Hashimoto’s Disease: The Danger of Thyroid Antibodies and Pregnancy

Hashimoto's Disease: The Danger of Thyroid Antibodies and Pregnancy

In 1990, a significant correlation between high levels of thyroid antibodies and an increased rate of miscarriage was first reported in the scientific literature.1 Where are we at a generation later?2 Despite the 20 years of compelling research confirming and expanding upon the initial finding, many doctors do not test a pregnant woman for thyroid antibodies, and few patients know to ask for proper testing.

Hashimoto’s disease is an autoimmune condition in which the body attacks and destroys its own thyroid gland. In a healthy immune system, antibodies act as the body’s army to detect and destroy invaders not normally present in the body, such as bacteria, viruses, fungi, and parasites. In the case of Hashimoto’s disease, a defective immune system wreaks havoc on the body by directing antibodies against its own thyroid gland as if it is a foreign invader. Although Hashimoto’s is the number one cause of hypothyroidism in the United States, it is a tragically overlooked disease in the health care system.

You may have Hashimoto’s disease and not even know it.

According to the American Thyroid Association, 10 to 20% of all pregnant women in the first trimester of pregnancy are positive for Hashimoto’s antibodies, but they are euthyroid. Euthyroid means they have normal thyroid functioning based on their TSH (thyroid stimulating hormone) level, the most common measurement of thyroid function. Their thyroid function in early pregnancy appears to be normal and they may even feel well, all the while their body is silently attacking and destroying their own thyroid gland. A significant percentage of these women will however develop a TSH above the trimester-specific pregnancy reference range by the third trimester, endangering the life of their fetus.3

 By testing TSH alone, thyroid antibodies in Hashimoto’s may be missed, and your doctor may have no idea your baby is at risk.

Consider for a moment the number of babies lost to Hashimoto’s disease just because doctors fail to perform a simple blood test. Hashimoto’s is confirmed by lab tests for these two antibodies:

  1. Thyroid Peroxidase Antibodies (TPOAb)
  2. Thyroglobulin Antibodies (TgAb)

Thyroid Antibodies and Miscarriage

Researchers in a 2011 study published in the British Medical Journal conducted a systematic review of 31 studies involving 12,126 women that assessed the association between thyroid autoantibodies and miscarriage. Of the 31 studies, 28 separate studies found thyroid antibodies increased the risk of miscarriage by 290%. According to researchers:4

“In the developed world, thyroid autoimmunity is the main cause of hypothyroidism, which itself results in poor obstetric outcomes. Even in women with biochemically normal thyroid function, studies have reported an association between the presence of thyroid autoantibodies, particularly thyroid peroxidase antibodies and adverse pregnancy outcomes, including miscarriage, preterm birth, and adverse neurodevelopmental sequelae in children.”

The Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and Postpartum recommend:5

Women with Hashimoto’s who are not receiving thyroid treatment require monitoring for hypothyroidism during pregnancy. TSH should be evaluated every 4 weeks during the first half of pregnancy and at least once between 26 and 32 weeks gestation. TSH levels above the trimester-specific pregnancy reference range should be treated (first trimester, 0.1-2.5 mIU/L; second trimester, 0.2-3.0 mIU/L; third trimester, 0.3-3.0 mIU/L).

According to Dr. David Clark, DC Functional Neurologist:6

  1. As a mother, if you have TPO antibodies that means you have a real risk for becoming hypothyroid. Hypothyroidism itself can cause miscarriages and premature birth.
  2. If you have TPO antibodies, you have ONE autoimmune disorder, and your immune system is attacking ONE tissue…it can now easily attack something else, like a developing fetus.

The lack of awareness about Hashimoto’s disease is pervasive. Do not assume your doctor is aware of the dangers of Hashimoto’s and pregnancy. Take charge of your thyroid health and insist on thyroid antibody testing.

This is Part 4 of my 5-part series entitled Miscarriage Awareness Month: The Dangers of Hypothyroidism And Pregnancy. Be sure to read:

Part 1 Have You Suffered A Miscarriage? Your Thyroid Could Be To Blame

Part 2 What Every Pregnant Woman Needs To Know About Hypothyroidism

Part 3 Miscarriage in New York City…Be Thyroid Aware

Part 5 Hypothyroid Mom’s Story of Hope: Her Miracle Babies

Hypothyroid Mom’s Top Resources

What about you?

Do you have Hashimoto’s? Were you aware of the risk in pregnancy?

Are you pregnant or thinking about getting pregnant? Have you had your thyroid antibodies tested?

Are you certain your doctor is aware of the risk of thyroid antibodies in pregnancy?

References:

  1. Stagnaro-Green, A., Roman, S.H., Cobin, R.H., el-Harazy, E., Alvarez-Marfany, M., Davies, T.F. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. Journal of the American Medical Association 1990 Sep 19;264(11):1422-5
  2. Stagnaro-Green, A. Thyroid Antibodies and Miscarriage Where Are We at a Generation Later? Journal of Thyroid Research 2011 May 12;2011:841949
  3. Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E.N., Soldin, O.P., Sullivan, S., and Wiersinga, W. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Retrieved from http://thyroidguidelines.net/pregnancy
  4. Thangaratinam, S., Tan, A., Knox, E., Kilby, M.D., Franklyn, J., Coomarasamy, A. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. British Medical Journal 2011;342:d2616
  5. Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E.N., Soldin, O.P., Sullivan, S., and Wiersinga, W. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Retrieved from http://thyroidguidelines.net/pregnancy
  6. Dr. David Clark, DC. Thyroid Antibodies and Risk of Miscarriage, Premature Birth. Retrieved from DallasThyroidDoctor.com: http://drclark.typepad.com/dr_david_clark/2011/11/thyroid-antibodies-and-risk-of-miscarriage-premature-birth.html

Take Back Your Thyroid Health! Sign up and never miss a post - it's FREE


About Dana Trentini

Who knew that little butterfly-shaped thyroid gland at the base of my neck could affect my life so completely? I founded Hypothyroid Mom in memory of the unborn baby I lost to hypothyroidism. Winner of two 2014 WEGO Health Activist Awards: Health Activist Hero & Best In Show Twitter. *Hypothyroid Mom includes Affiliate links. Connect with me on Google+

Comments

  1. “I’ve been diagnosed with hypothyroidism. However my doctor has only tested my TSH. I’ve never heard of thyroid antibodies. What lab tests should I have done?”

    Thx

    Michael

    • Dana Trentini says:

      Thank you for commenting Michael. Unfortunately not all doctors test for thyroid antibodies. The gold standard for thyroid testing by mainstream doctors is TSH (thyroid stimulating hormone), however this one measure does not give a full picture of the person’s condition. Diagnosing hypothyroidism should include a number of blood tests, including TSH, Free T4, Total T4, Total T3, Free T3, Thyroid Peroxidase Antibodies (TPOAb), and Thyroglobulin Antibodies (TgAb). In the month of November I will be including a post that outlines proper lab testing (so you’ll know more about blood tests than your MD). The lack of awareness about this condition is pervasive in the medical community, so you have to be an advocate for your own thyroid health and insist on proper testing.

      • Dana I cannot tell you how scared I am of this. My doctors have never been able to get my thyroid in range and my fiance and I are about to be married and want a family immediately. My fiance has had hashimoto’s himself I tested negative though my thyroid is still out there. I was told by my endocronologist that I can have children she did a test I want to know what test and also told me I would have to double my thyroid medication when pregnant. Now if my levels aren’t right to begin with I would think she would say do not get pregnant till we get this straight. It has been over a year since that discussion and I worry. One thing I also want to point out is that there are a lot of articles out on the web pertaining to the rise in woman with hypothyroidism birth defects miscarriages and women who cannot concieve because of hypothyroidism. The articles post that there is believed to be a correlation between the time around 1975 when the government started putting fluoride in most public water supplies and since this the numbers of those with those problems I mentioned have skyrocketed not to mention other problems aside. I know this may not be the case in someone like myself who has a family history of hypothyroidism. However could it effect me in other ways I don’t know yet i’m trying to find out. I am very scared very. I know what to look for there is no doubt in that. What I doubt are the doctors and their abilities to access the full situation. And how can you do it without a professional anyway. it is a double edge sword that is heading right toward me. thanks Dana for this article and for all the others you post. Saving lives preventing problems your doing it!

        • Dana Trentini says:

          Hi Jana,

          Thanks for commenting. There is hope for women with hypothyroidism to have babies. Please read my 5 part series “Miscarriage Awareness Month: The Danger of Hypothyroidism and Pregnancy”. By finding a great thyroid doctor I was able to get pregnant naturally with my second son and gave birth to him in October 2010. It’s all about knowing the facts and finding a great doctor.

          Absolutely yes you should make sure that your hypothyroidism is well treated before trying to conceive. Yes your doctor is correct that many hypothyroid women have to increase their dosage when pregnant to meet the increased demands in pregnancy for thyroid hormones. At least you have a doctor that understands this.

          Be sure you and your fiance are being properly diagnosed. Read my post “Top 5 Reasons Doctors Fail To Diagnose Hypothyroidism” and be sure to have at least your TSH, Total T4, Free, Total T3, Free T3, Reverse T3, and Thyroid Antibodies tested.

          http://hypothyroidmom.com/top-5-reasons-doctors-fail-to-diagnose-hypothyroidism/

          Keep in touch and best of luck trying to conceive!

          Dana

  2. In our experience, doctors do not test for thyroid antibodies unless the TSH or FT4 is abnormal. However, Thyroid UK agrees with Dana in that all the thyroid tests need to be done at the same time to get a full picture.
    I spoke to a young couple at a seminar in Jersey who had had a miscarriage and she had high antibodies. I also spoke to someone on the telephone today who is really poorly and has high thyroid antibodies but normal TSH and FT4. These tests can take a very, very long time before they go out of range.
    There is a paper – Effects of Prophylactic Thyroid Hormone Replacement in Euthyroid Hashimoto’s thyroiditis – that might help.
    Unfortunately, doctor’s don’t inform patients about thyroid antibodies. Doctors should be informing patients of all aspects of their condition and treatment. This is what Thyroid UK is raising awareness for this year!

    • Dana Trentini says:

      Thank you so much Lyn for commenting. I’ve spent countless hours reading over the material on your Thyroid UK site and included it on Hypothyroid Mom’s Top Resources page. I hope you know what a difference you are making in people’s lives all over the world, including mine over here in the U.S. The lack of awareness about thyroid dysfunction crosses the globe.

      I want to mention to my readers that Thyroid Awareness Week was instigated by Thyroid UK in 2006 to raise awareness of all aspects of thyroid disease. This year you are raising awareness of the fact that thyroid patients are not aware of their rights and responsibilities of the NHS Constitution including the right of information about treatments.

      http://www.thyroiduk.org.uk/tuk/TAW-2012.html

  3. I have Hashimoto’s and had a miscarriage in July at 9 weeks. I had my synthroid adjusted up as soon as I knew at 4 weeks and am now on a gluten free diet.
    I’m trying again – any suggestions for what else I can do about the antibodies ?

    Thank you so much for all you are doing !

