THE NATUROPATHIC VIEW: FERTILITY AND HYPOTHYROIDISM by Judith Fiore, ND - SPRING 2011

THE NATUROPATHIC VIEW

FERTILITY AND HYPOTHYROIDISM

by Judith Fiore, ND

The thyroid is a small gland, made up of two halves or lobes, which sits on the front of the neck. Its function is to take iodine, found in many foods, and convert it into thyroid hormones. These thyroid hormones are then released into the blood stream and are transported throughout the body where they control metabolism, which is the conversion of oxygen and calories to energy. Every cell in the body depends upon thyroid hormones for regulation of their metabolism, and when there aren’t enough thyroid hormones being produced by the thyroid gland your health and fertility are often compromised.

The hormone that is checked at yearly physical exams is the thyroid stimulating hormone or TSH. TSH is a marker of thyroid activity. If the thyroid gland is underactive, TSH levels will be increased in order for the thyroid gland to increase its function. If you would like to ask your physician about your thyroid, usually the first thing you would look at is your TSH levels.

While men with male factor issues should always have their thyroid function checked to rule out hypothyroidism as a possible cause1, women are much more likely to develop hypothyroidism during their reproductive years.2 If a woman’s TSH levels are high, and she has symptoms of an underactive thyroid, then fertility may be compromised.3 Women with hypothyroidism could have heavy and prolonged menstrual bleeding. Some women experience amenorrhea (no menstrual cycles). Other women may have irregular cycles due to problems with ovulation. With a low functioning thyroid, prolactin levels may increase and inhibit ovulation. In recent years, it has been shown that if a hypothyroid woman does become pregnant, she is more likely to miscarry or experience premature labour or stillbirth.4

Hypothyroidism is also associated with an increased risk of ovarian cysts. Even polycystic ovarian disease, or PCOS, may be linked to hypothyroidism, where irregular cycles or amenorrhea are common.5 PCOS may increase fourfold the risk of having hypothyroidism.

Symptoms of hypothyroidism are due to the decreased rate at which the body is using fats, proteins and carbohydrates. There are many symptoms related to hypothyroidism. Most often fatigue and weight gain are noted. There is usually sensitivity to cold, and the hands and feet never seem to feel warm except in the summer months. Constipation and headaches can also appear. Other possible symptoms are decreased libido (interest in sexual relations), dry skin, and hair loss (often the lateral hairs of the eyebrows will thin). In addition to falling, hair may become dry and brittle. Nails too can become thin and brittle. There can also be a feeling of a lump in the throat, which could be a sign of goitre (enlarged thyroid gland) or the voice could become hoarse and/or deeper. Another concern with hypothyroidism is that cholesterol and triglycerides may increase, and blood vessels can become more permeable resulting in tissue swelling or water retention.6

A Finnish study published in 2000 examined the prevalence of abnormal TSH levels amongst a population of women with fertility issues. The groups that showed the highest (abnormal) levels were women with ovulatory problems, irregular cycles, amenorrhea, and those with unknown causes for their infertility.7

The psychological component of low thyroid function can be depression and a feeling of weakness and fatigue. In fact, these are often the first symptoms. As the disease progresses, a person suffering with hypothyroidism may have difficulty concentrating and be extremely forgetful. As a naturopath, I often ask my patients what their energy levels are like, and whether they feel that their energy and sense of well-being have worsened over the years. For many women dealing with fertility problems and who believe that their energy, mood and ability to concentrate is not what it used to be, it would be important to look into the issue of hypothyroidism. For men, decreased energy and diminished libido may point to an underactive thyroid and should be investigated.

