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A  G U I D E  TO  M A N A G I N G 
H A S H I M O TO ’ S  D I S E A S E

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A Guide to Managing Hashimoto’s Disease

Introduction .......................................................................................................4

Chapter One: Why Hormones Matter .............................................................7

Chapter Two: Meet the Thyroid .....................................................................11

Chapter Three: Understanding Hashimoto’s Disease ................................18

Chapter Four: When Something Feels Wrong .............................................25

Chapter Five: Crunching Numbers: 
Diagnosing Hashimoto’s Disease .................................................................32

Chapter Six: What to Do After Your Diagnosis ............................................39

Chapter Seven: Treatment Options ..............................................................47

Chapter Eight: Side Effects ............................................................................69

Chapter Nine: What the Future Holds 
– Current Research and Future Expectations .............................................78

Conclusion: A Message For You ...................................................................85

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My name is Angela Byrne and I have Hashimoto’s disease. The story of my little 
thyroid and hormonal issues is a long and twisty one, but it’s one of the main 
reasons why I wanted to write this book.

I feel like I’ve had trouble with my thyroid for as long as I can remember. When I 
was 14, my mother took me to the doctor after I had this cold that seemed to never 
go away. My glands were still enlarged and I was exhausted. At that point, I was a 
chubby teenager even though I lived a fairly active life and participated in summer 
and winter sports.

So, our family doctor performed a full thyroid panel and my bloodwork came back 
positive for thyroid antibodies. If you have Hashimoto’s disease, you know what 
that means. I was diagnosed with Hashimoto’s Disease, but the doctor said there 
was no need to treat at that time since my TSH, T3 and T4 were all normal.

Reader, I wish I knew then what I know now. Although the doctor basically sent 
me away after proclaiming my thyroid stats normal, my symptoms continued. I 
couldn’t seem to lose the weight, I was tired all the time and kept getting recurrent 
infections.

When I occasionally asked my doctor about a possible link between my symptoms 
and my thyroid, he kept telling me not to worry because my annual thyroid tests 
were all normal!

This continued until the birth of my third child when my thyroid finally started

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producing abnormal values in my blood test results. During that time after my baby 
was born, I also lost ten kilos very quickly, but of course I assumed I was just 
stressed out from caring for two other kids and my new baby.

At first, I was surprised (okay, maybe a little excited) to discover that I was losing 
weight so rapidly after my third child. With my other two babies, the weight took 
ages to come off, so this time, I thought the weight loss was a good thing! But then, 
I started having trouble sleeping and was feeling off, very unlike myself.

That was when the doctor discovered that I had postpartum thyroiditis and was in 
a hyperthyroid state. He told me not to worry and explained that I would soon be 
hypothyroid and eventually go back to normal in a couple of months. Apparently 
this happens to some women after having a baby.

I was glad and relieved to see that he was right. The weight crept back on (as it 
does) and life pretty much went back to normal - except for a huge growth which 
appeared on the side of my neck and constant tiredness I couldn’t seem to shake. 
Honestly, I felt like the incredible hulk with my huge, thick neck!

Another visit to the doctor showed that the thyroiditis had left a goiter in my neck, 
and it just wouldn’t go away. The goiter was so thick that I had trouble turning in 
my driver’s seat to reverse my car! So, the doctor decided to remove it since it was 
also starting to press on my windpipe.

That was how they removed the right lobe of my thyroid.

Still, I kept waiting for the miraculous moment when the fatigue would be lifted and 
things would be good again, but sadly that did not happen. On top of that, every 
time I complained of being tired to a doctor, they brushed me off and asked ‘what 
do you expect with three young children?’

With so many drugs going through my body, I couldn’t get back to feeling like me. 
I hated how much medication I needed to use and hated the fact that I still felt 
sick with all those meds! So, one day I’d just had it. I got rid of all the medication;

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flushed them down the toilet, and started to read everything I could on endocrine 
disorders.