    • Dana Trentini says:

      I am sorry to hear of your loss Kristy. I know how deep the pain runs when we miscarry our babies. I will be publishing a post here on Hypothyroid Mom next Monday with what worked for me in getting pregnant despite my hypothyroidism. Please be sure to join me then when I explain this in more detail. First off, you should have comprehensive lab work done prior to conception, including TSH, Total T4, Free T4, Total T3, Free T3, thyroid antibodies, and vitamin levels. According to the “Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum” updated in 2011:

      “RECOMMENDATION 15 – Treated hypothyroid patients (those receiving thyroid replacement medication) who are planning pregnancy should have their dose adjusted by their provider in order to optimize serum TSH values to <2.5 mIU/L preconception. Lower preconception TSH values (within the nonpregnant reference range) reduce the risk of TSH elevation during the first trimester."

      The key here is prior to conception get your TSH levels less than 2.5 mIU/L. Not all traditional doctors know this. Print out this document and share it with them....

      http://thyroidguidelines.net/pregnancy

      As for your antibodies. I have found the work of Dr. David Clark, DC Functional Neurologist, to be incredible for diagnosing and managing thyroid antibodies in Hashimoto’s. Contact him through his site. He is happy to answer questions about Hashimoto’s. Check out his work….

      http://drclark.typepad.com/dr_david_clark/2011/11/thyroid-antibodies-and-risk-of-miscarriage-premature-birth.html

  4. this worries me. I have hypothyroidism and will be trying to conceive within the next few weeks. I have been taken levothyroxine. When should I go for blood work update, now, or as soon as I find out I’m pregnant? Is Hashimoto same as Hypothyroid?

    • Dana Trentini says:

      Hi Marie, I am happy you found me at Hypothyroid Mom. Thanks for commenting. There is hope for hypothyroid moms like us. After researching everything I could about this disease, I got in the best health ever and got pregnant with my second son. My boys are living proof that miracle babies do happen to hypothyroid moms. Next week I will be sharing what worked for me in getting pregnant despite my hypothyroidism.

      Hashimoto’s is considered the number one cause of hypothyroidism in the United States. There are other causes of hypothyroidism, however Hashimoto’s disease is number one in developed countries. Anyone who has been diagnosed with hypothyroidism, should have their thyroid antibodies tested to determine if they have Hashimoto’s. When you have one auto-immune disease, such as Hashimoto’s, you are vulnerable to other auto-immune diseases.

      You should have comprehensive lab work done prior to conception, including TSH, Total T4, Free T4, Total T3, Free T3, thyroid antibodies, and vitamin levels. According to the “Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum” updated in 2011:

      “RECOMMENDATION 15 – Treated hypothyroid patients (those receiving thyroid replacement medication) who are planning pregnancy should have their dose adjusted by their provider in order to optimize serum TSH values to <2.5 mIU/L preconception. Lower preconception TSH values (within the nonpregnant reference range) reduce the risk of TSH elevation during the first trimester."

      The key here is prior to conception get your TSH levels less than 2.5 mIU/L. Not all traditional doctors know this. Print out this document and share it with them....

      http://thyroidguidelines.net/pregnancy

      I found my body did not respond well on levothyroxine and not until I switched to Nature-Throid, a combination of T4 and T3 hormone replacement, did my symptoms improve and my thyroid levels reached the proper ranges. Everyone is different.

      Get your lab testing done now before conception, and then again as soon as you determine you are pregnant. Buy yourself several boxes of pregnancy tests. Don’t wait until a missed period to contact your doctor and do not wait for your first scheduled prenatal visit with your ob/gyn. Use pregnancy tests to determine as soon as possible when you are pregnant, and go to your doctor right away for thyroid testing. In pregnancy, the baby relies completely on the mother for thyroid hormone for its development in the first part of pregnancy, so thyroid levels change quickly in pregnancy. Don’t wait for a missed period and don’t wait for the normally scheduled first pre-natal visit, because thyroid levels can change quickly before then.

      There is hope, so no worries. Just be thyroid aware!

  5. Thanks Dana.. Your insight really helped..

  6. I have informed my close friend about having the proper thyroid blood tests now before she begins family planning. We are quite sure that her Father’s side of the family has suffered severe consequences from untreated thyroid disorders.

    More recently her Aunt has suffered the consequences of thyroid cancer. Chemo treatments caused her several debilitating symptoms.

    From the same family, second cousin, had her thyroid removed 20 years ago and passed away from cancer in 2007.

    How concerned should we be about genetic involvement?

    The women I speak of including my daughter are very similar.

    Thank you Dana,
    Johann

    • Dana Trentini says:

      Hello Johann,

      You ask an important question about heredity. If there is any history of thyroid dysfunction and/or thyroid cancer in one’s family absolutely they should be sure to have proper thyroid testing, especially prior to trying to conceive and as early as possible in pregnancy, including TSH, free T4, free T3, reverse T3, and thyroid antibodies. I will be writing in November about proper thyroid lab testing. Her doctor should also conduct a thorough physical exam, including her thyroid to feel for enlargement and lumps, as well as the gland’s size and firmness.

      Thyroid cancer affects women more than men. More research is needed to determine the causes of thyroid cancer. There is a link between people who received childhood radiation to the head and neck and an increased risk for thyroid cancer. Some forms of thyroid cancer also appear to be hereditary or genetic and run in families.

      Thank you for helping to spread awareness Johann. You may be helping your friend more than she knows.

  7. Dana, thank you so much for sharing this! I have just found your site and will be reading all I can. I am almost 45 years old (in three days) and have Hashimoto’s. I have only conceived once, five years ago, and it was a tubal/ectopic pregnancy. I don’t have a history of miscarriage. We would dearly love to have a baby someday but feel like we’re out of time and that no one can help…but maybe I will find something on your site that will point us in the right direction!

    • Dana Trentini says:

      Hi Debbie, I’m so happy you found Hypothyroid Mom. I had my second son at the age of 40 despite my hypothyroidism. There is hope for women with hypothyroidism. Have your Free T4 and Free T3 levels been tested are you on thyroid hormone replacement medication? There is a great book by Dr. Sami David called “Making Babies” that is a must read for all women who wish to get pregnant. In addition to being in the best thyroid help I could possible be in through proper diagnosis and treatment, I also followed this book and literally got pregnant the first month trying it. It’s a must read!

  8. Alisa Upson says:

    good, informative article – was wondering, especially after reading the above comment from Debbie regarding having a tubal pregnancy: could the Hashimotos possibly be a factor in tubal pregnancies, in addition to a “regular” miscarriage. I was diagnosed with the Hashimotos antibody last year, ended up having to have a thyroidectomy due to possible thyroid cancer as the biopsy was inconclusive and my thyroid was to quote the surgeon “huge” (9.9 on one side) and once it was removed the damage from the Hashimotos was very evident/visible. But 15 yrs ago I lost our second and final baby due to a tubal pregnancy, after losing the first to the same thing a year and a half earlier. Each time by the time we realized it wasn’t a normal pregnancy, the baby had grown enough that my tube was too mangled to save, leaving me with no way to conceive naturally. Now I am just wondering if the Hashimotos, even at that early stage could have had any part in it. My sister also has Hashimotos – thankfully she was able to give birth to both a beautiful daughter and twin boys.

    • Dana Trentini says:

      Hi Alisa, Thank you for sharing your story. I am sad to read what has happened to you. Do I understand correctly that as a result of two miscarriages due to tubal pregnancies, both your babies were lost and that you have no children as a result? This is so sad it made me sit quiet staring at my computer screen for a while upset at how thyroid conditions can go unnoticed and result in the loss of babies and for some women results in them never having babies. This is so tragic. While I did not find studies specifically on tubal pregnancies and hypothyroidism, the fact that tubal pregnancies result in miscarriage makes me think that there must have been tubal pregnancies included in these studies on the dangers of hypothyroidism and miscarriage even if they weren’t specifically listed as such. Since the thyroid has so many disastrous effects on women including infertility, miscarriage and still birth, there is a good chance that your Hashimoto’s was a factor in your losses. Of course there other factors besides hypothyroidism that result in miscarriage, but yes there is a chance that your condition was at play. It is stories like yours that compel me to spread awareness about the dangers of hypothyroidism and pregnancy. The lack of awareness results in babies lost to hypothyroid women.

  9. I was iodine deficient and hypothyroid…and miscarried. Iodine supplements changed my life. Check out: http://www.drbrownstein.com/

    • Dana Trentini says:

      Hi Annette, Thank you for sharing this link to Dr. Brownstein’s website. I’ve read a great deal about the link between iodine deficiency and hypothyroidism and found many references for the benefits at the same time found research showing that potential danger of iodine supplementation in hypothyroidism. In particular I read that iodine can worsen a Hashimoto’s condition. I decided to give it a try myself a year ago. I told my doctor before hand that I was going to give it a try but she too warned me that some thyroid sufferers do well on iodine and other’s don’t. She told me to get my thyroid levels tested after 3 weeks on iodine as a safety measure. Within 3-4 weeks on iodine, my TSH sky rocketed and my Free T4 and Free T3 levels dropped significantly, I gained about 5 pounds instantly and started feeling exhausted with mind splitting headaches. When my thyroid results came in, I immediately stopped the iodine. That said, I’ve read so much about the benefits of iodine and would like to research this some more. I’m happy that iodine works for you. I will be sure to check out Dr. Brownstein’s site. Thanks for sharing. I always love hearing what works for other hypothyroid people.

  10. Heather Perez says:

    All very interesting — thank you! I was diagnosed with hypothyroidism in 1996 after having my 1st child. It was difficult for me to conceive again and I finally became pregnant and had my son in 2004. My thyroid medication was increased after having him and I became pregnant again and had my second son in 2005 (they are 14 months apart). In February 2010, at 8 weeks pregnant, I miscarried for the first time. I was 100% certain it was due to my thyroid, however I could never get any of my doctors to agree. I was diagnosed last year with Hashimoto’s. I recently became pregnant again and was given a due date of 10/12/13, which would put me at 6 weeks today. Here it is, February again, and after what I woke up to this morning, and the day I have experienced, I am pretty sure I am no longer pregnant, but will not be able to see a doctor until next week. I can only conclude that it is my thyroid! Now how do I get my doctors to listen?? I can’t bear the thought of continuing to go through this….

    • Dana Trentini says:

      Heather, I am so sorry for what has happened. Of course there are many reason why a woman miscarries and so it is possible that it was due to another cause other than your thyroid. At the same time, it is clear that an under-active thyroid is linked to miscarriage. I wrote a post called “Miscarriage in New York City…Be Thyroid Aware” where at the bottom of that post under references you will find a link to the American Thyroid Association guidelines for pregnancy and the Endocrine Society guidelines for pregnancy. Print out copies of those two guidelines for yourself and for your doctor to be sure that should you be blessed with another pregnancy or hopefully that this current pregnancy has not ended that the guidelines are followed. Best of luck to you Heather.

      http://hypothyroidmom.com/miscarriage-in-new-york-city-be-thyroid-aware/

  11. Melissa says:

    I am so scared right now. I had some routine bloodwork done about 3 months ago which showed a TSH of 7. My doctor did a follow up test later which showed TSH of 4.15 (which she SAID was normal, but I don’t believe it based on what I’ve been reading) with TG antibodies of 1291 and TPO antibodies of 147. My doctor said the results suggested some type of thyroid inflammation and wanted to do a repeat test in 6 months. Well, it’s two months later and I just found out I am pregnant, currently 5 weeks. My husband and I have dealt with male factor infertility for years, so we were very surprised by this. I called my OB yesterday to let them know I am pregnant and about my recent thyroid test results, and they wanted to wait until my 8 week appointment to do more testing. I did get them to allow me to go in sooner, so I had my blood drawn yesterday, but only requested TSH and T4, not thyroid antibodies. I called my OB again today to ask for the antibody tests, but she was not in the office today so she is supposed to get back with me tomorrow. In the meantime, I am freaking out not knowing what is going on, and feeling like my OB does not understand any of this. My husband and I have two healthy boys, ages 5 and 16 months (the first one was a natural conception, the 2nd was IVF). I have never had a miscarriage. I don’t know if I have had thyroid issues in the past–I did get a TSH test right before my IVF and my TSH was 5, which the RE said he was okay with. Is there hope for this pregnancy? What do I need to ask my OB? This is all so overwhelming, if you have any guidance I would really appreciate it. Thank you!

