Like whoa, completely and utterly...just WHOA!
There was such an amazing community discussion at Mama Circle today. There were a dozen or so moms and babies to listen, learn, and share their stories and experiences. Some delayed their vacations or drove a distance to be there. That is incredible and I thank you for taking the time for yourself! From talking about hundreds of needle pokes for allergy testing to elimination diets...you mommas have a wealth of knowledge yourselves in your experiences which is what makes Mama Circle an invaluable resource for anyone going through similar situations. So thank you for allowing me to come into your safe and tight knit community..
We covered a TON of information today. I know some of you were taking notes and trying to absorb it all, so never fear! I decided to write a follow up post to help clarify some of the major points.
1. Test, don't Guess
The diagnosis for thyroid dysfunction is based upon both symptoms and test results. Thyroid antibody testing (specifically anti-thyroperoxidase (TPO)) can be tested for in early pregnancy with the benefit of these results being two-fold. You are able to predict the potential for postpartum autoimmune thyroid issues as well as start making some changes in your nutrition to lower your chances of developing an issue. Testing TPO early in pregnancy as well as 3 and 6 months postpartum is especially important if you are considered high-risk (history of previously high serum anti-TPO before, history of other autoimmune disease such as Type 1 Diabetes, or have a history of thyroid problems). I want to clarify that early is pregnancy is ideal (first trimester) because high TPO levels generally decline as pregnancy progresses, even though a problem may still be brewing.
Other tests I recommend are:
Thyroid Stimulating Hormone (TSH), Free T4, Free T3, and sometimes another one called reverse T3 (rT3). RT3 is generally only tested if you are having symptoms and your other tests are coming back normal.
As a functional medicine physician, I read blood test results differently than conventional doctors. I use what are called "functional lab ranges" which are based upon what levels people feel the best at. Clinical lab ranges are based upon a bell curve of what 98% of the population fall into. With my clients, I encourage them to ask their PCP for a full thyroid panel if I suspect something is going on. With online portals these days, patients have access to their results and are able to easily send them to me to re-interpret with a more critical eye. Some doctors won't test the full panel or it can even be cost prohibitive when done through insurance. In these cases, it is easier or more cost effective for me to order testing through labs that I am contracted with.
I could write a whole other blog post about the varying lab results and what they mean...and in fact I believe I shall! But that is for another day :)
2. Nutritional Support
Once we know more about what is going on, nutritional modifications is the next stop. Before supplementation or medication intervention, nutrition should always be addressed. Food is information and can either make the body go haywire or help resolve chronic disease. The majority of our country eats the SAD diet, which is exactly how it makes you feel...sad!
If TPO was tested positive, that tells me there is inflammation present. The best first course of action is to adhere to an anti-inflammatory diet. One of my colleagues, Dr. David Seaman, has this great resource on his website called the Deflame Guidelines. This is a great place to start if you have no idea what that means. Another way to learn is by consulting with an expert, such as an, ahem, functional medicine practitioner.
Try to buy organic from local farmers as much as possible (know your farmer, know your food!). If organic everything is too expensive, at least try to buy the "dirty dozen" organic. This list changes every year, so stay up to date on it!
One of the most inflammatory foods that contributes to autoimmune thyroiditis is gluten. Gluten can escape the tight junctions between the cells of your digestive system due to inflammation taking its toll. Once these little molecules escape, your immune system recognizes them as "foreign" and starts attacking them. Your immune system is smart, however, it is sensitive not specific. Meaning, it will start attacking anything that resembles this nasty little gluten molecule through a process called molecular mimicry. Specifically, it is the protein, gliadin, that triggers this response. This protein resembles the cells of your thyroid gland. Just like that, you are now the proud new owner of an autoimmune thyroid condition. This doesn't just go for Hashimoto's, the hypothyroid version. Gluten intolerance can also cause Grave's disease, the hyperthyroid version.
We also talked about gluten cross reactives, with the most common ones being dairy and corn. Food sensitivities can be really difficult to identify. These are not what we call the IgE sensitivities that are severe and can cause anaphylaxis (such as a peanut, citrus, or shellfish allergy). These are the IgG allergies that are subclinical and insidious. With clients who are not having results with an elimination diet, I will recommend IgG tests. These can be expensive and not the most accurate, but at least can give more information on unique foods that a client may be sensitive to. I have done my research and do use particular labs that have more consistent results that others!
3. Filling in the Gaps with Supplementation
Nutrition is the first line of treatment followed with supplementation in my book. If your diet is not ideal, supplements are not going to make that huge of an impact - especially if your guts are so inflamed that you can't absorb anything. It is no secret that our food is not as nutrient dense as it once was. Some baseline supplementation may be a good idea. However, for the most part, my goal is to get my clients stabilized and optimized, and then wean off of most supplements. Otherwise, chronic supplementation usage is no different than life long prescriptions. I am not a supplement rep and do not carry many things in my office, aside from the preNatal DHA that I recommend to all of my pregnant mamas. Therefore, I use an online dispensary called FullScript
to make individualized recommendations to clients. I research all of the companies that I use, and end of using a variety of companies since they all have their strengths when it comes to products! An important point to make it that although some iodine is necessary for a healthy pregnancy, any supplementation over and above what is in your preNatal can actually worsen autoimmune thyroid disorders!