For someone like me with a thyroid issue (or three), it only seemed logical to start 
my research with the thyroid gland. That was the best decision I made, and I regret 
that it took me so long. I meet people - mostly women - from time to time on the 
same journey to taking control of their health issues, sometimes thyroid issues 
and I just want to reach out and make their work easier.

• 
You’ve been recently diagnosed with Hashimoto’s disease and are seeking 
advice from someone who’s also down that road.

• 
You have a family member or friend who just received their diagnosis and 
you want to know what in the world Hashimoto’s disease is and how you can 
help.

• 
You don’t have the disease and you really don’t know anyone who does, but 
you’re curious about it and about the thyroid.

I’m so glad you’re here and we can talk about this together. Buckle up, it’s going to 
be a fun ride!

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If you’ve started reading this book, but are not sure exactly what hormones are, 
don’t worry. This chapter will help you understand what they are and why they have 
so much power over our bodies – a crash course in hormones if you will.

First off, you should know that the system of our bodies involved in hormone 
production and management is called the endocrine system. You may see those 
two words quite often during the course of this book, so just remember that it 
means “hormone control center.”

Hormones are chemicals our bodies make to control various important functions. 
These chemicals are in charge of our metabolism, growth, sexual development 
and function, and even emotions. They affect us strongly and in many ways, as 
you’ll learn throughout this book.

The body makes a variety of hormones, so before we dive fully into Hashimoto’s 
disease, it makes sense to get a (very) brief overview of the most important 
hormones and what they do. We’ll discuss them according to the glands that 
produce each one.

1. Pineal gland: This pea sized gland in your brain produces the hormone

melatonin. Sound familiar? That’s probably because this hormone regulates

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your sleep cycle. You may also have seen the name “melatonin” because 
some people with sleep issues might use melatonin supplements to fall 
asleep more easily.

The pineal gland responds to light by producing less melatonin (that’s how 
you know to stay awake) and in the dark, produces more melatonin so you 
can you fall asleep. Pretty nifty, isn’t it?

2. Pituitary gland: Is a very valuable gland in our bodies because it produces

the largest number of hormones! It has two parts, anterior and posterior. 
The anterior pituitary is basically the endocrine boss, because what it does 
is stimulate other endocrine glands to produce hormones. It also makes the 
growth hormone and a hormone for breast milk production called prolactin.

The posterior part of the pituitary is linked with two important hormones, 
vasopressin (also known as the anti-diuretic hormone) and oxytocin. But, 
both of these hormones are actually made in a different part of the brain —
the hypothalamus—and essentially shipped to be released by the posterior 
pituitary.

You might already know oxytocin as “the bonding hormone,” very active 
during and after childbirth. Oxytocin contracts the uterus, helping it return to 
a semblance of its former size, and is responsible for breast milk release. It 
also gives us those good feelings after a nice, long hug. Vasopressin, on the 
other hand, controls blood pressure and water content in the body. Not quite 
as fun as oxytocin, but equally important.

3. Pancreas: Bet you didn’t know the pancreas is recognized as a gland, huh?

Well, it is. It makes two hormones, one of which is very important to diabetics. 
You guessed it! Insulin. Yep, the pancreas makes insulin and glucagon, both 
of which work to regulate blood sugar content.

Insulin returns excess blood sugar to the liver after we’ve had a meal or very 
sweet dessert, while glucagon signals sugar back into the bloodstream on

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those days when we’ve missed breakfast and lunch. Glucagon helps us be 
less “hangry.”

People with diabetes either have zero insulin or lack enough insulin depending 
on the type of diabetes they have. Type 1 diabetes patients are usually born 
with little to no insulin, while type 2 patients lose the insulin production as 
they get older.

4. Adrenal glands: This is one of the less known glands in the body. We actually

have a pair of them, each sitting atop each kidney. They are also called 
suprarenal glands (over the kidney/ “renals,” get it?).