    • Dana Trentini says:

      Melissa, First congratulations on your pregnancy. While yes hypothyroidism of all forms including Hashimoto’s increases our risk of pregnancy complications, there is hope for us to have healthy babies. The fact that you are aware that your thyroid condition is a danger is a great advantage. I agree with you not to wait unit your 8 week appointment. Insist to have your thyroid tested as soon as possible because more than likely you will need an increase in your medication. Even if that means going to your family physician and explaining the issue and asking for testing. The American Thyroid Association issued pregnancy guidelines for pregnancy which you will find in the reference section at the bottom of the post attached. Print a copy of those guidelines and bring them to your doctor. Go through the document and highlight the relevant parts or circle them so your doctor can quickly get to the right information since it’s a long document. Scroll to the bottom and you’ll see “introduction”, “results”, etc make sure to copy it all. Here are the sections to highlight in the “Results” section:

      RECOMMENDATION 2 – Trimester-specific reference ranges for TSH are recommended: first trimester, 0.1–2.5 mIU/L; second trimester, 0.2–3.0 mIU/L; third trimester, 0.3–3.0 mIU/L.

      RECOMMENDATION 16 – In pregnant patients with treated hypothyroidism, maternal serum TSH should be monitored approximately every 4 weeks during the first half of pregnancy because further dose adjustments are often required.

      RECOMMENDATION 17 – In pregnant patients with treated hypothyroidism, maternal TSH should be checked at least once between 26 and 32 weeks gestation.

      Question 16: What proportion of treated hypothyroid women (receiving LT4) require changes in their LT4 dose during pregnancy?
      Between 50% and 85% (38,53,54) of hypothyroid women being treated with exogenous LT4 need to increase dosing during pregnancy. The incremental increase depends, in part, on the etiology of the hypothyroidism. There is a greater likelihood that dose increase will be required in those patients without functional thyroid tissue (e.g., due to radioablation, surgery) in comparison with patients with Hashimoto’s thyroiditis (55,56).

      RECOMMENDATION 14

      There exists great interindividual variability regarding the increased amount of T4 (or LT4) necessary to maintain a normal TSH throughout pregnancy, with some women requiring only 10%–20% increased dosing, while others may require as much as an 80% increase. The etiology of maternal hypothyroidism, as well as the preconception level of TSH, may provide insight into the magnitude of necessary LT4 increase. Clinicians should seek this information upon assessment of the patient after pregnancy is confirmed. Level A-USPSTF

      Question 23: In euthyroid women who are TAb+ prior to conception, what is the risk of hypothyroidism once they become pregnant?

      In 1994, Glinoer et al. (60) performed a prospective study on 87 thyroid autoantibody positive (TAb+) euthyroid women evaluated before and during early pregnancy. Twenty percent of women in the study developed a TSH level of > 4 mIU/L during gestation despite normal TSH and no requirement for LT4 prenatally. This occurred despite the expected decrease in TAb titers during pregnancy. Twelve years later, in a prospective and randomized study, Negro et al. demonstrated similar results (28). The authors found that in TAb+ euthyroid women, TSH levels increased progressively as gestation progressed, from a mean of 1.7 mIU/L (12th week ) to 3.5 mIU/L (term), with 19% of women having a supranormal TSH value at delivery. These findings confirm that an increased requirement for thyroid hormone occurs during gestation. In women who are TAb+, both OH and SCH may occur during the stress of pregnancy as the ability of the thyroid to augment production is compromised and increasing demand outstrips supply. When this happens, an elevated TSH occurs. In summary, patients who are TAb+ have an increased propensity for hypothyroidism to occur later in gestation because some residual thyroid function may still remain and provide a buffer during the first trimester.
      Question 24: How should TAb+ euthyroid women be monitored and treated during pregnancy?
      TSH elevation should be avoided during gestation because of the theoretical and demonstrated harm both SCH and OH may cause to the pregnancy and developing fetus. Because these risks are increased in this population, increased surveillance of euthyroid TAb+ women should occur. Based on findings extrapolated from investigations of treated hypothyroid women who are newly pregnant (54), it is reasonable to evaluate euthyroid TAb+ women for TSH elevation approximately every 4–6 weeks during pregnancy. TSH values that are elevated beyond trimester-specific reference ranges should be treated as described above. Serial testing should occur through midpregnancy because the increased T4 demand continues throughout the first half of gestation.

      RECOMMENDATION 20

      Euthyroid women (not receiving LT4) who are TAb+ require monitoring for hypothyroidism during pregnancy. Serum TSH should be evaluated every 4 weeks during the first half of pregnancy and at least once between 26 and 32 weeks gestation. Level B-USPSTF
      Question 25: Should TAb+ euthyroid women be monitored or treated for complications other than the risk of hypothyroidism during pregnancy?
      In addition to the risk of hypothyroidism, it has been described that being TAb+ constitutes a risk factor for miscarriage, premature delivery (28,60), perinatal death (44), postpartum dysfunction, and low motor and intellectual development (IQ) in the offspring (51). Some studies have found, in nonpregnant women, that selenium is capable of diminishing the TPOAb titers (61–63). Other authors have described conflicting data (64). It has also been described that the selenium level can be low in full-term pregnant women compared with nonpregnant women. Recently, Negro et al. (65) observed that TPOAb+ euthyroid pregnant women treated with 200 ?g/d of selenium not only had a significant decrease in the frequency of postpartum thyroid dysfunction (p< 0.01), but also had lower TPOAb levels during pregnancy compared with women in the untreated group. However, patients under treatment with selenium could be at higher risk of developing type 2 diabetes mellitus (66). At present, the risk to benefit comparison does not support routine selenium supplementation during pregnancy.

      RECOMMENDATION 21

      A single RCT has demonstrated a reduction in postpartum thyroiditis from selenium therapy. No subsequent trials have confirmed or refuted these findings. At present, selenium supplementation is not recommended for TPOAb+ women during pregnancy. Level C-USPSTF

      http://hypothyroidmom.com/hypothyroid-moms-story-of-hope-her-miracle-babies/

      Here is a link to the American Thyroid Association Guidelines themselves (remember to highlight these parts in the Results section that you’ll find by scrolling to the bottom of the introduction page) and bring this to your doctor:

      http://thyroidguidelines.net/pregnancy/results

      • Melissa says:

        Thank you so much for your response, Dana! I wanted to mention that I am not on any thyroid medication, and I never have been. I haven’t even been diagnosed. I figured that would happen in June when I had my 6 month retest, but I did not imagine getting pregnant before then, as we were not trying and have always had difficulty conceiving. So I don’t know how to tell my OB I want to be treated for something that hasn’t been diagnosed or treated yet, especially when she does not believe there is a potentially serious issue. Thank you so much for the information, it will be a lot more helpful than telling my OB “well, I read on the Internet…” It just feels like things take so long with the doctor…if I can convince my OB to test my antibodies, my lab results will probably take 4 or 5 days, and I know the wait will be excruciating. That puts me out a week from now before I can start any treatment (that is, if my OB agrees). I wish I could speed things up, this has me very stressed!

        • Dana Trentini says:

          I see the issue you raise. Here is a recommendation from the same American Thyroid Association for women with high thyroid antibodies but euthyroid (normal TSH) which is referred to in this document as women with TAb+ (thyroid antibody positive) but euthyroid (normal TSH):

          Question 23: In euthyroid women who are TAb+ prior to conception, what is the risk of hypothyroidism once they become pregnant?

          In 1994, Glinoer et al. (60) performed a prospective study on 87 thyroid autoantibody positive (TAb+) euthyroid women evaluated before and during early pregnancy. Twenty percent of women in the study developed a TSH level of > 4 mIU/L during gestation despite normal TSH and no requirement for LT4 prenatally. This occurred despite the expected decrease in TAb titers during pregnancy. Twelve years later, in a prospective and randomized study, Negro et al. demonstrated similar results (28). The authors found that in TAb+ euthyroid women, TSH levels increased progressively as gestation progressed, from a mean of 1.7 mIU/L (12th week ) to 3.5 mIU/L (term), with 19% of women having a supranormal TSH value at delivery. These findings confirm that an increased requirement for thyroid hormone occurs during gestation. In women who are TAb+, both OH and SCH may occur during the stress of pregnancy as the ability of the thyroid to augment production is compromised and increasing demand outstrips supply. When this happens, an elevated TSH occurs. In summary, patients who are TAb+ have an increased propensity for hypothyroidism to occur later in gestation because some residual thyroid function may still remain and provide a buffer during the first trimester.
          Question 24: How should TAb+ euthyroid women be monitored and treated during pregnancy?
          TSH elevation should be avoided during gestation because of the theoretical and demonstrated harm both SCH and OH may cause to the pregnancy and developing fetus. Because these risks are increased in this population, increased surveillance of euthyroid TAb+ women should occur. Based on findings extrapolated from investigations of treated hypothyroid women who are newly pregnant (54), it is reasonable to evaluate euthyroid TAb+ women for TSH elevation approximately every 4–6 weeks during pregnancy. TSH values that are elevated beyond trimester-specific reference ranges should be treated as described above. Serial testing should occur through midpregnancy because the increased T4 demand continues throughout the first half of gestation.

          RECOMMENDATION 20

          Euthyroid women (not receiving LT4) who are TAb+ require monitoring for hypothyroidism during pregnancy. Serum TSH should be evaluated every 4 weeks during the first half of pregnancy and at least once between 26 and 32 weeks gestation. Level B-USPSTF
          Question 25: Should TAb+ euthyroid women be monitored or treated for complications other than the risk of hypothyroidism during pregnancy?
          In addition to the risk of hypothyroidism, it has been described that being TAb+ constitutes a risk factor for miscarriage, premature delivery (28,60), perinatal death (44), postpartum dysfunction, and low motor and intellectual development (IQ) in the offspring (51). Some studies have found, in nonpregnant women, that selenium is capable of diminishing the TPOAb titers (61–63). Other authors have described conflicting data (64). It has also been described that the selenium level can be low in full-term pregnant women compared with nonpregnant women. Recently, Negro et al. (65) observed that TPOAb+ euthyroid pregnant women treated with 200 ?g/d of selenium not only had a significant decrease in the frequency of postpartum thyroid dysfunction (p< 0.01), but also had lower TPOAb levels during pregnancy compared with women in the untreated group. However, patients under treatment with selenium could be at higher risk of developing type 2 diabetes mellitus (66). At present, the risk to benefit comparison does not support routine selenium supplementation during pregnancy.

