#101 Post Partum Thyroid Issues with Dr. Christine Maren

postpartum thyroiditis and Hashimoto's, rather, there's a lot of overlap there. And so it's like, you know, it might be that some of the people who have postpartum thyroiditis actually had some underlying Hashimoto's that we just didn't know about, because nobody checked their approximate thyroid glabialin antibodies before getting pregnant, which is pretty common. Welcome to the Lest Stress Life Podcast, where our only priority is providing those aha moments to uplevel your life, health, and happiness. Your host, integrative dietitian nutritionist, Krista Bigler, helps health-conscious women reduce the stress and confusion around food, fatigue, digestive and skin issues at LestRastnutrition.com. Now onto the show. While most of us think about taking a prenatal vitamin during pregnancy, taking one both postpartum and starting one of the moment you are thinking about conceiving as just as important. Before pregnancy, the quality of your egg health can be influenced at least three months before conception, affecting fertility, and nutrients are doing much of this egg health work. Nutrition needs postpartum are often increased, especially if mom is pumping or breastfeeding, plus taking on the stresses of a new baby at home. All of these things are highly dependent on nutrients and you can feel better when you go beyond a lotus prenatal or gummy that isn't really meeting your needs for all these stages of change in your body. Full circle prenatal was developed as a two-year labor of love by my friend, mentor and colleague, Ella Barmer, a highly trained integrative dietician nutritionist, specializing in women's health and fertility. She took special care and sourcing the best quality nutrients and evidence-based quantities to truly give you the best bang for your buck and a comprehensive prenatal. Specifically, she ensures that there's a great amount of one of my favorite underrated nutrients, colon, which is essential for skin, brain, and liver health, but intake is often inadequate in over 90% of pregnant women. Other prenatal vitamins often undercut magnesium and calcium as well because of their large size in a supplement. But this compromises your dental and bone health needs while creating a baby or feeding one and not having enough magnesium can also lead to a cascade of issues with sleep, the nervous system, and even digestive problems. There is no other prenatal on the market, like full circle prenatal, and I'm proud to welcome this company of integrity as a sponsor for the Less Stress Life podcast. You can use the discount code LessStress to check out for 15% off fullcircleprenatal at fullcircleprenatal.com, and you can find all discount codes and links for everything mentioned in the podcast over at christabiggler.com/shop. Okay, today on the Less Stress Life, we have a very lovely doctor with us today, Dr. Christine Marin, who is an osteopathetic physician and the founder of a functional medicine practice in Colorado, Michigan, and Texas. She's also the co-founder of Hey Mommy, an online resource to help women navigate a healthy and happy momy hood. She was introduced to functional medicine after struggling with pregnancy complication and recurrent miscarriages. A functional medicine approach helped her address underlying health issues associated with gut infections, food sensitivities, type of thyroidism, hormone imbalance, and mold exposure. Now she's a mother of three, and she's devoted to her professional life, helping other women optimize their health during pregnancy, thrive in their postpartum, time, and get their life back. Just such a voice that we need to hear more of about postpartum health. So Dr. Marin is board certified in family medicine, and is an institute for functional medicine certified practitioner. Welcome, Dr. Marin. - Thank you. So glad to be here. - Yeah, so we met at an event. It was after a hormone conference. You weren't there for the hormone conference. We were in Portland, and we got to meet in person, which is such a lovely way to meet, but she's really a neighbor over in Denver, although practices virtually in a few different states. So if people want to see Dr. Marin, they can do that. And today, we're talking about such an important topic, which is really thyroid issues after people have their babies. Let's talk about your story a little bit first because it's really how this all started, right? So tell me a little bit more about how you got into this area. I know that you have some really specific thyroid family history as well. - Yeah, I do sure have some thyroid specific family history. Going way back, one of my sisters actually is Hashimoto's, and the other sister has grave. I have hypothyroidism. Has to every other woman in my family. So it's unfortunately very common among females, as you probably know, and I tend to have a specific passion for it just because it kind of affects everybody. That's really close to me. But my story really kind of goes back to pregnancy complications. That's really what sent me down sort of the rabbit hole of functional medicine. I really went into medicine actually with a very