They make a bunch of very important hormones including adrenaline/
epinephrine, the hormone that gets you into action and three different 
kinds of steroids. Not many people know this, but the adrenals also make a 
reasonable amount of androgens or male sex hormones.

5. Gonads: This is a fancy word for “reproductive glands” – testes in males and

ovaries in females. These organs, in collaboration with the adrenal glands, 
produce sex hormones that help in sexual development and reproduction.

The hormones these organs make control things like menstruation, ovulation, 
sperm production and all that good stuff.

6. Parathyroid glands: These are three or more (most people have four, but others

may have up to eight) super tiny glands usually behind the thyroid gland. 
About the size of a lentil seed, these glands regulate the body’s calcium and 
phosphate content, by means of a hormone called the parathyroid hormone.

This hormone increases the level of calcium in the blood, usually by drawing 
on bone reserves, while slightly reducing phosphate levels.

7. Thyroid gland: I saved the best for last. The thyroid gland, which is the focus

of this book and the organ affected in Hashimoto’s disease secretes a

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multipotent, active hormone called thyroxine (T4). This hormone controls 
our energy levels, moods, alertness, bone growth, fat metabolism, body 
temperature and more – basically EVERYTHING.

It also produces two other hormones called triiodothyronine (T3) and 
calcitonin, all of which we’ll learn lots about soon!

As you’ve seen in this brief rundown, hormones matter. They’re in our blood and 
basically the messengers that keep our bodies performing as they should. When 
our hormones are off track, our bodies inevitably begin to run off the rails too.

If you’d like to know more detailed information about all the vital hormones that 
make our bodies work like they do, I’ve also written a book to help you harness that 
power. You can find it here.

Going forward, we’ll look more closely at why the thyroid has such control over 
body processes and a few things that could go wrong with the thyroid, including 
Hashimoto’s disease. Understanding how your thyroid gland works, will help you 
understand this disease and how to handle it in the best way possible.

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The thyroid is a brilliant multitasker. This bad boy has its hand in every pot of 
your body imaginable. That’s why when the thyroid isn’t happy, you can’t be happy 
either. Ever wondered what the thyroid is exactly? Where it is in your body or what 
it looks like? Well, it’s time to meet the thyroid.

What you should know about the thyroid is that it is a gland in the lower part of 
your neck, just below your Adam’s apple. It may be H or U shaped and is basically 
two lobes joined in the middle (the middle is also called the isthmus). Some people 
also call it “butterfly-shaped.”

A few people have an extra lobe known as the pyramidal lobe extending from the 
top, while others have no isthmus. The body is always reminding us that although 
we are essentially the same blueprint, no two humans are exactly alike.

The thyroid has a ton of blood vessels running through it, probably because it’s so 
active all the time. As I mentioned before, the thyroid makes three main hormones. 
Remember the boss gland? The anterior pituitary?

That gland makes a hormone, called the thyroid-stimulating hormone. This hormone, 
also called TSH for short, causes another part of the brain, the hypothalamus, to 
release the thyrotropin releasing hormone (TRH) which directly controls the thyroid 
gland.

So whenever your body is low on thyroid hormones, it sends a signal back to 
increase both TRH AND TSH which then makes the thyroid produce more thyroid 
hormones. It’s like a cycle, get it?

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Now, let’s look a little closer at these thyroid hormones and see exactly what they 
do for our bodies.

1. Thyroxine (T4): This is essentially the inactive form of the thyroid hormone.

While both T3 and T4 are both made from iodine and a protein named 
tyrosine, T4 seems to be less potent than T3. It also has a longer half-life, 
meaning it lasts longer in while in your bloodstream.

So when the body signals for some thyroid hormone, T4 converts to its 
active form, T3, and T3 gets to work. This process requires an enzyme called 
deiodinase, because the process is basically removing one iodine molecule.

Keep this fact in mind, because this enzyme will come up again when 
discussing your treatment alternatives and I’ll test your memory, ha!

2. Triiodothyronine (T3): This active form is usually called the “true” hormone,

although both T3 and T4 are carried through the blood attached to proteins 
to help them last longer in the bloodstream.

