Pregnancy with a thyroid condition

Talk about pregnancy and fertility when you have hypothyroidism or Hashimoto's. So in order to get pregnant, it's so important that your body has balanced thyroid hormones. When my patients are pre pregnancy planning, I want their TSH around 1, I want their T4 between 0.9 and 1.2, and I want their T3 between about 3.6 and 4.2. Reverse T3 between 8 and 12. Okay? I don't want someone's TSH at 3. Okay. So I prime them with proper thyroid function, with medications. Right. With the support of medications. T3 is incredibly important in your ability to get pregnant and maintain pregnancy. So that's step one. Step two is early pregnancy. So early pregnancy, especially in thyroid people, you need to monitor your thyroid hormones, of course, but you also need to monitor someone's progesterone. Low progesterone is a very common issue in the thyroid sector when people are pregnant or even not pregnant. And it is single handedly the most important hormone for preventing miscarriage in early pregnancy. So at modern thyroid clinic, we check it and recheck it every one to two weeks if they have an issue with it. And we adjust their dose weekly if they need it. So that's early pregnancy. After about week 14, progesterone's less important. We are out of that risky zone of early miscarriage and now we're coasting. And for the remainder of pregnancy, we check thyroid labs every six weeks at modern thyroid clinic. Okay. Research shows women need an average increase of thyroid hormones of about 30% during pregnancy, most commonly in their second and third trimester. So we don't want someone's thyroid function plummeting while no one's checking it or they're checking it every three to six months. So every six weeks we check their, their labs and we adjust their medication. During pregnancy. T4 is the most important hormone for the baby's development. And I know you guys hear me talk about T3 all the time, and it is hugely important pre pregnancy, postpartum, and to an extent during pregnancy too. But T3 cannot cross the placental barrier. Only T4 can get to the baby. In order to support the baby's development. That baby, that little one, is relying on you and your T4 to get adequate thyroid hormones. So definitely I keep a close, tight eye on T4. I adjust it often, and I keep ranges between 1.0 and 1.2 during pregnancy. Reverse T3 as pregnancy develops naturally increases. That's normal. It's a physiological response to remind the woman not to overdo it and to lay down and rest and recover, which we all need to do when we're pregnant. Postpartum, I start checking labs. Six weeks. Postpartum, I check everything, including thyroid, a full thyroid panel and a full hormone panel. Because a lot of postpartum anxiety and depression is hormonal related and even thyroid related. So if we can support that to protect these women and put in a layer of safety for them and support, we want to do that as early as possible. We also want to check antibodies postpartum because it is the highest risk time for women to go into an autoimmune thyroid flare.