Hashimoto’s disease is an autoimmune condition where the immune system attacks the thyroid gland, a small, butterfly-shaped organ in the front of your neck. This attack causes inflammation and can damage the thyroid, leading to insufficient hormone production. While it presents challenges, pregnancy is possible with Hashimoto’s disease, requiring careful management and planning.
Impact on Fertility and Conception
Hashimoto’s disease can impact a person’s ability to conceive primarily through its effect on thyroid hormone balance. When attacked, the thyroid often leads to hypothyroidism, an underactive thyroid condition where insufficient hormones are produced. Low levels of thyroid hormones can disrupt the hormonal balance necessary for reproduction.
Thyroid hormones regulate the menstrual cycle and ovulation. Imbalances can cause irregular periods or anovulation, meaning no egg is released for fertilization. Beyond hormone levels, autoimmune antibodies like anti-thyroid peroxidase (TPO) antibodies may also influence fertility by affecting ovarian function or endometrial receptivity. Hashimoto’s disease is also linked with other fertility-affecting conditions, such as polycystic ovary syndrome (PCOS), which complicates conception due to hormonal imbalances interfering with ovulation.
Pre-Conception Planning and Preparation
Before attempting to conceive, individuals with Hashimoto’s disease should consult with their healthcare providers, including an endocrinologist and an OB/GYN. This team approach ensures a comprehensive assessment of thyroid function and overall reproductive health. Achieving stable thyroid hormone levels is a primary goal before pregnancy.
Doctors monitor thyroid-stimulating hormone (TSH), free T4, and thyroid antibody levels to ensure they are within an optimal range for conception. A TSH level below 2.5 mIU/L is often recommended prior to pregnancy to reduce risks. Medication dosages, usually levothyroxine, are adjusted to reach these target levels. It is advised to wait until thyroid disease is well-controlled before trying to get pregnant.
Managing Hashimoto’s During Pregnancy
Once pregnancy is confirmed, managing Hashimoto’s disease becomes important for the health of both the pregnant individual and the developing baby. Thyroid function monitoring is necessary throughout pregnancy, often requiring checks every 4 to 6 weeks. This frequent monitoring allows for prompt adjustments to thyroid hormone medication dosages.
Many pregnant individuals with Hashimoto’s will require an increase in their levothyroxine dosage, often by 30-50%, starting within the first 8 weeks of pregnancy. This increased demand is due to rising estrogen levels that bind thyroid hormone and the fetus’s reliance on maternal thyroid hormones until its own thyroid develops around 10-12 weeks. Close collaboration with an endocrinologist and obstetrician ensures that thyroid hormone levels remain within target ranges for each trimester, supporting healthy fetal development.
Potential Pregnancy Outcomes and Risks
If Hashimoto’s disease is not well-managed during pregnancy, there can be risks for both the pregnant individual and the baby. For the pregnant individual, uncontrolled hypothyroidism can lead to complications such as miscarriage, preterm birth, pre-eclampsia (a dangerous rise in blood pressure), and placental abruption. Anemia is also a concern, as Hashimoto’s can affect iron absorption.
For the baby, untreated maternal hypothyroidism can impact neurodevelopment, leading to lower intelligence quotient or learning disabilities. There are also risks of low birth weight and premature birth. However, with proper diagnosis and careful management of thyroid hormone levels throughout pregnancy, most individuals with Hashimoto’s disease have healthy pregnancies and deliver healthy babies.