A few supplements that I recommend for thyroid support are as follows:
-Selenium 200mcg per day: Selenium is highly anti-inflammatory and is safe to take while pregnant and breastfeeding. This is especially important to supplement with if there was a positive anti-TPO test.
-Zinc: Adequate amounts of this are found in your preNatal
-Iron: Iron deficient anemia can often be diagnosed as hypothyroidism and visa versa as they have many of the same symptoms. Iron is totally individualized case by case. I am extremely careful with iron supplementation because it can really hurt your stomach. I try to emphasize eating more iron rich foods like leafy greens, red meat, or beans. It should be noted that you need adequate amounts of Vitamin C to absorb iron, so also adding in citrus or Vitamin C supplementation can be a nice addition!
-Vitamin D: Get your levels checked! The Vitamin D Council has at home test kits available. I like to see levels above 60nM and no higher than 90nM. Vitamin D deficiency is correlated to autoimmune disease.
-Curcumin 1000mg twice daily: Curcumin is the powerful anti-inflammatory component of the spice Tumeric. This one is also incredibly important if levels of TPO were elevated. There are no good studies to confirm or deny the safety of Curcumin during pregnancy as it may be a uterine stimulant. If you are less than 37 weeks, I would avoid high dose supplementation with this one!
-Guggul 750mg daily: Guggul is an Ayurvedic herb with the powerful ability to heal, detoxify, and cleanse the liver and digestive system. Conversion of T4 to T3 happens in your liver and digestive system. If this is where your issue lies, Guggul would be a great option to help those body systems get back to doing their job. Guggul is not safe during pregnancy, but is safe while breastfeeding.
Specifically for hyperthyroidism or stressed out moms, I recommend the herbs Motherwort and/or Lemon Balm. These have an incredible calming influence on mom and can be such a game changer. They are most potent in the liquid extract form, however, this means there is alcohol present. I would stay away from this during pregnancy, but it is safe during breastfeeding because it is such a small amount. If you are uncomfortable with the extract form, it is also available in capsule form.
4. Medication Management
Here is my medication disclaimer: I cannot prescribe medication, change your dose, or take you off of your prescribed medications. This is something you can cover with your PCP. However, I want to provide some insight and education regarding the options. So many of my moms will feel guilty if they have to resort to this. DON'T! No mommy shaming or judgement here. I have a natural thinking mind, born and bred from an MD surgeon father. I try to have balance in all things, and sometimes, you need a firehose instead of a bucket of water to put the fire out. I totally get it!
Hypothyroid medications are safe to take during pregnancy and breastfeeding. Levothyroxine is T4 and is also the synthetic version. Synthetics are nice because they have standardized doses. However, synthetics also give people the heebie-geebies. That is where natural alternative like Armour Thyroid or Naturethroid come in. These are desiccated thyroid extracts from animal sources, most commonly pigs. These have a combination of T4 and T3 in them.
For the medical management of hyperthyroidism, anti-hypertensive drugs are commonly prescribed. Radioiodine treatment and antithyroid drugs are not useful for postpartum thyroid issues and not safe during breastfeeding or pregnancy.
5. Environmental Factors
A few words on the environment. Before I do, I want to remind you that we cannot be perfect and avoid EVERYTHING...unless you want to live in a bubble. The best we can do is to eat and live healthfully and be mindful of ancillary exposure that we can control. Many of the following things are hormone disruptors. So by minimizing our exposure, we can keep our hormones in better balance:
-Avoid plastic: by now this is pretty commonly known. Use glass, stainless steel, and paper as much as possible.
-Avoid fluoride and bromide: these molecules can interfere with proper thyroid function. Fluoride is of course in our water, so get a filtration system and buy non-fluoridated dental products. Bromides are found in things like breads, processed foods, and....as a flame retardant...yum.
-Heavy metals: We are exposed to heavy metals from the jewelry we wear, to our deodorant, to the aluminum foil we use. Again, our bodies can get rid of this if we treat it right. However, a high heavy metal burden can wreck some serious havoc on our hormones. I do not recommend doing a detox while pregnant or breastfeeding (unless there is concern over lead or mercury, and in that case you need to see your PCP for more intensive therapy). However, there are some gently detoxes you can do to get rid of these heavy metals before you get pregnant or when you are done breastfeeding.
Even if you do all the right things all the time, this may be the proverbial cross that you bear. In most women, postpartum thyroid issues with resolve in 6-12 months. 30% of the time, thyroid issues may become permanent and therefore need management. I recommend testing every 5-10 years if you are fully recovered and are not experiencing continued symptoms. At the first sign of symptoms, I would test sooner than later and re-evaluate where you are with the action steps above!
You all rock my world, and I can't wait to continue the journey towards elevated health and wellness with you!