Complete guide to hypothyroidism and infertility

Hypothyroidism is a condition in which the body is not producing enough thyroid hormones. The thyroid is a butterfly-shaped, small gland that is present at the front of the neck. The thyroid releases hormones that help the body in regulating and using energy. It is regulated by the pituitary glands. Hypothyroidism is also called underactive thyroid.

The thyroid gland is said to be responsible for supplying nearly every organ in the body with energy. They also control functions like the heartbeats and the digestive system. The body's natural roles start slowing down without the right amount of thyroid hormones.

Women are affected more frequently by hypothyroidism than men. It is most common in people over the age of 60, but it can also begin at any other age. This condition can be diagnosed through routine blood tests or after symptoms begin to show [1].

The treatments for hypothyroidism are considered safe, simple, and effective. Most treatments for this include supplementing the low hormone levels with artificial varieties. These supplementary hormones replace what the body isn’t producing on its own and thus, helping the body to return to normal.

The symptoms and signs of hypothyroidism may vary from person to person. The severity of the condition affects which symptoms appear and when they appear. Some early symptoms of this condition may be fatigue and weight gain. Both these symptoms are common in ageing, regardless of your thyroid's health. Therefore, one may not realize that these symptoms are related to thyroid until more symptoms appear.

Symptoms of this condition progress gradually over many years in most people. The symptoms become easily identifiable as the thyroid slows more and more. In case you suspect hypothyroidism symptoms, you must talk with a doctor. The most common symptoms or signs of hypothyroidism may be [2]

• Fertility difficulties
• Menstrual changes
• Weight gain
• Elevated blood cholesterol
• Pain and stiffness in joints
• Muscle stiffness, aches, and tenderness
• Decreased sweating
• Fatigue/ Tiredness
• Depression
• Impaired memory
• Constipation
• Puffy, sensitive face
• Dry skin
• Feeling cold
• Muscle weakness
• Slow heart rate
• Dry and thin hair
• Hoarseness

Hypothyroidism is a common condition and approximately 3% to 4% of the Indian population has hypothyroidism. The most common causes of hypothyroidism in adults include[3]:

Hashimoto's thyroiditis

The most common cause of hypothyroidism is a condition known as Hashimotos thyroiditis. In this condition, the thyroid gland has a decreased ability to make thyroid hormones and it is usually enlarged (goitre). Hashimoto's thyroiditis is an autoimmune disease. An autoimmune disease is a condition where the body's immune system mistakenly attacks itself. In Hashimoto's thyroiditis, the body's immune system attacks the thyroid tissue. This condition is said to have a genetic basis, meaning that you are more likely to develop Hashimoto's thyroiditis if it runs in your family.

Severe iodine deficiency

Iodine deficiency in the diet can lead to severe hypothyroidism. Hypothyroidism may develop if the body's iodine levels fall as iodine is essential for producing the thyroid hormone.

Thyroid destruction after radioactive iodine or surgery

People who receive treatment for hyperthyroidism usually receive radioactive iodine. This may lead to little or no functioning thyroid after the treatment. The chances of this happening depend on factors like the activity of the thyroid gland and the dose of iodine given.

If no significant activity of the thyroid gland is observed in the six months after the radioactive iodine treatment, it means that the thyroid gland is no longer functioning adequately and thus, resulting in hypothyroidism. Also, removal of the thyroid gland during surgery will cause hypothyroidism.

Pituitary gland or hypothalamic disease

In some cases, the pituitary gland or the hypothalamus are unable to signal the thyroid and instruct it to produce thyroid hormones. This causes a decrease in T4 and T3 hormones in the blood. The condition is known as secondary hypothyroidism if pituitary diseases cause a reduction in thyroid hormones. If it is caused due to hypothalamic disease, it is known as tertiary hypothyroidism.

Pituitary gland injury

Brain surgery or the decrease in blood supply to the brain may cause a pituitary injury. If the pituitary gland is injured, it results in hypothyroidism. This is because the thyroid gland is no longer stimulated by the pituitary resulting in low TSH (Thyroid-Stimulating Hormone) blood levels.

Over-response to hyperthyroidism treatment

Hyperthyroidism is a condition where the thyroid gland produces too much hormone thyroxine. Medications that are used to treat hyperthyroidism may cause hypothyroidism.

