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Trying To Get Pregnant When Having An Autoimmune Thyroid Condition

Whenever I consult with a pregnant woman who has either Graves’ Disease or Hashimoto’s Thyroiditis, there is understandably a concern about how this condition can affect the health of her baby.  There without question are risks for someone who is pregnant and who has an autoimmune thyroid condition.  And of course there are limitations when it comes to having a pregnant woman take certain supplements and herbs to help suppress the autoimmune response.  And so this can present a challenge for someone who has an autoimmune thyroid condition and is looking to get pregnant.

It’s not uncommon to consult with a woman who has either Graves’ Disease or Hashimoto’s Thyroiditis who is thinking about becoming pregnant in the near future.  There are two different sets of risks a pregnant woman with an autoimmune thyroid condition has to face.  One has to do with the autoimmune component of the condition, while the other relates to the imbalance in thyroid hormone levels.  I’m going to discuss each one of these separately.

Why Having Normal Thyroid Hormone Levels During Pregnancy Is Important

Having normal levels of thyroid hormone is very important to having a healthy pregnancy, as maternal thyroid hormones play a vital role in the development and function of both the fetus and placenta (1) [1].  This is especially true in the first trimester, as the fetus doesn’t have the ability to produce its own thyroid hormone. This is why it’s important for most women with a hypothyroid condition to take thyroid hormone during the pregnancy.  While I’m all for trying to address the cause of the problem, one needs to look at the risks vs. the benefits, and if someone has low thyroid hormone levels during pregnancy it is important to take thyroid hormone for the health of the baby.

On the other hand, if someone has a hyperthyroid condition then this does need to be managed.  Too much thyroid hormone can cause problems for the developing fetus.  So while I’m not thrilled about women taking medication during pregnancy, this is yet another situation where the risks and benefits need to be looked at.  And the risks of untreated hyperthyroidism is usually greater than the risk of the medication causing problems, such as congenital malformations.  This is especially true in severe cases of hyperthyroidism during pregnancy, as maternal risks include congestive heart failure, thyroid storm, preterm labor, preeclampsia, and increased mortality, whereas the fetus may be stillborn or small for gestational age or may develop congenital malformations (1) [1].

What Are The Potential Consequences Of High Thyroid Antibody Levels During Pregnancy?

When I consult with a woman who has Graves’ Disease or Hashimoto’s Thyroiditis who is looking to become pregnant in the near future, the autoimmune component of her condition is of greater concern than the imbalance in thyroid hormone levels.  The reason for this is because in most cases it is much easier to manage high or low thyroid hormone levels during pregnancy than to suppress the autoimmune response.  On the other hand, if someone has high thyroid antibodies, this can cause harm to the fetus, and it can be a challenge to lower these antibodies.  Numerous studies have shown a significant positive association between the presence of thyroid antibodies and miscarriage rate (2) [2] (3) [3].

But isn’t it possible that the pregnancy itself can result in a suppression of the autoimmune response, and therefore a lowering of the thyroid antibodies?  This without question is possible, and of course is the ideal situation for a woman with an autoimmune condition of any kind who becomes pregnant.  However, there is no guarantee that the pregnancy will result in a decrease in thyroid antibodies, as sometimes the antibodies actually increase during pregnancy.

There is some concern as to whether the antibodies will affect the thyroid function of the fetus.  Studies show that of the different types of thyroid antibodies, only those directed against the TSH receptor have been shown to cause fetal thyroid dysfunction (4) [4].  As a result, if someone has high TSI antibodies during pregnancy then this is a cause of concern when it comes to the thyroid health of the fetus, whereas thyroperoxidase and thyroglobulin antibodies don’t seem to have a detrimental effect on the thyroid gland of the developing fetus.

Can A Pregnant Woman With An Autoimmune Thyroid Condition Benefit From Natural Treatment Methods?

If a woman happens to become pregnant while her autoimmune thyroid condition is still active, there of course will be limitations as to which supplements and herbs she can take.  While I’m conservative with the herbs, when I’m dealing with a patient who becomes pregnant I will try to do things to help with the inflammatory component of the autoimmune condition, usually through fish oils and a good source of GLA (i.e. borage oil, black currant seed oil).  Selenium can sometimes help to lower the thyroid antibodies, and while most pregnant women can take a separate selenium supplement, you want to be careful not to take too high of a dosage.

As for balancing the thyroid hormone levels, a woman with an autoimmune hypothyroid condition very well might need to take thyroid hormone.  Even if she doesn’t want to take any medication, taking thyroid hormone might be important for the health of the baby.  I’m not saying that every pregnant woman who has Hashimoto’s Thyroiditis needs to take thyroid hormone, but many do.  While my goal is to attempt to restore someone’s thyroid health back to normal, one doesn’t want to jeopardize the health of the developing fetus.

And the same concept applies to hyperthyroid conditions.  Without question there are potential risks to the baby when taking antithyroid medication during pregnancy.  But as I mentioned earlier in this post, it all comes down to risks vs. benefits.  And if someone has high thyroid hormone levels, it is important to get these down.

In summary, there definitely are risks for someone who is pregnant and who has an autoimmune thyroid condition.  The autoimmune component itself of both Graves’ Disease and Hashimoto’s Thyroiditis poses a risk to the baby.  In addition to dealing with the autoimmune component of the condition, it is important to have healthy thyroid hormone levels.  This very well might mean that a woman with Hashimoto’s Thyroiditis who is pregnant might need to take thyroid hormone, while a pregnant woman with Graves’ Disease might need to take antithyroid medication.  It all comes down to risks vs. benefits, and during pregnancy, when following a natural treatment protocol it’s important to carefully consider the risks and benefits of everything.