          RECOMMENDATION 21

          A single RCT has demonstrated a reduction in postpartum thyroiditis from selenium therapy. No subsequent trials have confirmed or refuted these findings. At present, selenium supplementation is not recommended for TPOAb+ women during pregnancy. Level C-USPSTF

          • Melissa says:

            So is it the thyroid antibodies themselves, or the risk for hypothyroid that is a concern? Is this saying that I should just be monitored and only treated if I develop hypothyroidism?

  12. Dana Trentini says:

    Melissa, Hypothyroidism alone is linked to pregnancy complications. Even the very presence of thyroid antibodies is a danger to pregnancy because even women with hashimoto’s whose TSH is normal have the danger of the TSH rising quickly early in pregnancy due to the need of the fetus for the mother’s thyroid hormones for growth and development. So it is important to have your thyroid levels tested right away and very regularly to ensure your TSH is not rising and endangering your child. You should also speak with your doctor about these guidelines to decide whether or not you would benefit from thyroid treatment. The key is getting your thyroid tested right away and seeing your doctor as soon as possible to discuss what’s needed. By bringing your doctor these guidelines, at least you can be sure that he/she knows the guidelines and will base decisions on this updated information. I know it’s a lot of information to throw at you. Just wanted you to bring all this to your doctor so that they have what they need to make the right decisions for you and your baby. Best of luck to you.

    • Melissa says:

      Dana, I wanted to give you an update. My OB agreed to let me do my bloodwork this week and my TSH came back at 8.26, so she is putting me on 50 mcg of Levothyroxine and referring me to an Endo. She also said she wanted to retest in 8 weeks, but I asked if we could retest in 4 and she said that was okay. I feel so much better knowing that something is being done now. I want to thank you so much, Dana. You are an angel! I was able to speak much more confidently with the information you gave me, rather than just accepting what the nurse had to say, so you have been very helpful. The nurse told me to take my meds in the morning, though. Do I just start taking it tomorrow?

  13. Dana Trentini says:

    Melissa, so happy to hear that. So happy you pushed to be retested in 4 weeks. Please remember that the American Thyroid Association recommends a TSH of less than 2.5 in the first trimester so your 8.26 is too high and so happy you took action and started treatment. Push to have your appointment with the Endo as soon as possible so you get a second opinion quickly. Otherwise check my post attached below to find a good thyroid doctor and go get yourself a second opinion right away. So happy you are taking action. Hooray.

    http://hypothyroidmom.com/top-10-resources-to-find-a-great-thyroid-doctor-in-2013/

    RECOMMENDATION 2 – Trimester-specific reference ranges for TSH are recommended: first trimester, 0.1–2.5 mIU/L; second trimester, 0.2–3.0 mIU/L; third trimester, 0.3–3.0 mIU/L.

  14. i have hashimotos.as.well…currently 12weeks.4days.pregnant…have alot.of concerns..could.you lend.a “helping ear”

  15. I was diagnosed over summer with hashi’s. My level were off the charts i was told. Recently found out i was pregnant. Im new to everything with the thyroid. Well heres my concern..i was put on 100mcg of levothroid..generic synthroid..my ob gyn tested my levels at 9weeeks and said i needed to contact my pcp asap because my med needed adjusted. So i did..a week later he uped my dose to 112mcg. . I told my pcp i was nervous i dont want my baby harmed and he said my level wasnt off by alot it was a little above 3. .i have no idea what that meant or.means. And i love my pcp but im afraid hes not good at thyroid with pregnacy..because he then said we will re check you in 3MONTHS!! I found nothing wrong with that bc i am uneducated about this disease w pregnancy and i trust him. Well today at 12wks 4days pregnant i visited my obgyn and she said 3months is wayyy to long..and.scheduled testing for the end.of april. Heres my.other problem..she refered me to a better doctor to have a sobohram done when i reach 19weeks..bc she said she wans to be thorough bc thyroid can cause mutiple problems for.my unborn child and even after birth..im freaking out. If hats the case why is she waiting 6weeks to re test me…and although the pcp said my levels wernt far off n only changed my dose by 12mcgs..should i worry? I knew i had hashimotos so ive been taking meds..jus its flucuated…am i still at risk..and i scared waiting another 6weeks if my.levels are STILL off wouldnt that harm my child? Im so lost and confused..and also my obgyn told me to take synthroid..not he generic..my insurance doesnt cover that so i paid out of pocket for it…some say.thats senseless..is it? Didnt know there was a difference. Im just worried beyond belief..my.first child is 10yrs old and was always healthy i didnt have hashimotos with her..and im praying his baby is the same..any advice is welcome PLEASE

    • Dana Trentini says:

      Hi Kari, Congratulations on your pregnancy. There is hope to have healthy babies despite Hashimoto’s. The key is being in the hands of a doctor who understands thyroid conditions especially in pregnancy.

      Here is a link to the American Thyroid Association Guidelines themselves (remember to highlight these parts in the Results section that you’ll find by scrolling to the bottom of the introduction page) and bring this to your doctor. I agree with you that you want to be seen as soon as possible to make sure they are aware of the guidelines for pregnancy. Please print out a copy of these guidelines linked here and go to the bottom of the first page to the “results” and you will find all these recommendations listed. Copy the intro page and the entire results section for your doctor and highlight the parts that I’ve listed below that way your doctors have this very important information. Not all doctors have read these guidelines so it is important to bring copies of these guidelines to them. I would also recommend you try to seek a second medical opinion for your case. I’ve attached at the very bottom of this reply a link to my post “Top 10 Resources To Find a Great Thyroid Doctor in 2013″. Please see if there is a doctor in your area or one not to far away that you can drive to for a second opinion. At the same time you shouldn’t panic because your doctor is at least aware that your medication needed to be increased due to your pregnancy so that’s great because many doctors are not aware of this but I would still bring copies of these guidelines to them so they have the information they need. Best of luck to you and let me know how everything goes.

      http://thyroidguidelines.net/pregnancy/results

      RECOMMENDATION 2 – Trimester-specific reference ranges for TSH are recommended: first trimester, 0.1–2.5 mIU/L; second trimester, 0.2–3.0 mIU/L; third trimester, 0.3–3.0 mIU/L.

      RECOMMENDATION 16 – In pregnant patients with treated hypothyroidism, maternal serum TSH should be monitored approximately every 4 weeks during the first half of pregnancy because further dose adjustments are often required.

      RECOMMENDATION 17 – In pregnant patients with treated hypothyroidism, maternal TSH should be checked at least once between 26 and 32 weeks gestation.

      Question 16: What proportion of treated hypothyroid women (receiving LT4) require changes in their LT4 dose during pregnancy?
      Between 50% and 85% (38,53,54) of hypothyroid women being treated with exogenous LT4 need to increase dosing during pregnancy. The incremental increase depends, in part, on the etiology of the hypothyroidism. There is a greater likelihood that dose increase will be required in those patients without functional thyroid tissue (e.g., due to radioablation, surgery) in comparison with patients with Hashimoto’s thyroiditis (55,56).

      RECOMMENDATION 14

      There exists great interindividual variability regarding the increased amount of T4 (or LT4) necessary to maintain a normal TSH throughout pregnancy, with some women requiring only 10%–20% increased dosing, while others may require as much as an 80% increase. The etiology of maternal hypothyroidism, as well as the preconception level of TSH, may provide insight into the magnitude of necessary LT4 increase. Clinicians should seek this information upon assessment of the patient after pregnancy is confirmed. Level A-USPSTF

      Question 23: In euthyroid women who are TAb+ prior to conception, what is the risk of hypothyroidism once they become pregnant?

      In 1994, Glinoer et al. (60) performed a prospective study on 87 thyroid autoantibody positive (TAb+) euthyroid women evaluated before and during early pregnancy. Twenty percent of women in the study developed a TSH level of > 4 mIU/L during gestation despite normal TSH and no requirement for LT4 prenatally. This occurred despite the expected decrease in TAb titers during pregnancy. Twelve years later, in a prospective and randomized study, Negro et al. demonstrated similar results (28). The authors found that in TAb+ euthyroid women, TSH levels increased progressively as gestation progressed, from a mean of 1.7 mIU/L (12th week ) to 3.5 mIU/L (term), with 19% of women having a supranormal TSH value at delivery. These findings confirm that an increased requirement for thyroid hormone occurs during gestation. In women who are TAb+, both OH and SCH may occur during the stress of pregnancy as the ability of the thyroid to augment production is compromised and increasing demand outstrips supply. When this happens, an elevated TSH occurs. In summary, patients who are TAb+ have an increased propensity for hypothyroidism to occur later in gestation because some residual thyroid function may still remain and provide a buffer during the first trimester.

      Question 24: How should TAb+ euthyroid women be monitored and treated during pregnancy?
      TSH elevation should be avoided during gestation because of the theoretical and demonstrated harm both SCH and OH may cause to the pregnancy and developing fetus. Because these risks are increased in this population, increased surveillance of euthyroid TAb+ women should occur. Based on findings extrapolated from investigations of treated hypothyroid women who are newly pregnant (54), it is reasonable to evaluate euthyroid TAb+ women for TSH elevation approximately every 4–6 weeks during pregnancy. TSH values that are elevated beyond trimester-specific reference ranges should be treated as described above. Serial testing should occur through midpregnancy because the increased T4 demand continues throughout the first half of gestation.

      RECOMMENDATION 20

      Euthyroid women (not receiving LT4) who are TAb+ require monitoring for hypothyroidism during pregnancy. Serum TSH should be evaluated every 4 weeks during the first half of pregnancy and at least once between 26 and 32 weeks gestation. Level B-USPSTF

      Question 25: Should TAb+ euthyroid women be monitored or treated for complications other than the risk of hypothyroidism during pregnancy?
      In addition to the risk of hypothyroidism, it has been described that being TAb+ constitutes a risk factor for miscarriage, premature delivery (28,60), perinatal death (44), postpartum dysfunction, and low motor and intellectual development (IQ) in the offspring (51). Some studies have found, in nonpregnant women, that selenium is capable of diminishing the TPOAb titers (61–63). Other authors have described conflicting data (64). It has also been described that the selenium level can be low in full-term pregnant women compared with nonpregnant women. Recently, Negro et al. (65) observed that TPOAb+ euthyroid pregnant women treated with 200 ?g/d of selenium not only had a significant decrease in the frequency of postpartum thyroid dysfunction (p< 0.01), but also had lower TPOAb levels during pregnancy compared with women in the untreated group. However, patients under treatment with selenium could be at higher risk of developing type 2 diabetes mellitus (66). At present, the risk to benefit comparison does not support routine selenium supplementation during pregnancy.

      http://hypothyroidmom.com/top-10-resources-to-find-a-great-thyroid-doctor-in-2013/

  16. Sorry.for all incorrect.grammar im jus a wreck

  17. Caroline says:

    I’ve been googling info for a week now trying to find some guidance… but I’m as lost today as I was last week. I am 40 years old with 2 healthy children (10 and 13). In 2008, I was diagnosed with a multinodular goiter. My doctor is suspicious for Hashimoto but I’ve never received an official diagnosis. Since then I’ve had blood tests every 4 months (all returning normal) and annual ultrasounds. Last summer, I had 3 biopsies on nodules that were bigger than 1cm and one came back as indeterminate. So since I’ve had hypo symptoms despite my normal blood tests and there’s a chance I have thyroid cancer, my doctor is scheduling me for a total thyroidectomy in August. I just found out I am pregnant. I have just started my 6th week. I don’t know what to do. If I continue with the pregnancy, what will be the impact on the baby’s health and on my health? What are the risks involved with delaying my surgery? I had a blood test last week, and my TSH was 2.1 and my T4 was 17.1… what are my chances of having an healthy pregnancy and baby? thank you.