T3 is more powerful and actually has about four times the effect of T4. It 
makes sense then that out of all the thyroid hormone the body makes, only 
about 20 percent is T3, while 80 percent is T4.

3. Calcitonin: The least popular thyroid hormone, calcitonin leaves most of the

work for its more famous siblings. Still, it is important in the regulation of 
calcium.

Unlike the parathyroid hormone which we mentioned earlier, calcitonin is 
called in to lower blood calcium. It acts practically opposite to parathyroid 
hormone because it returns calcium from the blood to the bones.

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We already mentioned a few of the bodily functions that the thyroid hormone 
regulates, but it’s helpful to look more closely into some conditions that may affect 
the way the thyroid is set up and its function.

Hyperthyroidism: Just like the name implies, hyperthyroidism is excessive 
production of the thyroid hormones; TOO MUCH thyroid production.

This can happen due to various diseases. A popular cause of hyperthyroidism is an 
autoimmune disease called Graves’ disease. Graves’ is in many ways the opposite 
of Hashimoto’s disease.

Other reasons why the thyroid could begin making too much T3 and/or T4 include 
what doctors call a toxic goiter, tumors of the thyroid or the boss (pituitary) gland 
and inflammation.

Certain medications such as amiodarone, a medicine that controls heart rhythm, 
as well as taking iodine contrast for x-rays can also cause hyperthyroidism. 
Remember, iodine is part of thyroid hormones.

So, what happens when the body gets too much thyroid hormone, you wonder? It’s 
kind of like overdosing on caffeine, but worse. Much worse.

The body virtually goes into overdrive. All the functions powered by the thyroid are 
accelerated, but because the thyroid controls so many organs, it can be difficult for 
many people to figure out exactly what’s gone wrong.

Most people whose thyroids go into overdrive first notice weight loss despite 
eating everything in sight, insomnia, constantly feeling HOT, palpitations and mood 
issues. For instance, they may notice a spike in their anxiety and may be feeling 
constantly on edge.

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A percentage of patients have also complained of chest pain, breathlessness, 
diarrhea, hair loss and muscle weakness. Their skin usually feels warm and moist 
all the time, because of the inability to tolerate heat and menstrual periods may be 
light or absent.

In Graves’ disease, patients will also develop eye muscle issues that can result in 
noticeably bulging eyes, a goiter (which is when the thyroid becomes enlarged), 
and deep skin damage most commonly in the front of the lower legs.

Hyperthyroidism can be complicated by a life-threatening condition known as a 
thyroid storm.

At this point, a person would have gone without treating their hyperthyroidism and 
things basically explode. The symptoms occur at 100 percent severity and the 
body can simply shut down from overstimulation.

Hypothyroidism: In hypothyroidism, the situation is reversed as thyroid hormones 
are low. Throughout the world, the most common reason for an underactive thyroid 
is a lack of iodine. In more developed countries where iodine is available, though, 
hypothyroidism may happen for other reasons.

Some children are born with an underactive thyroid. This could be because their 
gland did not develop properly while they were baking, or doesn’t function right and 
just can’t make the hormones properly.

The most common cause in developing countries, especially when batches of 
newborns in a particular region have the condition, is maternal iodine deficiency. 
The mother’s lack of iodine, the nutrient important for making thyroid hormones 
means that the baby doesn’t get enough either.

In these newborns with congenital hypothyroidism, you will notice decreased 
activity, poor feeding and weight gain, decreased stooling or constipation, poor 
muscle tone and a characteristic hoarse cry.

These babies are what you could call “lazy,” because they just don’t have the energy

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that the thyroid provides. They’re often described as “good babies” because they 
rarely cry and they sleep a lot.

Some newborns show very few abnormalities and so doctors may miss the lack 
of thyroid hormones. But, these babies may eventually develop a goiter, a large 
tongue and developmental delay weeks or months after birth.