Typically, women are prone to hypothyroidism, and as such should be tested regularly to ensure that their thyroid gland is healthy. A simple blood test to check levels of TSH can indicate whether hypothyroidism is present. I offer a word of caution if your TSH falls within the normal range and yet you have many of the symptoms associated with hypothyroidism: you may be experiencing subclinical hypothyroidism. While not as serious as clinical hypothyroidism, subclinical hypothyroidism can be just as damaging to your attempts at getting pregnant and staying pregnant.8
A simple way to tell whether you are experiencing subclinical hypothyroidism is to check your basal body temperature. This is not a definitive test, but if you find that your basal body temperatures are consistently low, then you may want to consider further testing. You simply take your underarm temperatures upon waking. You must not get out of bed before taking your temperature, and it is important to make as little movement as possible. Women should perform the test on days 2 – 6 of their cycle. Men can perform the test at any time for five consecutive mornings. Basal body temperatures should be between 36.4C (97.6F) and 36.7C (98.2F). If your basal body temperatures are consistently lower than these values, then you may have hypothyroidism.
Although there are pharmacological treatments for overt hypothyroidism, naturopathic medicine can offer help for individuals who are dealing with subclinical hypothyroidism. The naturopathic approach can allow a woman to regain her energy and improve her health, and also allow her fertility to normalize. In this article, I will outline the nutritional approach that would be taken by a naturopathic practitioner. Please keep in mind that the best option is to visit with a naturopath to receive more specific care, especially if you would like to consider other naturopathic treatments.
Iodine: Iodine is necessary for the production of thyroid hormones. A deficiency in iodine causes a deficiency in thyroid hormone production, which often results in the development of hypothyroidism. Supplemental iodine in small doses is beneficial for hypothyroidism, but must be prescribed by your physician or naturopath as there is a risk of exacerbating the hypothyroidism.9,10
Selenium: Selenium is the main cofactor for the enzymes responsible for the thyroid’s metabolic activity, and a deficiency of selenium could cause reduced thyroid function. In one study of children who exhibited symptoms of hypothyroidism, a deficiency of selenium was recognized. After selenium supplementation, hormone levels returned to normal and symptoms disappeared.11
Zinc: The exact role of zinc in thyroid hormone metabolism is not completely understood, though it is viewed as a necessary component for proper thyroid function. In one study, zinc supplementation for 12 months was correlated with normalized thyroid hormone levels in the blood of all participants, 75% of whom had been found to be deficient in zinc.12
Vitamin B12: The exact role of Vitamin B12 in thyroid hormone metabolism is not fully understood. It is believed to play a role in the metabolism of the thyroid hormones.13
Folic Acid and Vitamin B6: Folic acid and Vitamin B6 are involved in homocysteine metabolism with Vitamin B12. High homocysteine levels have been linked to cardiovascular disease. To correct the increased homocysteine levels found in hypothyroid patients, supplementation with folic acid and Vitamin B6 may be needed. A deficiency of folic acid in individuals with hypothyroidism has also been reported in the scientific literature.14
Nutrition

One type of food that should be limited in the diet is the goitrogenic foods. The reason for this is that goitrogens can induce an iodine deficiency by combining with the iodine and preventing its uptake by the thyroid. Thyroid hormones are made from iodine, and without adequate levels the thyroid gland cannot function properly. Goitrogenic foods include brassica family foods (such as turnips, cabbage, rutabagas, and radishes), as well as cassava root, soybeans, peanuts, pine nuts, and millet. Cooking these foods, however, breaks down their goitrogenic constituents.

It is also important to eat foods that are good sources of iodine. These include sea fish, sea vegetables (arame, kelp, dulse, nori, wakame, kombu), and iodized salt. Of these, kelp is the most commonly consumed sea vegetable. A prime source of iodine, it is often sold in health food stores and the natural foods section of larger grocery stores. It has been used therapeutically for thousands of years, especially in Traditional Chinese Medicine.15

A word of caution: when purchasing kelp as a therapeutic supplement, always make sure that the kelp used is sourced by a reputable and trusted company, and that the kelp has been harvested only from uncontaminated areas and screened for the presence of toxins and contaminants like industrial waste, lead, or mercury.

Foods that are high in zinc and therefore helpful to thyroid function are seafood, beef, oatmeal, chicken, liver, spinach, nuts, and seeds. B vitamins also have a role to play in the normal manufacture of thyroid hormones, and the best sources are yeast, whole grains, and liver. If possible, it is best to buy organically grown foods since soil levels with organic foods tend to be higher in trace minerals important for a healthy thyroid.

The Final Word

There can be a great deal of confusion when it comes to determining whether your fertility problems may be related to hypothyroidism. It is estimated that between 10 and 20 percent of the population is hypothyroid, even though their TSH levels are in the normal range. Therefore, they are not eligible for medical treatment.

If you are dealing with low energy, thinning hair, dry skin, weight gain, sensitivity to cold, and difficulty concentrating, I would urge you to seek help with a naturopathic doctor. NDs are well trained in the nutritional therapies that have been discussed in this article. We also offer other therapies that have been shown to help those with subclinical hypothyroidism to turn the corner and feel well again, and hopefully improve fertility as well.

All references are listed on the IAAC website at iaac.ca/content/library

About the author
Judith Fiore, ND, is a registered naturopathic doctor who practices in downtown Toronto, in close proximity to TCART, Create, Mount Sinai Reproductive Biology Unit, and Life Quest fertility clinics, and she also practices at a second location in Mississauga. She is dedicated to providing naturopathic care (nutrition, acupuncture, IV vitamin and mineral therapy, etc.) to individuals and couples with fertility issues. She can be reached at 416-231-4477, or through her website: www.naturalfertility.ca.