holistic mindset, which is part of the reason I went to osteopathic medical school. My mission was always to be a more holistic minded physician. And I wasn't introduced to functional medicine until I started having issues with pregnancy complications specifically, pregnancy loss. So I had my first daughter and I had gestational diabetes. That's really when I delve into nutrition. I knew that it didn't make any sense that my blood sugar was high, because I didn't have the risk factors. And I knew that the conventional dietary advice surrounding gestational diabetes was kind of crazy. So I really took a dive into nutrition at that point. It was like checking my blood sugar four times a day and really became a tune to carbohydrates. And with those did to my blood sugar and different types of carbs and all that. But it wasn't until years later when my husband and I tried for our second baby that I experienced recurrent pregnancy loss. And at that point, I really like went down the functional medicine path and went through all the things. So thyroid and hormone balancing and gut and environmental toxins and mold exposure. And all of those things became relevant in my life and took me a couple of years to get my health back. I mean, I'm still on that path. You know, I still every day do things for my health. And it's a big focus of mine. But yeah, I mean, sort of my professional and my personal lives collided at that point. And I knew that functional medicine was not only the path I needed for my health, but the way it could best help other people. So it was a really kind of almost, I would say it's, I think it's appropriate to say it was a traumatic experience. What led you down that path, really? And you said, so I guess my question is for you off the bat is after you had your first baby, how was your thyroid? Did you already have a suppressed or hypothyroid prior to pregnancy? No, I actually didn't know enough at that time. I don't know. I think it was probably suboptimal thyroid function, but I don't know. I mean, my TSH was normal. It was on my radar because my sister's both had autoimmune thyroid disease. And so I would have my TSH checked and my TSH was within a normal range. But as we'll talk about, I'm sure, and a bit that doesn't always mean a lot. So that time it was normal-ish, but later on, I mean, thyroid medication changed my life overnight. So yeah, I don't know. I don't know how long it was really going on for me, that it was suboptimal thyroid function. I do not have overt autoimmune thyroid disease. So yeah, it's a little more subtle, but life-changing nonetheless. Yeah, I would agree that I always encourage people if you need, like, you really should just have your thyroid checked appropriately, because if you are not, if you need thyroid medication and you're not on it, it is more dangerous to not be on it, right? So people should not feel guilty about that. Even if they're trying not to medocate that much, that's definitely not something to feel guilty about. So something I was surprised to learn many years ago was I asked my oldest best friend, who was a pharmacist about the most commonly prescribed drugs. And she said thyroid medicine was number one. And I wasn't expecting that because I worked in more diabetes type care at that time. And so when you're surrounded by something, you think that that's the most common thing. I still think I'm jaded in the world. Yeah, I still feel like the things I'm addressing now are very, very common. And so do you know much about prevalence of thyroid disease? And it's totally fine if you don't. And then let's talk about that whole testing, because just testing TSH is certainly not a comprehensive way to assess total thyroid function. Right. Yeah, I don't know. I can't tell you off the bat, like what the prevalence is. Avert thyroid disease and of thyroid disease among females and then of Hashimoto's. We know that the most common cause of overt hypothyroidism is autoimmune, which is Hashimoto's. But I don't know the numbers. Well, we should probably define them as well before we were in talk about testing a little bit, because we're throwing these around. So hypothyroidism is, I'm going to let you define hypothyroidism and then the difference between Hashimoto's and Graves. Yeah. Okay. So hypothyroidism from a conventional standpoint, when we think of people who have overt hypothyroidism, what that means is that their TSH falls outside of a normal reference range. And the TSH goes high. TSH is like your brains. We have of trying to stimulate your thyroid to make hormones. So when that TSH is high, it's our picture into seeing that your brain is like telling your thyroid, I need more hormone. And so with somebody who has a overt hypothyroidism, we see a high TSH in a low free T4. Somebody who has subclinical hypothyroidism, that's another definition in conventional medicine, something I was taught in residency. So subclinical hypothyroidism would be somebody with a TSH outside of the normal reference range, but a normal T4. So T4 is the hormone that your thyroid gives off. And so then people with subclinical hypothyroidism, generally people just sort of watch