. Eric:
Also something to look at. There are a few options with that. Saliva testing is really good for looking at adrenals.
A lot of functional medicine practitioners would recommend DUTCH testing, if you are familiar with that, for someone who is struggling with fertility. That looks at adrenals, sex hormones, and the metabolism of the hormones as well as some other things. That might be something in the future that you want to look into. Have you heard of DUTCH testing?
Jenny:
I’ve heard about it. I don’t know too much about it. The name is familiar to me.
Dr. Eric:
Especially if someone is focusing on fertility, most practitioners of functional medicine recommend a DUTCH test. Not everyone. Some might just recommend saliva testing for adrenals and testing sex hormones in the blood. The thing is, you can’t look at the metabolism of the hormones in the blood. Still, I can’t say the DUTCH test is absolutely necessary, but the more information you get, the better. I would look into that.
You have already done some tests through the blood. You mentioned iron and B12 and magnesium. Magnesium in the blood, they often look at serum magnesium. RBC magnesium is better than that. Sometimes, you have to take what you get if you are running it through insurance. I understand that.
You mentioned the gut. You said the gut used to be a big problem, but not as problematic. Maybe you don’t need to do gut testing, like a comprehensive stool panel. You could always start conservatively. It’s really up to you. Some women understandably, especially if they have gone through IVF and want to do everything they can-
I tend to be on average more on the conservative side with the testing. Not to say that you need to spend thousands of dollars on functional medicine testing. In this situation, since you did have a history of gut issues, and you can’t always go by symptoms, you might want to dig a little bit deeper. If you do decide to do functional medicine testing, maybe consider the DUTCH and a comprehensive stool test.
Jenny:
I would be open to that. I wonder if there is something there still. It was so bad for a large chunk of my life. I am grateful that it’s better. Big impact on my life. That’s what prompted me to go- I have been gluten-free for 14 years. That was what helped me a lot. Still didn’t resolve it all, but it helped a lot. I would be interested in doing a comprehensive stool panel.
Dr. Eric:
I think the next steps: Continue with the diet. Gluten-free is great. I usually recommend paleo or autoimmune paleo for Hashimoto’s. If you are concerned about AIP being too restrictive, paleo is still pretty healthy. It eliminates the common allergens, the refined foods and sugars, unhealthy oils.
Stress management, we spoke about. Just continuing to work on sleep. Reducing your toxic burden. Trying to minimize cleaners, cosmetics in your home. Try to eat as organic as possible.
The functional medicine testing. Just to fill in the gaps. If you feel like you have done everything from a diet and lifestyle standpoint. Maybe you haven’t. Maybe there is still some improvement in that area. Even if you have done 100%, you want to make sure that everything goes according to plan with conceiving.
I would recommend doing the functional medicine testing. Some type of adrenal testing, maybe digging deeper and doing the DUTCH test, possibly a comprehensive stool panel.
That would be your homework for things to work on. Hopefully, you give me an update in a few months with some really good news. It’s not easy. I know it’s very stressful, very emotional. Even for those who aren’t having fertility issues, taking a functional medicine approach and trying to lower and normalize antibodies usually is not an easy process. I commend you for doing what you’ve done so far. I definitely would look into the functional medicine testing and give me an update in the future.
Jenny:
Thank you. I will definitely look into the functional medicine testing. I hope there is a good update. At the very least, I want to be able to be the healthiest version of myself and reduce some of these other symptoms that I have. If there is a baby, that would be beautiful. I hope there is an update for you.
Dr. Eric:
Hopefully you get the best of both worlds. You optimize your health, and you give good news of pregnancy and having a healthy baby.
The good news is that there are still things you can do. It’s not like you have exhausted everything. If you had said you had done all the functional medicine testing, even diet and lifestyle, there is room for improvement. I think you can continue to work on that. Consider functional medicine testing.
I’d like to be optimistic and confident that in a few months, you will shoot me an email with some good news. Definitely do so. Again, thank you so much for agreeing to do this audit, Jenny.
Jenny:
Of course. Thank you for your time and speaking with me.
Dr. Eric:
Thanks, everyone for taking the time to listen. I hope you found this conversation to be valuable. I look forward to catching everyone in the next episode.
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