    • Dana Trentini says:

      Caroline,

      First off congratulations on your pregnancy. I am sorry all that’s happened to you. I wish that I could answer your question about the risks involved in delaying your surgery. What I do know is that there is hope to have a healthy pregnancy despite your condition so long as your thyroid is monitored closely throughout your pregnancy. However it sounds like your doctors are doing that. What does your doctor say about the risks of delaying surgery?

  18. Hello Dana,

    Thanks for this great website with lots of useful and interesting information.

    I was diagnosed with Grave’s disease after the birth of my daughter. I was on medication for one year then stopped to see if my levels would remain normal. My levels including my TSH have remained within the normal range without medication. I am TSI positive and also TAb positive. After about 6 months that I stopped the medication, I started to experience symptoms like anxiety, palpitations, slight tremors, also hair loss, sleep problems and constipation. These symptoms come and go every few months now. Since my thyroid levels continue to be in the normal range, my doctor says there is not much to do and believes it’s my body’s way of switching over to Hashimoto’s disease. She also thinks it could be Hashitoxicosis.

    I would really like to have another baby but I’m so scared that this could be harmful to the growing baby and could cause problems to the baby once he/she is born if I pass on the antibodies. Any advice on conceiving/pregnancy with hashitoxicosis?

  19. Hey all,

    I’m a 37 1/2 year old who wasn’t ever sure she wanted kids for several reasons- lack of a decent guy, a family history of children born with severe medical conditions, and a Hashimoto’s diagnosis a few years ago. I finally started seeing a wonderful man a few months ago and just found out I am pregnant this past Friday. I called a doctor to set up an appointment to get confirmation and figure out the next steps since from all sides (age, thyroid, family history …) it sounds pretty high risk. To say I’m trying not to freak out is an understatement. I’m finding your articles very helpful but do you have Any advice? Thoughts?

    Jo

    • Dana Trentini says:

      Hi Jo,

      Congratulations on your pregnancy. Please don’t be scared because there is hope to have beautiful health babies. Call your doctor today for thyroid testing immediately because often times a woman’s TSH shoots up quickly in the early weeks as the baby depends on the mother for thyroid hormone so get your testing right away because often times thyroid sufferers need an increase in their medication in early pregnancy so it’s about getting tested asap.

      Make a copy of the American Thyroid Association Guidelines for pregnancy linked here and bring it to your doctor.

      http://thyroidguidelines.net/pregnancy/results

      RECOMMENDATION 2 – Trimester-specific reference ranges for TSH are recommended: first trimester, 0.1–2.5 mIU/L; second trimester, 0.2–3.0 mIU/L; third trimester, 0.3–3.0 mIU/L.

      RECOMMENDATION 16 – In pregnant patients with treated hypothyroidism, maternal serum TSH should be monitored approximately every 4 weeks during the first half of pregnancy because further dose adjustments are often required.

      RECOMMENDATION 17 – In pregnant patients with treated hypothyroidism, maternal TSH should be checked at least once between 26 and 32 weeks gestation.

      Best wishes to you and your baby.

  20. I’m 33 and have had one ectopic pregnancy, one baby to term (he’s almost 21 months) and I’m pregnant again. when my son was discovered (we weren’t trying) they two ultrasounds a week apart measured him at different weeks. And though I do know that that is to some degree normal the current pregnancy is also measuring off. According to my math we are 7.5 weeks but the ultrasound tech yesterday said 6. I was diagnosed with Hashi’s 4 years ago as well as several complications like leaky gut. I have done a lot of reading and research and realize that Hashi’s patients tend to have smaller babies (my son was 6 lbs 4 ozs) but does the Hashi’s also affect size in utero? They say that my son was 3 weeks early but my husband and I think it was only a week or so and the new pregnancy ultrasound results are making me think.

    • Dana Trentini says:

      Viv,

      Congratulations on your pregnancy. Have you had your thyroid level recently tested? Are you on thyroid medication? Please call your doctor and ask for testing if you haven’t already. The American Thyroid Association issued guidelines on pregnancy in 2011. Here they are bring a copy for your doctor. They recommend a TSH of less than 2.5. Your baby may be well and healthy, however better to be cautious and go see your doctor to discuss and bring the guidelines for them to review.

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472679/

  21. I recently found out that i have hypothyroid and have been on levothyroxine for the past 4 weeks , i got blood work done yesterday and found out my levels are good but that my thyroid antibodies levels are high , my blood works also shows that my hcg levels show that i am 2 weeks pregnant . I am very nervous and was just looking for some tips on what to do to insure a successful prgnancy as me and my husband lost a baby at 32 weeks due to a blood clot which is a whole other set of problems

    Any tips would be appreciated

    • Dana Trentini says:

      Hi Taylor,

      Congratulations on your pregnancy! If you haven’t already please go right away to get your thyroid testing done and bring a copy of the American Thyroid Association guidelines for pregnancy to your doctor because many doctors have not read it. Which states:

      ■RECOMMENDATION 2

      If trimester-specific reference ranges for TSH are not available in the laboratory, the following reference ranges are recommended: first trimester, 0.1–2.5 mIU/L; second trimester, 0.2–3.0 mIU/L; third trimester, 0.3–3.0 mIU/L.

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472679/

      There is hope to have beautiful healthy babies as happened to me but you must be sure your doctor regularly tests your thyroid levels throughout your pregnancy as the guidelines state to make sure you are okay throughout. Often times are dosage needs to be increased in pregnancy.

      ■RECOMMENDATION 14

      There exists great interindividual variability regarding the increased amount of T4 (or LT4) necessary to maintain a normal TSH throughout pregnancy, with some women requiring only 10%–20% increased dosing, while others may require as much as an 80% increase.

      ■RECOMMENDATION 16

      In pregnant patients with treated hypothyroidism, maternal serum TSH should be monitored approximately every 4 weeks during the first half of pregnancy because further LT4 dose adjustments are often required. Level B-USPSTF

      ■RECOMMENDATION 17

      In pregnant patients with treated hypothyroidism, maternal TSH should be checked at least once between 26 and 32 weeks gestation. Level I-USPSTF

      I was interviewed by thyroid advocate Mary Shomon on Fertility and Pregnancy for Thyroid Patients. Here is a recording:

      http://cdn.voiceamerica.com/health/011268/shomon060513.mp3

      • I cannot thank you enought for the advice I have start to see a endocrinologist and a high risk obgyn your website had made such a difrrence and has help so much thank you

  22. Hi,

    I have a lovely 4 year old daughter. Had 2 MMC in the past year(#1 at 8 weeks and #2 at 6 weeks) . Had my thyroid checked last week and the blood work came back normal but my Antibodies were slightly over the limit. Doctor said that I would most likely become Hypo in the future. I asked him to put me on a low dose TSH hormone. He prescribed 50mg Synthoid. (Can this negatively influence a subsequent pregnancy if my levels are normal 0.81? )Do you think that I lost my babies due to not being able to produce enough Thyroid hormone while pregnant? Or could it be that my body is attacking the fetus? I have read somewhere else that if your Thyroid Antibodies are elevated, this could indicate that your NK cells and T-cells are overactive. Do you think I must continue with the Synthoid?

    We are trying again, and I just need to eliminate possible causes for my own peace of mind.

    • Dana Trentini says:

      Vicky,

      TSH alone is not enough to give a full picture of your condition. Thyroid advocate Janie Bowthorpe includes a list of recommended lab work and getting proper testing is the first step in determining what’s best for you.

      http://www.stopthethyroidmadness.com/recommended-labwork/

      Given the importance of being as thyroid healthy as possible before conception, get multiple medical points of view. I compiled a list of the top 10 resources to help readers find a great thyroid doctor in their area. It’s worth it to see several doctors to hear all points of view.

      http://hypothyroidmom.com/top-10-resources-to-find-a-great-thyroid-doctor-in-2013/

      There are other important things to consider for Fertility and Pregnancy. I was interviewed by thyroid advocate Mary Shomon on fertility and pregnancy. It was a great show. Here is a recording:

      http://cdn.voiceamerica.com/health/011268/shomon060513.mp3

      • Charity H says:

        I have Hashimotos. I even saw a a specialist who monitors high risk pregnancies in addition to my obgyn. I had two consecutive miscarriages. Neither physician ever told me that my body could be attacking the baby. I was given zero answers for the miscarriages. The only thing that the Dr did was increase my synthroid. I just don’t understand why this issue is not discussed or tested (regarding the antibodies).

        When I was diagnosed a few years ago. I was told there was nothing I could do but take synthroid the rest of my life. The endo told me medical research doesn’t know why , many women get it, and there was a high correlation with woman my age who are diagnosed. To add insult to injury my PCP insisted I had depression and I walked around misdiagnosed for three years until the PA ordered bloodwork. By the time I was diagnosed I was functioning at a TSH severe range. My bp was 85/45 body temp 97 and heart rate 45. I would try to stand and fall over.

        Needless to say I am very angry with the medical care I have received. We are a system of bandaids. Its really just disgusting. Thank you for your work! I wish I found this last year. I continued to trust Drs. And i shouldnt have without researching it. My nutrtionalist has truly opened my eyes! And that’s how I found this blog!

        Charity Hoffman

        • Dana Trentini says:

          Hi Charity,

          It is truly shameful how little attention thyroid conditions received by the medical community. It took miscarrying for me to get so angry and start researching on my own. Happy to have you at Hypothyroid Mom.

  23. Hi Dana,

    Thank you for this great website.
    Just today I was diagnosed with Hashimoto’s; I’m shocked.
    The diagnosis came out unexpectedly, I was suffering from vaginal yeast infections for a whole year non-stop. Finally I found a gyn. who ordered thyroid hormone tests AND she ordered the TPO antibodies test. It came back elevated, all other hormones were fine. Then she directed me to an endocrinologist, who, after checking me and getting me a sonogram diagnosed me with Hashimotos.
    Now – I don’t have any symptoms at all. I wanted to get rid of the yeast infection in order to get pregnant – we were planning to start trying in a month or so.
    I have one non-developing pregnancy in the past (5 years ago).
    I am scared, scared to death. Will I be able to carry a child, will I be able to conceive, will the child be healthy?
    Maybe I shall not have any children at all? What if they inherit this autoimmune condition?
    The doctor told me that I should be fine, she gave me some meds, and said that I should be closely monitored during the pregnancy and all should be fine.
    But I am still scared.

    Anyway, writing this makes it easier.

    Thank you again Dana!

    With Best Regards,
    Maria.

    • Dana Trentini says:

      Hi Maria,

      Yes we can have healthy babies despite hypothyroidism including Hashimoto’s but it’s about being as thyroid healthy prior to conceiving. What medication did your doctor give you? I was interviewed by thyroid advocate Mary Shomon on fertility and pregnancy. Excellent show. Here is a recording:

      http://cdn.voiceamerica.com/health/011268/shomon060513.mp3

      Be sure to have your selenium tested because low selenium levels are linked to Hashimoto’s and there is research showing selenium supplementation to normal selenium levels can reduce antibodies. There are other major thing known to lower antibodies is going gluten-free.

      http://chriskresser.com/the-gluten-thyroid-connection

      • Hi Dana,

        Thank you so much for the informative response!