them until they become overtly hypothyroid and are really struggling, and then Medicaid after that. And most of those people go on to develop over hypothyroidism. And then I keep saying this suboptimal thyroid function, suboptimal thyroid function is really more of like a functional medicine definition. That is when your TSH might be in the normal reference range, but it's not in the optimal range. It's outside of that optimal range, and that can make a big difference for people. There's a lot of controversy around that range. And there's some literature which supports making that range more narrow, but ultimately it hasn't been made more narrow, except for purposes of fertility. So there's research looking at people who are trying to get pregnant, and that a tighter reference range is needed for fertility purposes. But basically unless you're trying to get pregnant, like that reference range is pretty broad. Okay, let's talk about what the reference range is conventionally, and then if we're looking at suboptimal hypothyroidism, how do we get pregnant? What is the reference range change for? - Yeah, so okay, so if you are looking at a conventional lab, or you're looking at your cluster lab for lab, the reference range for TSH is generally about 0.5 to 4.5. It might be off by a couple of points depending on the lab, but somewhere in between there, I say an optimal reference range is more like 1 to 2 if not closer to 1, or maybe just a little below 1. So generally you want your TSH around 1. If it's 2 1/2 or 3 1/2, even though it won't be flagged as abnormal in the lab, you might have, and then when we get to 3T4, and then the other components of a full thyroid panel, the optimal reference range changes a lot. So 3T4, when you're in a conventional lab, the lower limit of the reference range is 0.8, and the upper limit, I'm gonna need to pull up some labs, but I think it's like 1.6 or so, you need to 1.8. I usually, you know, 3T4, my optimal range is like 1.1 to 1.4. So what does it feel like when someone has hypothyroid or underactive thyroid? - Yeah, so there's a lot of different symptoms. Generally the TG feeling exhausted, feeling cold to the bone, that's like that chill where you just can't warm up. Thinning of the outer third of the eyebrows, thinning our dry hair, dry cracking skin, sometimes constipation, doesn't always have to be constipation though. Sometimes people experience other kinds of digestive issues, because the thyroid also guides the metabolism of the viscera, basically meaning like your digestive organs, the motility is a factor, but also the way that they express digestive enzymes and file and things like that. There could also be sort of like mysterious skin conditions and rashes that come up, sometimes brain fog, some people are more sensitive to the effects of low thyroid on mood, and so they'll experience either depression and/or anxiety, low libido could be an issue, and then metabolism. So either weight gain or just the inability to lose weight, but accompanied with that also, there could be issues with blood sugar or issues with high cholesterol. What else? I see sometimes people will have like muscle pain, goes along with sleep issues sometimes, mood swings, periods is a big one. So menstrual cycle, if that's your regular, a lot of times thyroid could potentially be a component, and then low heart rate is another one, and low body temperature. Yeah, it's a big mess, right? - Yeah, it's a big net in general, because these symptoms of course, as usual, overlap into other things as well, but there are some like, I think some of these, we kind of feel like are a little bit more dead rigor, sort of kind of, you know, that then dried hair and the kind of fatigue and kind of cold. I feel like those are really common things that you hear a lot about. So what normally happens, I feel like, or this is what I see, is people have a TSH checked, and if that's abnormal, then maybe you get your other thyroid labs checked, how do you feel about that approach? - Yeah, so normally some doctors will order a TSH with reflex, and what that means is that they draw a TSH, and if it's outside of the reference range, then the lab will reflex to draw a free T4. Generally in conventional medicine, free T3 and reverse T3 is not regularly checked, nor are thyroid antibodies, like thyroid proxidase and thyroid glibuline. I don't think I ever answered your question earlier about Hashimoto's, but we'll get into that. But, you know, there's autoimmune conditions of the thyroid, Hashimoto's, there's also graves, but those will produce the antibody against the thyroid. So like if you do a full thyroid panel, those are nice to have, but generally what's checked is a TSH, and then if you go to your doctor and your TSH is abnormal, and they haven't reflexed to a free T4, they might and draw a free T4. But that's usually about as far as they go. - This is tricky because some people have a normal TSH, and then they have very abnormal thyroid antibodies, and so it's very hard to get to that point, right? People have to fight to get to there, right? That happens. - Yep. - Let's talk about what's going on with antibodies. What