Other medications

Psychiatric medication like lithium is also known to modify the functions of the thyroid and cause hypothyroidism. Interestingly, drugs containing large amounts of iodine can also cause changes in thyroid functions resulting in hypothyroidism.

Pregnancy

Some cases of hypothyroidism develop during or after pregnancy (postpartum hypothyroidism). This is often a result of the body producing antibodies to their thyroid gland. If it is left untreated, it increases the risk of premature delivery, miscarriage, or a significant rise in the woman's blood pressure during the last three months of pregnancy. This can also seriously affect the fetus.

Although hypothyroidism can develop in anyone, you have an increased risk of getting it if you,

• Have a family history of thyroid diseases
• Are above the age of 60
• Have an autoimmune disease
• Have received treatment with radioactive iodine or anti-thyroid medicines
• Received radiation to your upper chest or neck
• Had a thyroid surgery
• Are a woman above the age of 30
• Are pregnant or have delivered a baby within the last six months

If left untreated, hypothyroidism can lead to several health problems like[4]:

Goitre

Constantly stimulating the thyroid to release more hormones may lead to the gland becoming larger. This condition is known as a goitre. Usually, this condition is not uncomfortable, but a large goitre will affect your appearance. It can also create problems in swallowing or breathing.

Heart problems

You may also have an increased risk of heart disease and heart failure if you have hypothyroidism. This is because of the presence of high levels of low-density lipoprotein (LDL) cholesterol or bad cholesterol.

Mental health issues

Hypothyroidism can lead to slowed mental functioning. It can also cause depression in the early stages and may become more severe over time.

Peripheral neuropathy

If hypothyroidism is left uncontrolled for a long time it causes damage to the peripheral nerves. Peripheral nerves carry information from the brain and spinal cord to the rest of the body. Peripheral neuropathy causes numbness, tingling, and pain in the affected areas.

Myxedema

Undiagnosed hypothyroidism can lead to a rare, life-threatening condition known as Myxedema. This is a term used for severely advanced hypothyroidism. Its symptoms include drowsiness, intense cold intolerance, and slowing of the functioning in multiple organs. It can also cause lethargy and unconsciousness.

A myxedema coma is usually triggered by stress on the body, sedatives, or infection. In case you have any symptoms of myxedema, you require immediate medical treatment.

Infertility

Low levels of the thyroid hormone can interrupt the process of ovulation, which may lead to subfertility or infertility. Also, one of the most common causes of hypothyroidism- autoimmune disorders can also impair fertility.

Birth defects

When women with untreated thyroid give birth, the babies have a higher risk of birth defects in comparison to babies born to healthy mothers. These children may also be more prone to serious developmental and intellectual problems. Infants who have hypothyroidism and are left untreated have serious problems with mental and physical development.

If hypothyroidism is diagnosed within the first few months, there are excellent chances of normal development.

There are two primary ways of determining if you have hypothyroidism[5]:

Medical evaluation

The doctor performs a complete and thorough physical exam and asks about your medical history. They will also check for physical signs of hypothyroidism like:

• Slow reflexes
• Dry skin
• Swelling
• Slower heart rate

In addition, the doctor will also ask you if you have symptoms such as depression, fatigue, constipation, or are feeling constantly cold. You must inform your doctor if you have a known family history of thyroid conditions.

Blood tests

The only reliable way to confirm a diagnosis of hypothyroidism is through blood tests.

A TSH (thyroid-stimulating hormone) test measures the amount of TSH the pituitary gland creates. If the thyroid gland does not produce enough hormones, the pituitary glands boost TSH in order to increase thyroid hormone production.

If a person has hypothyroidism, their TSH levels are high. This is because the body is trying to stimulate more thyroid hormone activity.

A T4 (thyroxine) level test is also helpful in diagnosing hypothyroidism. T4 is a hormone that is directly produced by the thyroid gland. TSH and T4 tests help in evaluating thyroid function.

Usually, if a low level of T4 and a high level of TSH is detected, it means that the person has hypothyroidism. However, there are several other tests required to diagnose the wide spectrum of thyroid diseases.

