If there is one gland thought to command the body, many medical experts would pin the butterfly-shaped, hormone-producing organ of the throat known as the thyroid. Thyroid dysfunction, with its complex causes and treatments, is a rising concern in the United States. An estimated 2-4 percent of women who are of reproductive age, and 0.1 percent of men, are affected with thyroid disorders. Of those affected, autoimmune hypothyroidism is the most common category. With autoimmune hypothyroidism, the body’s immune system mounts an attack on the thyroid gland, causing it to become underactive. Other causes include inflammation of the thyroid gland, drug-induced damage to the gland, improper communication between the brain and thyroid, and cancers. While syndromes and treatments differ for each cause, there are some overarching symptoms and supports that can be applied, which will be discussed later in the article.
The Thyroid-Ovarian Connection
In the early 1900s, the importance of thyroid function for reproductive health was discovered from cases of severe hypothyroidism that entered puberty prior to 9 years old, also known as precocious puberty. Since that point, thyroid dysfunction has been implicated in many reproductive disorders, including menstrual irregularities, and infertility for both males and females. Of them, infertility continues to cost the most in health care expenses and lost opportunities.
There are several dominant mechanisms through which infertility can be caused by thyroid dysfunction. One such way is by causing an “anovulatory cycle”, which means a failure to produce an egg (follicle) within the 28-day cycle. Another way is by altering the brain’s ability to speak with the ovaries, resulting in alterations of the two most important hormones in the female cycle: estrogen and progesterone.
Estrogen dominates in the follicular, the first half of the female cycle. This part of the cycle prepares for ovulation by stimulating growth in the follicle as well as thickening the uterine lining. In order for the egg to be released, there must be a sufficient signal from the brain to the ovaries to release a surge of estrogen right before ovulation occurs. If the amount of estrogen is insufficient, there will be no ovulation.
Progesterone is the main player in the luteal phase, the second half of the female cycle. Higher levels of progesterone maintain a comfortable environment for the fertilized egg to implant and grow. If the progesterone is not at an adequate level, the pregnancy may not take. Low progesterone can also be recognized from very heavy periods.
In addition to hormonal imbalances, many women with hypothyroidism have been found to have endometriosis and polycystic ovarian syndrome (PCOS), two very common causes of infertility—and extreme discomfort—in women. Other factors may independently affect fertility or worsen the effects of hypothyroidism on infertility. These other factors range from genetic predispositions (including but not limited to MTHFR) and other immune system attacks on the body to nutritional deficiencies and “estrogen dominance”. Focused attention on the individuality of each person allows functional medicine clinicians—who restore body function by addressing the root cause of an issue—the best chance of assisting the body to prepare for pregnancy.
Hidden Infertility Contributor
A scientific study on infertility from 2012 noted that 23.9 percent of patients presenting for an initial consultation for infertility (unable to conceive after 1 year of trying) were found to have hypothyroidism. Of these cases 62.7 percent were found to be “subclinical”, meaning their lab values did not meet the classic, clear-cut criteria for diagnosis of a thyroid condition. The participants were supplemented with replacement thyroid hormone and 76.6 percent were able to conceive within six weeks. Over half of these women had a thyroid disorder that could have easily been overlooked or missed by conventional labs because they did not fit the classic criteria for diagnosis of thyroid disease.
For those women able to conceive with thyroid dysfunction, there are still other complications that may occur as a direct result. It is known that hypothyroidism, hyperthyroidism and immune dysregulation can cause fetal death. Other complications associated with hypothyroidism in pregnancy include prematurity, low birth weight, maternal anemia, postpartum hemorrhage and life-threatening pre-eclampsia emergencies during pregnancy.An obstetrician will manage these complications to the best of their ability, but preventing them from occurring in the first place is ideal.
Determining the cause of this hypothyroidism is imperative to optimize maternal and fetal health. Supplementing with thyroid medication can be a quick and easy fix. However, without determining the root cause of the dysfunction, there is the risk of compromising maternal and fetal health, or developing additional autoimmune conditions or chronic inflammatory disease.
Nutrition Plays an Important Role in Thyroid Health
Gluten is highly associated with thyroid function. Throughout the years, autoimmune hypothyroidism has been correlated with celiac disease as well as in patients with known gluten sensitivities. Testing for celiac disease should be included in a complex evaluation of thyroid dysfunction. Even if negative, most patients with autoimmune thyroiditis benefit from a gluten-free diet.
Other important nutrients that should be evaluated are vitamin D, selenium and iodine. Iodine has been supplemented into the salt supply to help ameliorate the problem; however, there is some controversy over whether this has helped or hindered the issue of thyroid disease. Vitamin D is mainly from the sun, and the majority of American’s are deficient, particularly in the Northeast. Selenium is a commonly deficient nutrient in the standard American diet. It can be found in Brazil nuts, fish, eggs and some seeds. However, even with a “well-balanced” diet, our soil has become so depleted of these nutrients that a deficiency may still exist. Diet modification, supplementation and occasional lab assessments may be necessary, particularly in someone with difficulties carrying a pregnancy to term.
It is important to take any lab study with a “grain of salt” and understand that they are only a piece of the puzzle; they should not be relied upon for diagnosis of any condition. That being said, some of the large lab companies do not go into enough detail with thyroid function, micronutrients and gluten sensitivities. In some cases, these lab tests should be performed by specialized labs companies that have more focused panels. Functional medicine practitioners are familiar and comfortable with clinical diagnosis, and understand when it is appropriate to use such specific testing for further investigation.
The Bottom Line for Healthy Babies
The costs associated with infertility are tremendous, and do not always produce the desired effect of having a child. When the body resists carrying a child to term, asking why can be the job of a functional medicine clinician, a practitioner that specializes in restoring order and function to the body rather than masking symptoms.
With hormonal imbalances and autoimmune diseases on the rise in Western civilization, it is almost as though the maternal body is asking for change in how we eat, exercise, sleep, breath and behave. Luckily, inflammatory conditions leading to limitations in fertility can be improved or even reversed using the functional medicine approach, including medication if necessary. In addition to an evaluation with a comprehensive thyroid panel including autoimmune and gluten sensitivity markers, functional medicine practitioners are trained to diagnose based on symptoms and subtle nuances; they aim to treat the patient, not the lab values. Functional medicine workups lead to the “root cause” of medical problems, offering benefit for healthy conception, and a healthy early life for both mother and child.