is an antibody, and what's going on to Hashimoto's engraves then? - Yeah, so with autoimmune thyroid disease, basically with autoimmunity, it's your body's immune system attacking your own tissues. So it's like an aberrant immune response. Hashimoto's is a very common one among females. Graves is less common. Hashimoto's generally presents with low thyroid function over time, whereas grave the opposite. Graves is making usually thyroid receptor antibodies and somebody's hyperthyroid. So that's like the opposite symptoms where hyperthyroidism will be anxious and fast, heart rate, losing much weight, sweaty, and all those kinds of things. So their metabolism's way revved up. Hashimoto's is much more common, and causes more of the symptoms we're talking about today with the hypothyroid type picture. - Yeah. - Okay, and it's interesting that you get to have just a little bit of everything in your family. - I know. - So you guys are just kind of interesting. - Uh-huh. - Yeah. - Okay, so I think we've kind of been walking around this topic, but so why is it that thyroid issues really go untreated so often? - Yeah, well, I mean, because the full thyroid panel is not checked, and so I can't tell you how many women I've seen and men who have had symptoms for a year or so, and they've said to me, I know something's wrong. They keep telling me I'm fine. And this isn't to like put down other physicians because I think that physicians are really intelligent. They train for a heck of a long time, but unfortunately with the current medical model, it limits their time with patients, and also sometimes limits what they're allowed to order. - Right, it's interesting. - So it comes with, yeah, I mean, they don't like people to order a lot of labs. And I will tell you, I have cash pay rates through Quest. Freeti3 is like 20 bucks. I mean, it's not super expensive, but that is sort of the paradigm is to like save money and be cost-conscious, and you know, there might be a time and place for that, but I don't think that thyroid is one of them anyhow. You know, in residency or in medical training, they're not really taught that if there's an autoimmune condition of the thyroid, it doesn't matter. You're still gonna treat it with synthroid. So they don't necessarily test for those autoimmune markers. So somebody might know that they're high blood thyroid, but they have no idea if it's their high blood thyroid because they have environmental toxins or iodine deficiency, or if they're high blood thyroid, because they actually have an autoimmune condition. In my world, as a functional medicine doctor, that makes a big difference because if somebody has autoimmunity, I treat that differently. I have a specific approach for that, but in conventional medicine, it's just not in their toolbox. It's not the thing they do. And so, you know, when a normal doctor orders a TSH and a TSH is in this what's called normal range, which is way too wide to begin with, a lot of thyroid patients get missed, and it just becomes sort of a bit of a tragedy for some people who lived for 10 years with sub-optimal thyroid function and are depressed or think they have postpartum depression or whatever other thing, there might be on statins for their cholesterol when really we could just address the thyroid issue. - Yeah, that's a great point because that one, definitely, I don't hear people talk about that one as much, about kind of bandaging the side effects in terms of cholesterol, which is definitely problematic. And I 100% agree with you that when it's autoimmune thyroid issues, that's a very different ballpark of like what the strategy and the linear approach that you're gonna take with someone versus just hypothyroidism. So, not that it's just type of thyroidism. So we're talking specifically about, we can wrap this two ways. We're gonna talk about postbabies, why people develop hypothyroidism. In general, and we may have already addressed this, in general, what do you think causes hypothyroidism? And how is that different when you are postpartum? - Okay, so in general, I think there's kind of two schools of thought, well not really, well like two big buckets. So number one would be autoimmune thyroid disease like Hashimoto's. So Hashimoto's itself is not a thyroid problem. That's an immune problem. But over time, it causes thyroid destruction and causes the thyroid to underproduce hormone. And so that is one very common cause, especially when you see overt hypothyroidism. When it's more suboptimal, I think a lot of it is related to environmental toxins. Our thyroid is like a magnet for toxins and to nutrient deficiencies. So some of those toxins and/or nutrient deficiencies or the combination of both, will make your thyroid underperformed. So your thyroid needs and relies on specific nutrients in order to make hormones. So one of those nutrients is iodine. We know that iodine has been deficient for a long time. That's why we started iodizing salt. I believe it was in the 50s, but we've sort of stopped eating iodized salt and many of us are still iodine deficient. Iodine is a pretty controversial one. So it's like two little or two much is both problematic