Thyroid and fertility/ pregnancy

Thyroid health and fertility. Let's dig into this. So I tell my patients, when you are pre pregnancy planning, we have to get your thyroid in order before you become pregnant. What does that mean? It means your T3 really needs to be optimal. Your ability to get pregnant and maintain pregnancy early on is heavily related to adequate T3 levels. So I want my patients T3 between about 3.6 and 4.2 for the bulk of their day. I want their TSH when they are actively pre pregnancy planning less than 2 and I really want it close to 1. I want their T4 between about 0.9 and 1.2. So those are the important factors I'm looking at when pre pregnancy planning. I also ideally would like to get their antibodies if they have Hashimoto's a little bit low, basically showing that their autoimmune burden has been lessened or as much as possible. But this is not make or break. You can get pregnant even if you are in an active Hashimoto's state early on in pregnancy. Again, we have to make sure T3 is adequate and we also want to make sure progesterone is adequate as progesterone is what maintains pregnancy and to a large degree prevents miscarriage. During pregnancy things shift a little bit. T3 is so important. You guys and you guys hear me talk about this all the time. However, T3 cannot cross the placental barrier. So we have to make sure T4 or your inactive hormone is optimized because that is the hormone your baby has access to. I like T4 during pregnancy, especially middle to late pregnancy between about 1 and 1.2. So I hope that helps, that offers clarity. We also check labs every six weeks during pregnancy and adjust medication doses throughout because research shows pregnant women on average need an increase of about 30% in their medication. And again, you want to optimize it for the woman, but you also want to optimize thyroid function for the baby. We then check it 4 to 6 weeks post postpartum because again, that medication then needs to be adjusted because you are no longer pregnant. Often that need reduces. And also to make sure Hashimoto's didn't worsen or show up postpartum when it very commonly does. So I hope that helps.