My Pregnancy Journey: Navigating Hashimotos
By Stacey Thureen
After undergoing a partial thyroidectomy in June 2011, due to a benign inch size growth on my thyroid, I was diagnosed with Hashimoto’s Thyroiditis. According to the American Association of Clinical Endocrinologists, Hashimoto’s thyroiditis is the most common thyroid disease in the United States. It is an inherited condition that affects over 10 million Americans and is about seven times more common in women than in men. Hashimoto’s is when the immune system attacks the thyroid tissue. It causes the thyroid gland to become hypothyroid so it doesn’t produce enough thyroid hormones.
A Journey
Within the first month post-surgery, I felt drained, sluggish, and not myself. Blood work confirmed the autoimmune disease and that I needed to go on daily thyroid medication. By the end of October 2011, my thyroid levels were in good standing and I was feeling a lot better.
Come the middle of January 2012 I learned I was pregnant for the first time! My endocrinologist at Lahey Clinic gave me some great advice back in October: as soon as I knew I was pregnant to let him know. He said women need 50% more thyroid hormones during the first trimester of pregnancy, and that he would need to increase my medication by 50% and monitor my thyroid levels more closely.
Because of my condition my nurse practitioner said they would need to monitor my levels closely, as well. A simple TSH blood test that my OB office took at eight weeks indicated my levels got really high. My nurse practitioner said this jump in thyroid hormone levels, during the first trimester, was very common among women with Hashimoto’s.
My medication was then adjusted by my endocrinologist. A few weeks later my levels went down, but were still out of the American Thyroid Associations recommended guidelines. Once again my medication was increased for the third time.
So far I’ve stayed at the current dose since early April. Even though my TSH level went up by almost a point this month, it still stayed within the American Thyroid Association guidelines. So my endocrinologist recommended to keep my medication where it is, and have me come back in July to get blood work done. He said if my levels increased again we’d discuss adjusting the medication, and then he’d want me to come in for an appointment a month before the baby is due.
Alternatively, if my levels remain the same or improve, then his recommendation was to continue with the current dosage, continue with the routine blood work, and I will need to see him in mid-October when I’m about a month postpartum to start lowering my dose.
What has helped
People have asked me how I’ve been feeling, and how the pregnancy has been. I share that my thyroid has really taken a shock to my system. What has helped me ‘feel’ like I still have a piece of my body intact has been getting regular exercise, eating well, getting enough rest and keeping a balanced work and social life.
I was an avid runner, walker, and swimmer before pregnancy. And thankfully my OB has continued to give me the green light to stay active. So keeping a healthy lifestyle while pregnant has helped me tremendously. It has helped me get through those days when I feel sluggish. And it helped me during those first 18 weeks when my thyroid medication was adjusted three times.
9 Months Postpartum with Hashimoto’s Thyroiditis
Two years ago I underwent a partial thyroidectomy due to an inch size growth on the left side of my thyroid. Post surgery I learned that I was cancer-free, but I have Hashimoto’s Thyroiditis. I started taking daily thyroid medication, and seven months later I began the autoimmune mom journey.
Before Delivery
Due to this thyroid autoimmune condition, throughout pregnancy my thyroid levels were monitored every two weeks with a simple blood test. The blood test checked my TSH, T3, T4, and free thyroxine levels.
Prior to the due date, my TSH was at a 2.2 mIU/L which fell within the recommended guidelines by the American Thyroid Association. But throughout the pregnancy, my thyroid levels fell above and below these recommended guidelines which required adjustments to medication as needed.
Postpartum
When I was six weeks postpartum, I had a scheduled visit with my endocrinologist which included the blood tests to screen all of my thyroid levels. Days leading up to the visit I was experiencing symptoms that many women claim to endure during postpartum. These symptoms included night sweats, hair loss, an increased resting heart rate, and frequent trips to the bathroom. My symptoms confirmed what I sensed in my gut. The blood work came back and my TSH was at .58, which is right on the cusp of hyperthyroidism. The recommended normal TSH range for women is anywhere between .5 to 4.5/5.0 mIU/L.
From there my endocrinologist reviewed the other lab results and decided to lower my daily medication and recommended I come back in six weeks for follow up blood work. Come mid-November, blood work indicated my TSH jumped from .58 to 3.3. I was still experiencing some hair loss and night sweats, meanwhile many of the other hyperthyroid symptoms subsided. Even though I was starting to get more sleep at night, I still felt sluggish.
Prior to pregnancy I felt more like myself when my TSH level was around a 1.0 uIU/ML. I spoke further with my endocrinologist about next steps after the 3.3 test result. After his review, he recommended a slight increase in my medication and in six weeks get another round of blood tests drawn.
By the end of January my TSH was at a .96 mIU/L. I was still breastfeeding, and feeling great, so no adjustment to the medication was needed. My endocrinologist recommended I stay on the current dose, and come back for blood work six weeks after I stopped breastfeeding.
By early June the lab work showed my TSH was at a 3.6 mIU/L. After reviewing it along with the free thyroxine test results, an adjustment was made to my daily thyroid medication. Interestingly enough, I went back on the same dose of thyroid medication that was prescribed for me after giving birth. Further blood work has been ordered as part of monitoring my thyroid levels throughout the first year postpartum.