for the thyroid. But nonetheless, we needed at least some iodine to make thyroid hormones. So T4 is made of, there's four iodine molecules there and then you strip one and make T3. So we need iodine, but there's other environmental toxins that are very common in our life, which resemble iodine. They're right next to it on the periodic table and they'll kick iodine off the thyroid when you're exposed to a lot of it. So that's things like chlorine or chloride, fluorine or fluoride, bromine or bromide. So if we get exposed to those things and we do every day, that sort of compounds the issue with like iodine deficiency, halide dominance and then let's tack on some heavy metals, right? So heavy metals will play a part two when it comes to thyroid function because they can inhibit the conversion between T4 and T3 and also they can affect the production of thyroid hormone. - Cool, I love how like sitting on a couch, you described that, you're like, you know what, they just kick it off. If one comes in, they just kick one off and they start to cause problems and I'm like, that is fantastic. I love the way you described that, very good. - I should do some sort of thing on a couch with that. 'Cause that's a good, I like that. - It's just very comfortable. - It's very comfortable. Like, hey, you know, like, see ya. (laughs) Don't need you, see ya. - Don't need you right now. - For it's here. - Yeah, exactly. Like, got this other friend that showed up. So iodine and you've talked about the other things that affect that, but what are some other nutrients that play a role? Yeah, so thank you. for bringing that up. So Ida and Zvig1, Iarn, tyrosine, tyrosine's actually an amino acid, zinc and selenium are big ones. Certain other vitamins like vitamin E, B2, B3, B6, vitamin C, vitamin D, even plays a role. And then vitamin A is a big one too. Vitamin A actually can improve the cellular sensitivity to thyroid hormone. - So Iarn could be tested. It's not too hard to get some Bs and Cs and A, not commonly at the doctor. But are these things that you check for completely or are you only checking for some of these because there's not a lot of companies that do micronutrient testing to be quite honest. I'm actually surprised at how little options they're offer this. - Yeah, I check these through Quest or through LabCorp. So I check a vitamin A, I check a vitamin D in the serum. Sometimes they'll do an RBC selenium and/or an RBC zinc. Sometimes in the serum, I'll check these. Depends, I prefer to do functional medicine testing. So I do organic acid testing, which isn't in the urine, to pick up on a lot of the B vitamins. But one of the markers I look at in blood is called homocysteine. And so homocysteine's sort of a functional marker of B2, B6, B12, B8, and Colleen. So homocysteines one way. Sometimes I'll check B2 or B6 in the serum as well, depending on what functional medicine that I'm putting patients doing. So yeah, I do check a lot of nutrients. It's a lot of blood work though. Like every RBC nutrient you order is its own tube of blood. And so they add up. - Right. And as you mentioned, homocysteine there, which is kind of just a flag for some other ones, is actually a little bit more of a common one that is tested for inflammatory markers. - Yeah. - Okay, so what you're talking about in general causes of hypothyroidism. Now let's talk about what happens postpartum specifically. - Oh yeah. - Oh yeah, they may be like very much overlapped a little bit, but what happens specifically postpartum? - Yeah, so postpartum is this, well, number one, you got a lot of nutrient deficiency postpartum. You've gone through pregnancy and then you're nursing. And so that is one factor, compounded with stress. There's a lot of stress, we're not sleeping or we're trying to learn how to take care of a baby and we're up every two hours breastfeeding or whatever. So I think those all play a role, but also postpartum thyroiditis. So postpartum thyroiditis is an interesting one. It's like an inflammatory autoimmune condition that happens specifically in the postpartum timeframe with thyroid antibody, so either thyroid peroxidase or thyroid globulin. And it must happen in that first year postpartum. So by definition, it excludes women who did not have overhybrid disease prior to getting pregnant. So somebody who has known Hashimoto's or known over thyroid disease prior to pregnancy, we don't call that postpartum thyroiditis, but it's really common. Like postpartum thyroiditis and Hashimoto's rather, there's a lot of overlap there. And so it's like, it might be that some of the people who have postpartum thyroiditis actually had some underlying Hashimoto's that we just didn't know about because nobody checked their proxidase and thyroid globulin antibodies before getting pregnant, which is pretty common. I would say the role. Now postpartum thyroiditis, they said earlier, was common, that's not necessarily true. It depends what you read. I think, I mean, I have read statistics anywhere from like 3% to like, I think the higher one was either 12 or 15%. Don't quote me on that, but the prevalence is kind of all over the map. I'm not sure what it is, but it