Understanding TSH Levels in Diagnosis

Nowadays, experts consider 0.3 to 3.0 mIU/L as the normal range for TSH levels. If you are diagnosed with TSH above 3.0, you have hypothyroidism.

Experts believe that some women find difficulty in conceiving or maintaining a pregnancy when their TSH is above 2.0 mIU/L. This indicates the poor functioning of the thyroid. Studies have indicated that TSH levels must be under 2.5 mIU/L before conception. Other studies suggest that the TSH must be at or below 1.2 mIU/L before and during pregnancy.

Hypothyroidism can be treated in many ways. Usually, doctors prescribe medications to treat it however there are other treatments available as well. They are all mentioned below.

Medications

Hypothyroidism is mostly a lifelong condition. Medication can help in reducing or alleviating the symptoms of hypothyroidism.

The best treatment for Hypothyroidism is with the use of levothyroxine- Levothroid or/and Levoxyl. This is a synthetic version of the T4 hormone. It copies the actions of the thyroid hormone that the body normally produces.

This medication helps in returning adequate levels of the thyroid hormone to the blood. After the hormone levels get restored, symptoms of hypothyroidism start to disappear or at least become manageable.[6]

It takes several weeks to start feeling relief after the treatment begins. Follow-up blood tests are required for monitoring the progress. The doctor may take some time to find the dosage and treatment plan that best addresses your symptoms.

Most people with hypothyroidism remain on these medications for their entire lives. It is unlikely that you continue to take the same dose. In order to make sure the medication is working properly, your doctor will test your TSH levels annually. If the test results indicate that the medicine is not working properly, the dosage will be adjusted by your doctor until a balance is achieved.

Alternative treatment for hypothyroidism

Animal extracts containing thyroid hormones are available. Thyroid glands of pigs are used as a method of treatment for hypothyroidism as it contains both T4 and T3.

Consuming levothyroxine provides you with T4 and not T3. But that is what you need because the body can produce T3 from the synthetic T4.

Alternative animal extracts are mostly unreliable in dosing. They haven’t been proven to be better than levothyroxine. Therefore, animal extracts are not routinely recommended.

Additionally, glandular extracts are available for purchase at some health food stores. These products are not regulated or monitored by any food authorities or administrations. And so, their legitimacy, purity, or potency is not guaranteed.

You may use the above-mentioned products at your risk. If you decide to try these products, you must tell your doctor so that they can adjust your treatment accordingly.

Reproductive hormone imbalance affects thyroid function and vice versa. High levels of estrogen reduce the amount of active thyroid hormone. This is due to the excess estrogen which increases TBG. TBG is the protein that transports and binds T4 and T3, but excess TBG can render them inactive upon binding. In women who have normally functioning thyroid, the body produces compensatory thyroid hormone to take care of this. But women with hypothyroidism, this compensatory thyroid hormone cannot be produced which leads to worsening of the symptoms in the presence of excess estrogen.

Hypothyroidism may affect your fertility and can also cause problems even while you are pregnant. Researchers have been trying to find the exact cause of this and results are mentioned below.

Fertility & Conception

Conception becomes difficult in women with hypothyroidism as low levels of thyroid hormone hinder the release of eggs from your ovary, this, in turn, impairs fertility. In addition to this, the cause of hypothyroidism, pituitary, or autoimmune disorders can also impair fertility [7]. Both hypothyroidism and hyperthyroidism impair fertility by causing ovarian dysfunction. Also, women with hyperthyroidism have a disrupted reproductive hormone balance and menstrual cycle abnormalities like scanty periods, flooding, or irregular cycles.

Although the precise mechanism of hormonal disruption is not defined, researches have shown that it is associated with reduced LH and FSH levels. LH and FSH are required for ovarian production of progesterone and estrogen, and egg follicle maturation. Researchers have also linked hypothyroidism with the development of ovarian cysts. These cysts may regress upon proper thyroid treatment.

Pregnancy

10-15% of pregnant women develop thyroid disorders during pregnancy. Thyroid hormone is essential for the development of both the placenta and the fetus. Pregnancy is considered a “stress test” for the thyroid of pregnant women. This is because the mother's body needs to produce 20-50% more thyroid hormone for accommodating the increased metabolic needs of the mother and the fetus. If they are unable to produce enough thyroid hormone due to hypothyroidism then that becomes a problem. It increases the risk of preterm birth, miscarriage, low birth weight, or postnatal developmental issues.