In the United States, Hashimoto’s disease is the most common cause of 
hypothyroidism in adults. Yep, let that sink in, if you didn’t already know. Similar 
to Graves’ disease, it is also an autoimmune disease, but with the opposite effect.

Hypothyroidism in general is two times more common in women than in men. It 
also happens more in middle aged or older persons. People who have a family 
history of thyroid problems are unfortunately also more prone to hypothyroidism. 
The same applies to persons who are obese or have high blood cholesterol levels.

For adults, the symptoms of hypothyroidism in general aren’t very different from 
what babies experience. They notice that their clothes are getting tighter, even 
though their appetite is barely there, they can hardly keep up with their formerly 
active schedules as they’re tired and sleepy all the time.

If your thyroid is underproducing, you’ll also notice that you’re always the coldest 
person in the room. Hair loss, poor memory and concentration also occur frequently 
in hypothyroidism.

The will often experience joint pain, muscle weakness, aches,  and cramping. 
Although most sufferers point out that the weakness can be felt all over their 
bodies, many of them typically experience it in the muscles that are closest to the 
center of their bodies, such as the thigh or shoulder.

Pain in these areas can cause problems climbing stairs or combing your hair. 
In rare cases, hypothyroidism can cause more severe muscle symptoms. One 
example is something called Hoffman’s syndrome, in which patients experience 
generalized enlargement of their muscles.

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This leads to very stiff muscles, more weakness and pain. There are also times 
when patients will experience something doctors call rhabdomyolysis. This is 
when muscle breaks down quickly.

These two are very rare muscular manifestations of hypothyroidism usually 
triggered by the combination of being hypothyroid and engaging in vigorous 
exercise or taking a statin (a cholesterol-lowering medication).

Doctors don’t know exactly why hypothyroidism would affect muscles so adversely 
but some experts think the thyroxine (T4) deficiency that hypothyroidism causes 
may lead to chemical reactions that affect our metabolism, causing injury to our 
muscles and affecting their function.

Fortunately, I haven’t experienced these.

The disturbances in your menstrual cycle will also become noticeable. You will 
slowly want sex less and less and will find yourself often constipated.

It honestly feels like your body is giving up on you. That’s the power of the thyroid.

Sick Euthyroid Syndrome: As if it isn’t enough that thyroid hormones can go up 
and down and make us ill on their own, there are times when other non-thyroid 
illnesses make our thyroids ill. Bummer, eh?

But, it happens. Thankfully any abnormalities in thyroid testing associated with 
illness of other systems tend to reverse once the original problem is fixed. Whew.

Thyroid issues can be disconcerting for your body, you, your partner, and your 
family in general, because the effects are so far reaching. But, you should know 
that you’re not alone.

These are just the basics of what could go wrong with the thyroid. Of course, like 
many organs in the body, the thyroid can develop benign (harmless) or malignant 
(cancerous) growths. There are various nodules and tumors that affect the thyroid, 
but we won’t spend any more time chattering about the thyroid.

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You’re probably itching to hear about it, so it’s time to discuss the reason why you 
bought this book: Hashimoto’s Disease.

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Chapter Three 
Understanding 
Hashimoto’s Disease

If you’ve been diagnosed with this challenging illness, I’d like to send you a virtual 
hug and remind you that you’re doing the best you can.

Quick fun fact: The disease is named after a Japanese physician, Hakaru Hashimoto 
who first described in 1912. This thing has been around FOREVER. Funny that it 
was only recognized as an autoimmune disorder in 1957.

Hashimoto’s disease, also called Hashimoto’s thyroiditis or chronic lymphocytic 
thyroiditis is one of the autoimmune diseases that affect the thyroid gland. I know 
I’ve just used a bunch of medical jargon, but don’t worry, I won’t leave you at the 
mercy of Google.

The “-itis” at the end of the word “thyroiditis” is a Greek suffix that means 
“inflammation.” Whenever “-itis” is added to the end of a word, say in the case of 
bronchitis, colitis or arthritis, we’re talking about inflammation.