        I listened to the show and read the article about the gluten and TPO antibodies connection.
        Congratulations to you for being in the top 10% in the’change the world competition”!

        Below are my test results and the medications:
        TSH is 3.2 ( lab normal is 0.5-4.1)
        T4 free is 1.3 ( lab normal is 0.85-1.85)
        TPO antibodies is 191.3 ( lab normal is less than 40)
        My thyroid is enlarged and inflamed.
        My gyn sent me to these tests as I have a yeast infection which is persistent for more than a year, she says autoimmune and yeast are connected. I do not have any other symptoms.
        My prescription is: L-tyrixine 25 for 16 days, then for 1.5 months L-tyroxine 50. Then I shall check my TSH levels. Also I take ibuprofen 200 for about 3 weeks twice a day.

        After reading and listening to the show I decided to get my T3 free and reverse and selenium levels tested. Also I will start a gluten free diet.
        I am currently in my home country (Armenia) and here I can just walk in to the lab pay and have any test done. Then I will call my endo to talk about the results.

        I am going to return to Canada in 2-3 weeks ( i live in Canada now) and I am very scared that they will not send me to an endo, and I am scared they will refuse testing during pregnancy. But I will fight for that! I have read that they do not treat Hashi in patients whos hormone levels are not impaired…

        Also I wanted to tell, that 5 years ago I lost a pregnancy also and I am pretty sure it was my thyroid that caused it.

        Finally I would love to volunteer to help you with your initiative here, in case you need it. I think your work on this matter is incredible and it will save many babies and make so many women happy moms.
        Thank you Dana!

        With Best Regards,
        Maria.

        • Dana Trentini says:

          Hi Maria,

          Thank you for volunteering your help. So kind. I would appreciate help in sharing my blog with your friends and family, people who you feel would benefit. I am hoping that by readers spreading this information that it will reach the people who are suffering and don’t know why.

          As you know from my interview radio show with Mary Shomon that the American Thyroid Association guidelines for pregnancy recommend a TSH less than 2.5 for women trying to conceive and in the first trimester. Your TSH at 3.2 is high. So of course your doctor could adjust your dosage. However I am happy to hear you will be getting the additional testing including Free T3 because it may be you would benefit from the addition of T3 medication.

          http://hypothyroidmom.com/which-is-the-best-thyroid-drug-for-hypothyroidism/

          There is a great book you should read to help reduce your thyroid antibodies by Dr. Izabella Wentz. Here is a link to the website for her new book. Best wishes to you.

          http://www.thyroidlifestyle.com

    • Dear Maria, Dear Dana,

      First, thank you Dana for your work and this great site!

      Now, Maria, I thought that maybe you’d like to hear some words of encouragement. I was diagnosed with Hashimoto’s some 10 years ago. In the meantime, I went from 25 µg of L-thyroxine to 150 µg and back down to 75 µg again. We have been trying to get a child for five long years and only then I became aware of the connection of my super-high levels of TPO antibodies (1600!) and the problems to conceive. I did not know anything about going gluten-free as a way to reduce the TPOA, but I did try taking selenium methionine 200 µg/day for some time and then it happened! We have a healthy beautiful boy now.
      I should maybe also mention that I continued taking selenium through the first trimester, and I was taking iodine for the whole duration of my pregnancy (yes, I know this is what the doctors will always say you shouldn’t do if you have Hashimoto’s, but my endo said it is absolutely necessary for the baby to be healthy). My boy was born 6 weeks earlier. Basically, after several checks, the doctor said the baby was not feeling well and decided for an emergency c-section. All the checks after the birth confirmed everything was fine with him, so I cannot but wonder if my TPOAs started giving him a hard time in there. In retrospect, maybe taking selenium all the way through the pregnancy would have helped to keep it going to the end of the term, but I had nobody to consult about it and was afraid of passing selenium to my baby for such a long time.

      Wishing you a lot of luck, let me know if I can help you with any advice!

      Marianne

      • Dana Trentini says:

        Hi Marianne,

        Thank you for sharing your story. There is considerable research on the benefits of selenium for reducing thyroid antibodies. It’s sad how nutrient deficiencies like selenium, D3, B12, magnesium, and zinc are often not tested yet play such an important role in thyroid health. Congratulations on your son. Our children are truly miracles.

  24. Hi, Dana. Thank you for creating this blog. In the last 18 months I suffered 5 early miscarriages. I had 2 chemical pregnancies and 3 losses around 6 1/2 weeks. I have one living child that is 3 years old. I am shocked that after my first and healthy pregnancy I suffered so many losses. Each time it happened I was convinced that my thyroid was to blame for but my doctors just kept saying that is most likely my age rather than my thyroid. I was 39 when my 1st miscarriage happened. I went through every fertility test under the sun and all was normal. None of the doctors wanted to test my thyroid even though all the symptoms I had implied that there may be something wrong with it. Also, my mom, her 2 sisters and my grandmother were diagnosed with thyroid condition. Everytime I brought a thyroid issue my drs were ignoring me and telling me that i feel this way because of the saddness from recurrent pregnancy loss. After my 3rd loss I insisted that my OBGyn tests my thyroid. She ordered the following test Tsh, t4 free and t3. She didn’t bother checking any of the thyroid antibodies. All of the test that she ordered came on a lower end of normal range.
    Last week after my latest loss I decided to see my primary physician for annual exam. I expressed my concerns about my thyroid. During the exam my dr checked my thyroid and said that it feels prominent and irregular. She ordered some thyroid tests that I just got the results for. I haven’t talk to her yet but all seems normal except thyroglbuline antibody. It is slightly elevated. TSH is at .92 standard range is .40 – 4.50; T4, free, direct was at 1.0 and Standard range is .8 -1.8; thyroid peroxide antibodies were at 15 and standard range is <35; thyroglobulin AB was at 23 and standard range is <20. Is it possible that I have a beginning stage of Hashimoto's Diesease even though my levels are normal except one? I worry that my primary physician is going to say that my test results are normal while in fact my thyroid is beginning to show signs of distress. I am just lost and feeling alone in this fight against my infertility issue. Any kind of advise will be greatly appreciated.
    Thank you,
    El.

    • Dana Trentini says:

      Oh Elli, I am so sorry for the loss of all your sweet babies. That is a tragedy. Absolutely your thyroglobulin antibodies may be a factor in your pregnancy losses. Now 23 when a normal range is <20 is not far out of normal but this is worth investigating further. Hashimoto's is considered the number one cause of hypothyroidism in the US and a person with Hashimoto's can have one or both thyroid antibodies. Full testing should include Free T3, Reverse T3, adrenals, full iron panel, sex hormones, D3, B12, magnesium, zinc, selenium, bacteria/viral infections, Candida, food intolerances especially gluten (several readers have gone gluten free and their thyroid antibodies reduced to normal), and blood sugar issues. Thyroid antibody levels can fluctuate so retest your levels periodically to see if they change and also request a thyroid ultrasound to have a closer look at your thyroid gland and can confirm Hashimoto's.

      There is a great book about lifestyle changes to treat Hashimoto's by Dr. Izabella Wentz.

      http://hypothyroidmom.com/hashimotos-thyroiditis-lifestyle-interventions-for-finding-and-treating-the-root-cause/

  25. Jen Calderwood says:

    Hi Dana,
    I have been dealing with Hashimoto’s for 6 years after my first child was born. I am taking synthroid, keep having to increase the dose and my big concern is that my antibody tests are all VERY high. I have stopped eating gluten, am seeing a naturopath to help support my immune system but it doesn’t seem to help my numbers go down. My thyroid peroxidase (TPO) is 2,834. normal is 0-34. Do you have any suggestions on what to do about this? We are also considering having a third baby, I have no idea if I should with my lab results the way they are. I also suffer from migraines and the root cause has not been identified yet. Any suggestions on what type of doctor could help with this. Or what I can do to calm down my immune system.
    thanks so much
    Jen

  26. My daughter was diagnosed with hoshimotos in 2010. Her t4,tsh levels remain within normal range, so, endo decided not to treat her at this time. Her OBGYN tested her t4,tsh before advising her to get pregnant nine month ago. She finally conceived in august. she went to the dr who did an ultrasound and saw tissue measuring 6 weeks gestation, yet, no heartbeat. She returned last week, still no heartbeatand there was no longer evedince of implantation. He suggested a D&C and told her the pregnancy was no longer or she could wait a week or 2 to recheck, but, really gave her no indication of hope. She opted to wait, hoping for a miracle. Any suggestions? Thank you.
    Nancy

  27. Gina Gentile says:

    Hi Dana,
    I am writing to tell you my story to encourage others, and also to ask a question. The question is can a 3.9 TSH cause an elevated FSH? Particularly if I have Hashimoto’s..

    Ok my story, I was pregnant at 23 and had a huge mass appear on my thyroid. The tried needle aspiration and could not get diagnostic cells. The doctor suspected cancer because of it’s rapid growth, and wanted to operate and remove it right away. I refused surgery for fear of harming my baby, and I delivered a healthy baby boy. (I did however, have him 6 weeks early due to premature rupture of membranes).
    During my pregnancy doctors told me my thyroid levels were normal. (I don’t know what the numbers were though, I was young and trusting.)
    After I had baby, I have a nuclear scan and found the mass was cold, non-functioning. I had been told a few years previously that I had lupus. I was sick a lot, with joint pain, fatigue etc and had a positive ana test. So I did some reading and discovered hashimoto’s. I asked my doctor to check for anti-thyroglobulin and anti-microsomal antibodies and I was positive for those. In my 30s the mass got large enough to deviate my trachea, so I had it removed. They biopsied it and the remainder of my thyroid and definitively diagnosed the Hashimotos. I stayed on synthroid after that. I had some bad times and didn’t take care of myself, and didn’t always take my meds and didn’t care. (Depression). My thyroid got incredibly low and I got help for the depression and back on meds. Then, at 43, a new man in my life, I suddenly had a surprise pregnancy. I was thrilled! But I miscarried. I believe my thyroid was low, but the dr didn’t check, and I was despite being 43, naïve. After the miscarriage, I ready every book on the marked about fertility and took my thyroid very seriously and went on to become pregnant again at 44 and had my little boy at 45! I am so blessed with my sons. Even my latest pregnancy, however, the doctor didn’t check my tsh without me asking him to! and he was a high risk specialist. So- the moral of my story is to let ladies know, it IS very possible to have babies with hashimotos, and it IS even possible at an older age! But you have to be proactive about your health and talk to your doctor and ask for tests if he doesn’t do them! I am now 47, and would like to have another baby. (I know, I’m crazy, but I love my kiddos and feel great.) Anyway, my tsh is 3.9 now and my fsh is 19.6 (which could be menopause). My other hormones are all normal. So, I’m hoping getting my tsh down, may lower my fsh and maybe I’ll be blessed with another. Take care to you all.
    Gina

    • Dana Trentini says:

      Hi Gina,

      Congratulation to you on your pregnancy at age 43. I was age 40 when I had my second son. Yes miracle babies are possible for us with hypothyroidism even in our 40s. While I have not read specifically about FSH and TSH, my guess would be that there would be a connection. It is well known that the endocrine system all works in concert with each other so why low thyroid also often comes with abnormal sex hormones level and abnormal adrenal hormones. 3.9 is too high for pregnancy. The American Thyroid Association recommends a TSH less than 2.5 for hypothyroid women planning to conceive and in the first trimester. It’s very sad your doctor who is a high risk specialist did not pay closer attention to your thyroid. I am sorry to hear about your miscarriage. Thank you for sharing your story.

      http://hypothyroidmom.com/miscarriage-in-new-york-city-be-thyroid-aware/

  28. Hey this amazing girl I’ve been dating just broke up with me after telling me she wanted to step back and get her Hashimotos under control.