Hashimotos Disease- an autoimmune condition is the most common cause of hypothyroidism in reproductive-aged women. Researchers have proven that when the body has thyroid auto-antibodies the rates of neurodevelopmental issues, miscarriage, and preterm birth is higher. Thus, it is recommended to undergo screening every 4-6 weeks for pregnant women to check for thyroid disorders like hypothyroidism [8].

Now that you know about the link between hypothyroidism and reproductive fitness, you must support your thyroid health. You can do so by taking proper medications and consuming a rich and healthy diet. Here are a few nutritional recommendations that will help you in improving your fertility by keeping your thyroid under control.

Nutritional/Dietary recommendations for people with hypothyroidism

People with hypothyroidism don’t have a specific diet. However, the following recommendations must be kept in mind,

Increase iodine intake

In order to fully function, your thyroid requires an adequate amount of iodine. Taking an iodine supplement is not necessary to make that happen. A balanced diet containing beans, whole grains, fruits and vegetables, and lean proteins should provide your body with enough iodine.

Increase selenium intake

Selenium helps in activating the thyroid hormones so they can be used by the body. Selenium also has antioxidant benefits, meaning it can protect the thyroid gland from getting damaged by molecules called free radicals.

Adding foods rich in selenium to your diet can help you boost your selenium levels. This includes tuna, brazil nuts, sardines, legumes, and eggs.

However, you must not take a selenium supplement unless advised by your doctor. This is because supplements provide large doses, and selenium in large amounts may be toxic [9].

Increase zinc intake

Zinc also helps the body in activating thyroid hormones [10]. Studies have shown that zinc helps the body in regulating TSH, the hormone which tells the thyroid gland to release the thyroid hormones.

If you have hypothyroidism, you must eat more zinc-rich foods including beef, oysters, chicken, and other shellfish.

Monitor soy intake

Soy often hinders the absorption of thyroid hormones. If you consume too many soy products, your body will not be able to absorb your medication properly. Soy is found in:

• Tofu
• Vegan cheese products
• Vegan meat products
• Soy milk
• Soy sauce
• Soybeans

Your body requires steady doses of medication for achieving even levels of the thyroid hormone in the blood. It is recommended to avoid drinking or eating soy-based foods for at least two hours before and after your medication.

Avoid Goitrogens

Goitrogens are compounds that can intervene in the normal functioning of the thyroid gland.

Surprisingly, many daily foods contain goitrogens, including [11],

• Vegetables like broccoli, cabbage, kale, spinach, cauliflower, etc.
• Fruits and starchy plants like cassava, sweet potatoes, peaches, strawberries, etc.
• Soy foods like tofu, edamame, etc.
• Nuts and seeds like millet, peanuts, etc.

Be smart with fibre

Just like soy, fibre also interferes with hormone absorption. A high intake of dietary fibres prevents the body from getting the hormones it needs. Fibre is an important part of the diet so don’t avoid it entirely. Instead, avoid taking your medication a few hours before and after eating high-fibre foods.

Don’t take thyroid medicine with other supplements

Try to take medicines at different times if you have to take supplements or medications in addition to your thyroid medicine. Other medications can also interfere with the absorption of thyroid hormone, so it is best to take the thyroid medicines on an empty stomach.

One of the ways to keep your thyroid levels in control is to maintain a diet plan. If you are not able to follow a particular diet plan you can just include some of the superfoods important for your diet and refrain from some foods. They are all mentioned below.

Foods to eat

For people with hypothyroidism, it is recommended to include the following foods in your diet:

• Fruits like Banana, berries, oranges, tomatoes, etc.
• All Vegetables, but cruciferous vegetables must be consumed in moderate amounts
• Meat - Lamb, beef, chicken, etc.
• Fish - All seafood, including tuna, salmon, shrimp, halibut, etc.
• Eggs
• Gluten-free grains and seeds like rice, quinoa, buckwheat, chia seeds, and flax seeds
• All dairy products, including milk, yoghurt, cheese, etc.
• Water and non-caffeinated beverages

People with hypothyroidism must consume a diet filled with fruits, vegetables, and lean meats. They are very filling and low in calories, which helps in preventing weight gain.