Okay, so the thyroid is inflamed. Why? That’s where “autoimmune” comes in. An 
autoimmune disease means that your body is fighting  against its own cells for 
some reason. So, in Hashimoto’s, the body uses its own lymphocytes or white 
blood cells (hence the word “lymphocytic”) against itself.

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What happens is that your body attacks and gradually destroys your thyroid gland. 
With an entire body targeting it, the poor gland becomes less active and produces 
less hormone. This is where hypothyroidism comes into the picture.

You may wonder, “why on God’s green earth would the body attack its own organ?!”

Honestly, scientists aren’t sure either. But they think that the immune system 
generates antibodies (the stuff that usually fights infections) against some thyroid 
related enzymes. Think of thyroid enzymes as factory workers in the thyroid factory.

Other workers within the body called the lymphocytes, or white blood cells, attack 
the workers in the thyroid factory and damage the factory in the process. When 
viewed under the microscope, thyroid glands with the disease are practically 
invaded by these white blood cells and show signs of damage.

Interestingly, studies show that some individuals in the population may have these 
antibodies and still never develop Hashimoto’s thyroiditis. Lucky, eh?

Besides becoming underactive, the thyroid gland itself usually changes over time 
with Hashimoto’s disease. It initially enlarges, forming a typically painless goiter 
and then because it slowly gets damaged over time, the thyroid shrinks in size.

Every year between 0.30-1.5 persons in every 1000 people is diagnosed with 
Hashimoto’s disease around the world. In adults in the United States, studies 
show that 3.5 per 1000 women per year and 0.8 per 1000 men per year develop

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Hashimoto’s disease. So, it’s pretty common!

Researchers believe that Hashimoto’s disease occurs as a result of a combination 
of genetic and environmental factors. On the side of genes, as I mentioned before, 
some people are born with circulating antibodies against the thyroid and not 
everyone is lucky enough to dodge the disease.

In studies performed on identical and non-identical twins, researchers also 
discovered that when one twin had these scary antibodies, the other twin likely did 
as well! In identical twins who share nearly 100 percent identical genetic material, 
there was an 80 percent chance that they both had the antibodies and between 
38-55 percent chance in non-identical or fraternal twins.

So, I guess sometimes, you’re just born with it.

Also adding to the risk is the presence of other autoimmune diseases. A wise 
doctor once told me that autoimmune diseases like to bring a friend; they never 
come alone. Hashimoto’s is actually associated with different genes (I won’t bore 
you with the details) among various ethnic groups.

The most common autoimmune diseases associated with Hashimoto’s (aka 
Hashimoto’s friends) include type 1 diabetes (which we already discussed), vitiligo 
(when patches of your skin lose pigmentation), alopecia (hair loss), pernicious 
anemia (caused by B12 deficiency), lupus (a chronic disease that affects different 
body systems), and celiac disease (a digestive disorder).

Other related autoimmune diseases include Addison’s disease (another hormonal 
disorder), Sjogren’s syndrome (causes dry eyes and dry mouth), rheumatoid arthritis 
(long-term joint inflammation), and autoimmune hepatitis (an autoimmune disease 
of the liver). If you have Hashimoto’s and one of these, well, now you know why.

Sometimes you don’t have to be the one with the autoimmune disease to have a 
greater risk of Hashimoto’s disease. People whose family members have thyroid 
disease or other autoimmune diseases are also at greater risk of developing the 
disease.

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Also related to Hashimoto’s are chromosomal disorders. Chromosomes are DNA 
molecules carrying all our genetic information. They’re pretty important and any 
abnormalities with them can affect us widely.

Chromosomal disorders linked to Hashimoto’s disease include Turner syndrome (a 
condition where a woman is missing one X chromosome), Down syndrome (which 
more people may be familiar with), and Kleinfelter syndrome (in which males have 
an extra X chromosome).