    We had problems because she just didn’t seem interested in holding hands, kissing, etc. Of course, I’ve now made the mistake of reading a bunch of Hashimotos divorce stories.

    I don’t want to give up on this but I’d like some advice on what I can do to help. And I’m also wondering, are we destined to spend our whole lives on opposite ends of the couch?

    Thanks for all you’re doing.

  29. Hi Dana,

    Thank you so much for the information you’ve compiled on your website. I’m so sorry for your loss but very thankful for how you are using it to help other women.

    I am 29 years old and have had two perfectly normal, healthy pregnancies, my girls are now 5 and 3. Last July I was diagnosed by my OB as hypothyroid, a month later we found out wee were pregnant. It was a surprise as we were not trying but my doctor assured me that since I had started taking medication for the hypothyroidism that everything would be fine. I miscarried at 9 weeks and was concerned that perhaps it was related to the thyroid but my doctor assured me it had nothing to do with it.

    We waited about five months and then got pregnant again. My doctor said my levels were within “normal range” and I expected everything to be fine. Again, we miscarried at 9 weeks. My doctor still insisted that it could not have anything to do with my thyroid and called it a “fluke”. I did not believe her and went looking for more answers. On the recommendation of a friend I began seeing an endocrinologist who specializes in thyroid issues and diabetes. The first thing she did was test my TSH and run an antibody screen. She found that while my thyroid function was within the “normal” range, it was still higher than recommended for pregnancy (as you have illustrated above). She also found that the antibodies were present and diagnosed me with Hashimoto’s

    She told me that keeping the antibodies away was just a matter of keeping my TSH levels low enough. I have been on Synthroid ever since and was given the go ahead to try again to conceive. We did, I am pregnant, I had my levels checked and my TSH looks great.

    Here is my question: I found Dr. Clark’s site before I found yours and he seems to indicate that simply lowering the TSH may not get rid of the antibodies. However, I can’t find anything on his site about what I need to do to lower them. I am terrified that even though we have diagnosed the problem, and even though we are treating it, that what we are doing is not sufficient and I am going to have another miscarriage. So my question is, what did you do (if anything) apart from taking thyroid medication to have a healthy pregnancy?

  30. Hi There, I have Hashimotos, and always have very high antibodies, anywhere between 600 too grater that 1200 one is always double the other.

    I have just found out I pregnant and want to know when it is most dangerous to the baby, I am only 4 weeks, but haven’t been taking my meds very regularly and want to know how urgently I need to get to my Endo.

    p.s my Thyroid function is generally ok just the antibodies that never reduce

    • Dana Trentini says:

      Hi Libbie,

      Congratulations on your pregnancy. If you haven’t already please go as soon as possible to get your thyroid levels tested. Please bring a copy of the American Thyroid Association guidelines for pregnancy to your doctor which recommends a TSH less than 2.5 in the first trimester and many of us require an increase in thyroid medication dosage and why it’s important to be tested. Best wishes to you and your baby.

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472679/

  31. Claudine Schlieffers says:

    Hi there, I’ve just come across this great blog via Izabella Wentz – thank you! Our 3rd child was stillborn at 37 weeks. I had been diagnosed with Hashimoto’s at 5 weeks pregn. and immediately started on 50mcg of thyroid med which gave my hyperthyroid symptoms. i dropped down to 25mcg even though I still had heart palpitations and anxiety/nervousness. We will never really know what happened, but I would love to hear from anyone else with a similar experience. Our first 2 children were healthy; 3rd pregnancy was similar. 4th pregnancy also similar and only on 25mcg. Our 4th child was born healthy at 42 weeks. I don’t really see how the meds could have helped (25mcg is a child’s dosage) and I never ever had symptoms. I have stopped all meds and still have no symptoms (other than a slightly raised TSH). I do wonder if taking 50mcg at 5 weeks affected our daughter…Many thanks for any responses! Claudine in England

    • Dana Trentini says:

      Hi Claudine, I am so sorry to hear about the stillbirth of your 3rd child. So upsetting. Hashimoto’s can come with cycles up and down in TSH with hyperthyroid and hypothyroid symptoms which can make treatment challenging and why it’s so important to be treated by a doctor with great experience with Hashimoto’s patients especially during pregnancy. There are many possible reasons this happened and I imagine it’s hard to know precisely why now. However one thing that is interesting is that you say you’ve never had symptoms. For me the number one thing is to always listen to your body. Your body whispers warnings if something is not right and if everything feels right for you then that’s important to listen to too. We are more than our lab numbers.

      • Thank you, Dana! I have been listening to my body – and you are so right – that is the most important thing to do. Unfortunately, it’s very scary especially in pregnancy to go against a doctor’s advice – and sometimes we Do know best. One of the books I recommend as a childbirth educator and nutritionist is an old one: Dr. Robert Mendelsohn’s How to Raise a Healthy Child ..In Spite of Your Doctor. When I had my first child in 1996, the internet was so new and blogging was of course unheard of – we are so very lucky to have people like you out there now. Kind regards, Claudine

        • Dana Trentini says:

          Thank you Claudine for sharing that book. I will check it out. I think it’s dangerous to go against doctor advice especially during pregnancy. The safe route is to first find a great doctor before you become pregnant or in pregnancy if you feel your doctor isn’t helping you to quickly seek out a second medical opinion. It’s challenging to find a good doctor but they are out there. I am thankful that I found my doctor who listened to me and my symptoms very carefully so I know there are good ones out there. I put together resources to help readers locate good doctors in their area.

          http://hypothyroidmom.com/top-10-resources-to-find-a-great-thyroid-doctor-in-2013/

  32. Hello I have just found out two weeks ago that im 5 months I was tested 3 times for pregnancy and it always came back negative I even had a vaginal ultrasound done at 4 months and thry didnt see the baby… I have hashimotos and obviously it wasnt being treated correctly how can this affect my baby?I am having my appointment tomorrow with a specialist what questions should I ask what steps should the specialist take? Im so soo worried

    • Dana Trentini says:

      Hi Lety,

      Congratulations on your pregnancy. Wow that’s so unusual that the pregnancy tests came back negative and the vaginal ultrasound at 4 months didn’t show the baby. I would ask about that when you see your doctor. Also bring a copy of the American Thyroid Association guidelines for pregnancy which states that TSH should be less than 2.5 in the first trimester and less than 3.0 in the second and third. Many women require an increase in thyroid medication dosage so it’s important your thyroid is tested as soon as possible. I have many readers who went on to have beautiful healthy babies even though they weren’t monitored for their thyroid condition during pregnancy. So please don’t worry about what’s happened so far but focus on being sure you are carefully monitored the rest of your pregnancy. I really believe our babies can feel our stress from within the womb. Best wishes to you and your baby.

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472679/

  33. My name is Angie & I am 31 years old. I was diagnosed with “hypothyroidism” 7years ago at age 24. I have taken medication for one month & stopped because I lost my job and medical insurance. I had become pregnant in December of 2007 & went to the hospital, they couldn’t find a heartbeat. I was told that my heartbeat was “most likely” over-riding the baby’s. I then miscarried in April of 2008. I was only 9wks carrying the baby for 8 more weeks before my body let the baby go. It was the worst thing I’ve EVER had to experience. Later that year, in November I went to the hospital with an extremely painful period, come to find out I had a UTI & was just a few weeks pregnant. I miscarried again on Thanksgiving night. Immediately after, I then miscarried with the third in December. I went to a Dr. to get my thyroid straight after doing months of research on how it affects the hair, energy level, hair, skin etc… come to find out it affects the FETUS too!!! I have been to 3 drs after my levels went from 7.5 a year before the miscarriages, to 5.5 after to 3.3. I was told that my thyroid was FINE and I just have the antibodies so I don’t need medication, even after I advised them of the miscarriages and was NEVER told ANYTHING about pregnancy and how it affects it. I want a baby more than ANYTHING in this world one day. I don’t have medical insurance let alone know ANY dr’s or how to go about getting myself tested to find out if I can EVER carry a child. Can you help me? Thank you , Angie

    • Oh Angie, thats terrible, i’m so sorry for your loss! I’m in Australia, so it may be different over here, however, it looks like you defiantly need medication, to carry a pregnancy you need your TSH to be under 2 (not 3.3, too high) and when you do become pregnant you need to increase your medication by 25%.
      The positive thing however is that you defiantly are fertile! You just need to get on some medication to get your levels right, to support your baby through the pregnancy. It’s very sad that you don’t have government funded healthcare over there, everyone deserves the right to be happy and healthy even those with out a lot of money.
      To give you an idea, my levels were all only just out of range when I was diagnosed, but had high antibodies, my endocrinologist still put me on 50mg a day and now they are great, I will still keep taking medication.

    • Dana Trentini says:

      Oh Angie I am so sorry to hear about your lost babies. Please thyroid medication is so important especially in pregnancy. The American Thyroid Association guidelines for pregnancy recommend a TSH less than 2.5 for hypothyroid women planning to conceive and first trimester. Your high TSH may have been the issue in your pregnancies and before you try to conceive again you should have your TSH lower than 2.5. Here is my miscarriage story.

      http://hypothyroidmom.com/miscarriage-in-new-york-city-be-thyroid-aware/

  34. I’m so sorry to hear of the loss of so many babies, and I do see it all of the time in my clinical practice! A healthy thyroid is so crucial for a healthy pregnancy. Dana, I’ve been reading your blog and articles for some time and absolutely love your message. Thank you for spreading the word on such an important topic. Thyroid function can affect the health of mothers and babies in massive numbers worldwide.

    I did do quite a bit of research recently into the controversial topic of iodine and Hashimoto’s, specifically for the time of fertility and pregnancy. If anyone would like to read my article I’d be most honoured.

    http://www.whitelotusclinic.ca/blog/dr-fiona-nd/iodine-and-hashimotos-fertility/

    Another article of interest is one that I published in NDNR Journal back in 2011, on Autoimmune infertility:

    http://www.whitelotusclinic.ca/blog/dr-fiona-nd/natural-treatments-for-autoimmune-infertility-concerns/

    I’m currently working on the sequel to the above autoimmune infertility article and it will be published in the April 2014 edition of NDNR.