Foods to avoid

Fortunately, you do not have to avoid too many foods if you are diagnosed with hypothyroidism. However, as mentioned earlier, foods that contain goitrogens must be consumed in moderate amounts and after being ideally cooked.

Highly processed foods must be avoided as they contain a lot of calories. This can cause weight gain if you have hypothyroidism. Here is a list of supplements and foods you should limit or avoid,

• All varieties of millet
• Highly processed foods like burgers, cakes, cookies, etc.
• Supplements: Selenium and iodine are essential for thyroid health. But getting too much of either of them can cause harm. Consume supplements only when your doctor has instructed you to.

Following are the foods you can eat in moderation:

• Cruciferous vegetables like kale, broccoli, cabbage, spinach, etc.
• Certain fruits like pears, peaches, and strawberries
• Soy-based food
• Beverages like green tea, coffee, and alcohol. These beverages cause irritation in the thyroid gland [12]

If you are planning to conceive, you should try these herbal methods of controlling thyroid. You must speak with your doctor before using any of the mentioned supplements if you are taking any thyroid medications:

Ashwagandha

Ashwagandha is a well-known herb in India. It is known as a thyroid stimulant, stress reliever, reproductive system tonic, and adrenal tonic. It is used to help with Hashimotos Disease as it may modulate the body's inflammatory responses. It also helps with stress-related infertility.

Guggal

Guggal is an ayurvedic tonic. It helps in T3-T4 conversion and the healthy functioning of the reproductive system.

Seaweed

Seaweed is known as a good source of minerals like iodine. The iodine that is present in seaweed protects the thyroid from radioactivity.

Gotu Kola

Gotu Kola is known for supporting thyroid function. It also supports FSH and LH production in cases of hypothyroidism.

Maca

Maca can help in improving symptoms of hypothyroidism as it is a nourishing superfood which supports the thyroid, pituitary, reproductive and adrenal function.

Asian Ginseng

Asian Ginseng is a stress-relieving herb. It helps the pituitary glands and hypothalamus in increasing stress resistance. It also stimulates the functioning of the thyroid and acts as a reproductive tonic. Asian ginseng is best for weak and seriously ill patients. Researches have shown that it is not healthy for consumption by people under the age of 40.

Vitex

Vitex is used for balancing sex hormones that are thrown off because of hypothyroidism. It also works on the pituitary gland to provide endocrine support.

Schisandra

Schisandra is an adaptogen (stress reliever), immunomodulatory ( a chemical agent which helps in modifying the functioning of the immune system), and an adrenal tonic. It also helps in stimulating the thyroid glands. It is helpful for patients with autoimmune diseases like Hashimoto's disease. Schisandra is also known for helping with stress-related infertility.

Rhodiola Rosea

Just like Schisandra, Rhodiola Rosea is an adaptogen. It is also known to provide support to the reproductive system.

Licorice

Licorice is a herb containing phytoestrogens that help in balancing the estrogen activities in the body. It is also an adaptogen, adrenal tonic, and an immunomodulator. Licorice provides liver support that leads to a healthy hormonal balance.

Even if you are undergoing treatment for hypothyroidism, you may have to deal with long-lasting complications. These are a few ways to lessen the effects of hypothyroidism:

Develop fatigue coping strategies

You may experience fatigue despite taking medications. And so, you must get quality sleep and eat a diet filled with fruits and vegetables. You must also consider the use of stress-relieving mechanisms, like yoga and meditation, for helping you battle low energy levels.

Talk it out

It is stressful and difficult to have a chronic medical condition, especially when it is accompanied by other health concerns. Therefore, it is important to find people you can openly express your experiences and feelings. This person can be a close friend, a family member, a support group, a therapist, or even other people living with this condition.

Monitor for other health conditions

Hypothyroidism goes along with other conditions like,

• Diabetes
• Celiac disease
• Adrenal gland disorders
• Rheumatoid arthritis
• Obstructive sleep apnea
• Lupus
• Pituitary problems

It is very important that you pay attention to your body changes during your lifespan. In case you notice a significant difference, you must talk to your doctor to check if a thyroid problem is present.