Baby Steps
At my six week OB/GYN postpartum appointment, I learned that once I stopped breastfeeding my thyroid levels would probably go back to normal. I also learned I would probably be able to take the same level of thyroid medication I was on prior to pregnancy. While this was encouraging to hear at the time, at nine months postpartum I feel tired, my mind is a bit foggy, and it’s taking time to get back to a regular monthly cycle. I believe my thyroid levels will eventually level off, and I won’t need as many adjustments to medication. I admit it’s taking a bit longer than I had hoped, though.
So how am I coping while the hormones are trying to stabilize? Well, I’m trying to adopt the mantra ‘baby steps.’ For example, I have made a health and fitness goal to run my first half marathon this fall. Running any long distance can be a daunting task, but I’ve found a great training plan that breaks it down one week at a time. I’ve also been reading more of the Bible with the hope of eventually reading it cover to cover in one year. To help, I started a daily reading plan which breaks certain sections of the Bible down over the course of several days.
Something else that has been helpful is changing my diet. Eight months ago I took some ‘baby steps’ with a gluten free approach. I started substituting certain foods, like pasta, with gluten free alternatives sold at our local grocery store. I’ve come to adopt this way of eating on a more regular basis. Furthermore, my endocrinologist was supportive of this decision, knowing that a gluten free diet helps decrease common Hashimoto’s symptoms like constipation and inflammation.
18 Months Later: The Hashimoto’s Seesaw is Starting to Stabilize
At a year and a half postpartum I’m feeling more optimistic about balancing life as the mother of a toddler and coping with Hashimoto’s thyroiditis.
I remember last year coping with this condition wasn’t exactly a walk in the park. My thyroid levels were staying stubbornly stagnant - on the high end of the normal range. I was dealing with symptoms like fatigue, brain fog, and it was taking a while to get back to a regular monthly cycle. While this was a frustrating season to endure, my endocrinologist encouraged me to stick with the medication dosage I was on, believing things would eventually improve.
Slow and Steady
Since October of 2013, my thyroid levels have steadily improved. My endocrinologist acknowledged that being postpartum depleted my thyroid and it needed some time to stabilize. This is not uncommon among women with Hashitmoto’s thyroiditis and those diagnosed with postpartum thyroiditis.
Also in October of 2013 I had an annual physical exam in which I underwent a full round of blood work. This was the first time my vitamin D lab results were not within the normal range. From October until mid-January I was prescribed to take a weekly vitamin D supplement to help overcome the deficiency.
What Helped
For a little over a year I’ve been trying to eat less gluten. I decided to try the gluten-free approach because, in doing some personal research and talking with other women with Hashimoto’s, I learned that it isn’t a diet that will help improve thyroid function but it can help reduce the severity of certain symptoms. While I’ll be the first to admit that every now and then I have the occasional slice of bread, I have noticed significant improvements in my overall digestive function. I’m also trying to reduce my caffeine intake which isn’t easy being a mom. Yet, I’ve noticed that on the days I drink less caffeine my energy level stays at an even keel. This is a gift because this allows for me to keep up with my toddler, and stay more engaged with her world of learning and growing throughout the day.
What I believe also helped with the slow and steady improvements was listening to my body, and living out the mantra ‘stay faithful to the process.’ With that in mind I’ve been consistent in taking my medication at the same time every day; I wait at least 30 minutes before I eat or drink anything. I’ve also been adhering to what is recommended on the prescription bottle which is to not take antacids, calcium or iron within four hours of taking the medication. This might sound simple, but taking daily thyroid medication as prescribed is important because it maintains a consistent level of thyroid hormone within the body.
On a positive note, after being diagnosed with Hashimoto’s thyroiditis in 2011 I joined a local Toastmasters public speaking club. I became a member because I wanted to find my voice; a voice that had the potential to be permanently changed as a result of a partial thyroidectomy. While my physical voice didn’t change, I still felt like it was important to improve my written and oral communication skills. Lately, as a stay-at-home mom, attending Toastmasters meetings has become a great way to get out of the house. It has also been a great way to gain support as I learn how to become more articulate about my faith and living with this chronic condition.
Next Step
At the end of April I had another round of thyroid blood work and an office visit with my endocrinologist. I’m thankful to report that my thyroid levels continue to improve, and I’ve been prescribed to take a lower dose of daily thyroid medication. My endocrinologist asked me how I was doing and I said, “I’m feeling the best I’ve felt since before getting pregnant.” It’s true. I’m really starting to feel more stable, in what has seemed like such a seesaw these last couple of years.
Within eight weeks from the visit I will have another round of blood work done to make sure this lower dose is sufficient. My hope is that I will be able to continue on this lower dose, and start getting back into a routine of monitoring my thyroid levels once every two to three months.
About the Author
Stacey writes and shares her health journey from diagnosis, to treatment, to acceptance of the thyroid autoimmune condition. Since then she has become a mom, she has been featured on Everyday Health.
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