    • Dana Trentini says:

      Hi Dr. McCulloch,

      Thank you for reaching out to me. I read over your attached articles. They are excellent. I was born and raised in Toronto before moving to the US in 2000. My husband and I may one day move back to Toronto and I’ve wondered where to find a good doctor to help me with my thyroid condition. I will save your information. Over the next few months, I am selecting a few guest blog post writers to include articles at Hypothyroid Mom. Your article on iodine, Hashimoto’s and fertility is particularly interesting because there is so much controversy over iodine and Hashimoto’s and my readers have asked about it. Would you be interested in including a guest blog post at Hypothyroid Mom for the month of February? Let me know dana@hypothyroidmom.com

  35. I have Hashimoto’s, and will begin trying to conceive in a couple of months. My primary care doctor is checking my thyroid levels, and upping the dosage of my levuthyroxine to get me into the optimal range for pregnancy. She seems to have a handle on what to do. However, this worries me:

    “If you have TPO antibodies, you have ONE autoimmune disorder, and your immune system is attacking ONE tissue…it can now easily attack something else, like a developing fetus.”

    What is the answer to this problem? Is the risk mitigated at all in patients who have diagnosed Hashimoto’s and are being treated for it, as opposed to those who are undiagnosed? I am doing all I can to prepare for a healthy pregnancy, and I hate to think that there is nothing I can do about the chance of my immune system – as opposed to the hypothyroidism itself – causing a miscarriage. :(

    • Dana Trentini says:

      Hi Stacy, There are many potential triggers for Hashimoto’s including food sensitivities such as gluten and dairy, nutrient deficiencies (such as D3, B12, selenium, magnesium, zinc), low iron, poor adrenal function, blood sugar issues, bacteria/viral/parasite infections, digestive issues, etc. Addressing Hashimoto’s should also include an investigation into the person’s triggers and treating them. There is a great book by Dr. Izabella Wentz on testing and treating these triggers. Now whether these supplements listed in the book are safe while trying to conceive would be something to discuss with your doctor but well worth reading.

      http://hypothyroidmom.com/hashimotos-thyroiditis-lifestyle-interventions-for-finding-and-treating-the-root-cause/

  36. HI Dana,

    Thank you, I’m so happy to hear you liked my article – that means a lot from you! It’s so great to meet a fellow Torontonian as well. I’ll send you an email soon. Have a wonderful holiday season!

    Fiona

  37. When I was diagnosed with hashimoto’s disease I was 16, the dr was an idiot and he told me I would have fertilty problems with such tact “you forget about being a mom you’re only going to lose them” so far I’ve felt better about it since I have a new dr who has gotten my thyroid levels to normal range but still, I’m afraid sometimes I’m 19 now and I’m concerned about the fertility issue, is it true that even if you have a baby they are a lot more likely to be intellectually disabled or other problems? my dr won’t answer these questions because he tells me it’s too soon to start worrying but I know that although my mom isn’t hypothyroid she had very complicated pregnancies and deliveries and the odds aren’t looking good for me either.

  38. I was diagnosed with Hashimoto’s about 5 years ago. When I was first diagnosed, my TSH was normal and my endocrinologist did all the other tests. My antibodies at that time were sky high. I have had a few US and they show natural progression of the disease. My TSH has been well controlled on levothyroxine for about 4 years. I just had an appointment and told my FNP that I wanted to try and conceive. She ordered a TSH and it was 1.65. After reading through your site I am wondering about the antibodies again. Do the antibodies calm down with a controlled TSH level? Should I ask my FNP for those other labs before I conceive?

  39. Hi Dana, My daughter was diagnosed with Hashimoto’s when she was 17. She is 19 now and feels that she will never be able to have a family. It really weighs on her. I had complicated pregnancies as well but have never been diagnosed with a Thyroid problem. I do not know what to tell her but I will refer her to this site so she can read your blogs. I am heartbroken for her and hope you can help. Thank you for posting.

  40. Hi dana. I just has early miscarriage. My thyroid just came back all normal except thyroglobulin antibodies which was 1.9 normal is 0-.9. Is this the reason for miscarriage. Will I ever have children?

  41. Rebecca says:

    I was diagnosed with hashimoto’s when I was 19. I have just learned I am pregnant and I don’t really know what questions to ask. I know that my TSH needs to be well controlled, but do I need to talk to my doctor about antibody testing again? I haven’t had my antibodies tested in more than 3 years.

  42. Hi Dana
    I listened to you on the Thyroid Summit and want to thank you so much for opening my eyes. I knew I was hypothyroid but thought I was being treated correctly. After listening to you I went into my GP today (my normal one was away) and asked for my history and repeat bloods that you recommended. I’m still waiting for results.

    I found out that I have Hashimoto’s and had a TSH level of 40 back in 2011 when I was diagnosed. I lost my baby in January last year and now believe it was due to this. I kept asking the drs if I was ok as I have put on 20 kg in the last 2 years and only had 10 kg weigh gain from my early 20s to late 30s. I haven’t felt myself since but they’ve all said I was ok and the mc wasn’t to do with my thyroid. Fortunately I recently lost 13 kg but it’s a hard slog and I’ve always been skinny before this.

    The GP today told me that I should have been tested regularly during the pregnancy. I’m so mad I could just scream. The GP who gave the form for my pregnancy blood test is the same one who started me on thyroid medication!

    July last year I had a THS level of 3 and the GP wants to get me down to below 2. I’m tempted to up my medication myself by 25% while I waiting on the results as I am having insemination done on Friday – I can’t lose another baby. We have struggled to conceive since the mc in January 2013 and have undergone 6 I.U.I.s. The first one had an attempted implantation so I also wondering if that was due to my thyroid. I’m on 100mg and think I might add a 1/4 tablet for the next few days while awaiting the test. Not sure what view you have on this??

    Thanks for informing me about not taking coffee or dairy or multi-vitamins at the same time as medication – I have been doing this for YEARS!!! I’m now setting my alarm for 3.30 so I can have that morning coffee with milk!

  43. Tiffany Olmstead says:

    Hello,

    I just wanted to share that I was diagnosed with Hashi’s the summer of 2011 about a year and a half after my son was born and after my 4th miscarriage. My TPO was near 2,000 and I was ensured Synthroid (levothyroxine) was my “hope”. Aka a mask for your symptoms until your thyroid is desroyed. I decided to do my own research and found a clinical study being done in Denmark on selenium. I talked to my Endocrinologist about it and she ensured me nothing could lower my antibody count except immune suppressing chemotherapy drugs, which would do more harm than good for someone like me. I actually said I was going to try the selenium anyway and her words were “go ahead it won’t hurt, but it won’t help.” Well, 3 months later my antibodies were lowering…I continued and saw results every 3 months. 5,6,7,&8 miscarriages later I decided I was ready to get a tubal… With my 8th miscarriage my level was exactly 100 so I just assumed a 2nd baby wasn’t meant for me. However, I got pregnant yet again. With extensive labs and knowledge I had an antibody count of 41. At 13 weeks I was at 36, so it was still dropping. And now 22 weeks my level was 29….I was obviously high risk and had at least 10 ultrasounds so far and get labs every 4 weeks and everything is coming back normal. Selenium also has helped my cousin who has Hashi’s too AND my Endocrinologist even hugged me and told me she already suggested selenium to 6 of her patients. My only source is that I’m in school to be a medical technologist and after 3 chemistry courses and mastering the thyroid function selenium became an obsession. I decide to self experiment and got extremely lucky. I recommend 200mcg to anyone with this awful disease. I have not had any thyroid medication in over a year and even had viral thyroiditis. I’m proof that miscarriages are definitely a result of a high antibody count and am also proof you can fix the root of the problem. After I have the baby I’ll be doing my 2nd uptake scan to ensure no further destruction to my thyroid has happened.

  44. My dr noticed my enlarged thyroid when I was 2 months pregnant with my son. He ran blood tests and did a sonogram on my neck. My blood tests were only slightly off and they found 3 nodules. I was not medicated or monitored closely during my pregnancy and at 38 weeks had my son who was only 5 lbs!! (Low birth weight) about 4 months later I was diagnosed with hashis. My son now 2 1/2 I’ve noticed what I thought to be an Adam’s apple. My in laws recently came to visit us and were shocked to see that in a toddler so I decided to look into it to see if it was normal for some children to have larger Adam’s apples and it’s not supposed to show until they hit puberty. I already made an appt with my sons doctor but I’m worried that this could have been the direct cause and affect by my untreated disease during pregnancy. If anyone has any insight as to what this could be or what the effects are on children in this case PLEASE respond. Thank you.

  45. Hi
    My wife diagnosed with Hashimoto last year after miscarriage. Her levels came normal and she got pregnant again this April. We went to our endo and her TSH was 0.4 on May 14 but her doctor didn’t increased any dosage. Now her levels checked again on June 18 and TSH level is shooted to 22 now. Now endo raised dosage from 117mcg to 175 mcg. I am too worried as she has not increased dosage initially. Can it be dangerous for baby development with non increased dosage and sudden shoot of levels in just 5 weeks from .4 to 22

    • Hi Mandy, TSH can rise quickly in pregnancy. Yes there is concern when TSH rises to 22 in pregnancy but hopefully this rise in TSH happened recently and the increase in thyroid medication will result in a healthy baby. One thing you should do is bring a copy of The American Thyroid Association guidelines for pregnancy to her doctor that recommend a TSH less than 2.5 in the first trimester and less than 3.0 in the 2nd and 3rd. Be sure her thyroid is regularly tested throughout pregnancy. All the best to you all.

      http://www.thyroid.org/thyroid-guidelines/pregnancy/results/

      • Dana,
        Thanks for the reply.
        What are the risks if thyroid was 22 for
        4-5 Weeks during first trimester.
        What should be the frequency to check Thyroid Levels during first trimester.

        Regards
        Mandeel

  46. Melodie says:

    Hi Dana,

    You mentioned Dr. Clamp. I saw her a few years ago in Rockville, MD. Was she your primary thyroid Dr during your pregnancy or did you also see a reproductive endocrinologist? If so, were they in Md? Thank you so much! Dealing with these thyroid issues has been a long journey!

  47. Hi Dana:

    Have you ever read the book ” It’s your body baby friendly” by Alan Beer ?
    If no, please do so..it has a deep explanation of 5 categories of Immune System Diseases, like Hypothyroidism and how causes infertility, miscarriage, etc.

    Its a great book to recommend to your followers just like me from today :-)
    All the best and thanks for sharing al your knowledge!
    Warm Regards,
    Paula

Trackbacks

  1. [...] Yes, I had all the auto immune tests and the chromosomal abnormalities bloodwork done after my chemical. My RE wanted to run all the immunological tests to rule those out because he just couldn't understand why we lost it. Good thing we did! My TSH was 1.5 a year ago which is totally normal but my thyroid antibodies were way elevated so I want to talk to my GP about getting on levothyroxine too. I would definitely talk to your RE about staying on the pred until the heartbeat at least. My RE is pretty sure that's why we miscarried. I only took it for four days which would explain why there was implantation but once I stopped, the antibodies attacked the embryo Maybe the levothyroxine is enough to regulate it without the pred but I would ask anyway. I know that once you are pregnant your thyroid goes all wacky because of the hormones, so that worries me. That's why I want to talk to my GP too. I know that for the first 12 weeks, the baby relies on the mother for thyroid function until the baby develops their own. Here's a good website with info about thyroid function and infertility: http://thyroid.about.com/library/weekly/aa050199.htm and this one: http://hypothyroidmom.com/hashimotos…and-pregnancy/ [...]

  2. […] and and an Endocrinologist diagnosed me with Hashimoto’s Thyroiditis. I later found that Hashimoto’s is linked to low birth weight, miscarriage, still birth and more, but at that time I was simply told to “take this pill and everything will be fine“, […]

Speak Your Mind

*