How’s your bingo sheet looking? Knocking off any risk factors yet? I’ve got a big 
one coming next.

Did you know that women are seven times more likely to develop Hashimoto’s 
disease than men are? SEVEN. Although the disease can happen in teens and 
young women, it is more common in middle age, between ages forty and sixty, 
especially for men.

Sadly, the risk of Hashimoto’s disease is also increased in women who had thyroid 
issues after having a baby – a condition known as postpartum thyroiditis. While 
the thyroid usually goes back to normal after about 12 – 18 months of delivery, 
these women have a higher risk of later developing Hashimoto’s disease.

As I mentioned in the introduction, I actually had postpartum thyroiditis after the 
birth of my third child. After losing ten kilograms very soon after she was born, I 
first thought I was simply stressed, because I already had two kids, plus a new 
baby to look after.

But, eventually, my thyroid tests showed that my postpartum thyroiditis had caused 
me to become hyperthyroid and you know what happened next.

The thyroid is a pretty interesting gland because it affects different people in a 
variety of ways. Many people with Hashimoto’s disease have symptoms slightly 
different from fellow sufferers.

My point though, is that issues like postpartum thyroiditis, while they may be solved

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in the short-term, might rear their heads again, unfortunately, as Hashimoto’s 
disease.

We’ve talked about genetic factors that increase the risk of developing Hashimoto’s 
disease, but if you remember, I mentioned another set of relevant factors – 
environmental.

Environmental factors which can trigger the condition include high iodine 
intake, selenium (a mineral we need for our bodies) deficiency, medications like 
amiodarone, which I mentioned before and even lithium (used by patients with 
bipolar disorder).

Some infectious diseases may also increase the risk of Hashimoto’s disease.

It’s important to remember that these factors won’t give just anybody Hashimoto’s 
disease. They trigger the disease mostly in people who are already genetically 
prone to it. They just combine forces with our genes to decide whether or not we 
get this disease.

I’m Pregnant. Could I Still Have 
Hashimoto’s Disease?

Pregnancy in general causes many changes to your body and hormones and these 
can affect the way your thyroid works.

First off, the thyroid gland can increase in size during pregnancy, which we call a 
goiter, although this is more common in areas with a lack of iodine. In countries 
like New Zealand where I live, we lack iodine, so goiters and thyroid issues as a 
whole can happen more frequently here too.

The main hormone of pregnancy, human chorionic gonadotropin (hCG), the

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hormone that you check for in pregnancy tests and estrogen, the main female 
hormone can affect the thyroid. HCG can increase your thyroid function causing 
you to appear hyperthyroid at the beginning of your pregnancy.

But usually, things should return to normal as you go through your pregnancy. 
Estrogen on the other hand, increases the amount of the proteins that the thyroid 
hormone binds to which basically increases the total thyroid hormone levels in the 
blood. But, the “free” active hormone, that is, not bound to protein usually remains 
normal.

So, despite the changes, in a “normal” pregnancy, all thyroid values - TSH, Free T4 
and Free T3 – are within normal range throughout the pregnancy.

Still, hypothyroidism can occur in pregnancy either as a first time show of 
Hashimoto’s disease, in a woman who already had hypothyroidism, but wasn’t 
properly treated or in a woman who was hyperthyroid and was overtreated.

Hormones are quite the balancing act, aren’t they? Whew.

What am I saying, in summary? If you’ve already had thyroid issues in the past, be 
vigilant during pregnancy! They can easily come back up because of the changes 
caused by your growing baby.

If you never had any thyroid issues, still exercise caution. You don’t need to live in 
fear, but listen to your body and don’t be shy; ask your doctor lots of questions!

Hashimoto’s disease should be managed in pregnancy, because if not treated, 
hypothyroidism can cause problems for both the mother and the baby. But, don’t 
worry! Thyroid medicines can help prevent problems and are safe to take during 
pregnancy.

Later in this book, we will also discuss more holistic methods of handling thyroid 
issues and Hashimoto’s disease in particular.

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