can be a pretty hard thing to go through on top of an already hard time. You know, you're trying to like nourish your baby, and it classically, it starts with this transient hyper thyroid state. So somebody might be like, really anxious, and like, ravenous and super hungry, and their metabolism like crazy, and they lose all their baby weight. And then weeks later, it goes into this transient hypothyroid state where they're like, just dragging and exhausted. And it can be confusing because we have so many other things we're dealing with postpartum as a new mommy. You know, you're dealing with all these other sorts of symptoms that you don't know, you know, what's thyroid and what's just like the stress of being a new mom. So I actually, it's the most part of thyroiditis, it resolves. It actually didn't know that postpartum thyroiditis was its like, oh, unique diagnosis. Mm-hmm. It sounds like it just like fits under one of the other ones, you know? So it knows its own code. Like, hey, no, you were specific, and you're just supposed to hang out here for a little bit. I feel like this could easily get missed all the time, because one, as a new mom, you are like, well, I'm supposed to be tired. And I mean, that makes sense. That makes sense of it, right? Like, you're not sleeping. I mean, there's just so many things. It's like, oh, everything is broken right now. And I'm like, it will slowly come back together. And so I cannot imagine how complicate. And really, if people find out they have this, who knows what kind of tools, if any, they would be equipped with, I guess, to manage it. Like, how did you become kind of passionate about postpartum thyroiditis? I think that will help uncover. Yeah, well, I'm just passionate about helping women who are postpartum, because I think women in this postpartum timeframe are really forgotten about. It's like, you have a baby, and then you're just sort of like, that's it. Good luck. Let me see the baby. Good luck with that, you know? So I am passionate about helping women in that stage of life, because I think we deserve it. And we don't have a lot of help there. Our village is sort of gone. I mean, honestly, even ACOG, so the American College of Obstetrics and Gynecology issued a new statement. I don't know. I think it was in 2017, maybe 2018, calling for better care after baby is delivered. But insurance companies don't reimburse for that. So it's really like it's an uphill battle at this point, like redefining what postpartum care really looks like. But, you know, in this postpartum timeframe, generally, I find that a lot of women are experiencing symptoms that are hard to deal with. And they're often ignored, because they're postpartum. You had a baby, you're fine. It's 'cause you're tired, you haven't slept, you're nursing, you'll be fine, wait a year. Yeah, I couldn't resonate with more with it. I don't even know what to say about it, because it's a channel, either before this episode or right after this episode, there's one all about, it's called Beyond the Kegel, all about pelvic floor dysfunction. And so, and we talk, of course, about the same thing where we need such better. Like this is pelvic floor dysfunction and diocese is recti and just like the muscle, like everything is going unnoticed, untreated, maybe for years, because no one really gets follow-up care. And that's like, I mean, I feel like that's as important, if not more important, postpartum, than some of the care. Of course, all the prenatal care is very, very important. And really, before anyone is pregnant is really important. We know that, but man, it just does not stop. You need so much postpartum. You need more support if anything. I don't even know how else to summarize it, 'cause there's so many bullet points that go underneath of it, if for anyone. I know. And I feel like, to, you know, your postpartum and your home with your baby, it's like, you're just not, sometimes it's just that women aren't even thinking of themselves. You know, they're like, whatever, I just gotta take care of this baby and like get through it. So unless things are really bad, generally they're not necessarily even seeking care. And then it's like, who do you go to? You're OB to deliver to you, but they're sort of like, well, you know, see ya. I mean, they are their postpartum care, but, you know. - Go on, I wish. - I wish. - Yeah, people has been accomplished. Now, you know, so that's where I love virtual meta-things. I'm like, nurse your baby, talks me through the camera and we will figure this out. - Well, and that is the thing. I mean, you've now gone to the doctor every week. This last month, I think that's what it is. It's been a while for me. I don't even know anymore. It's like every month, it's every couple weeks, then it's every week at the very end. It's like the last thing you wanted to just go back in and be like, I think something's wrong, but I don't know what it is because we've all been there. We're like, okay, you know, we don't have to talk about that necessarily, but I guess my question for you is, is there really a postpartum protocol? I mean, we see someone six weeks later, what are the things that are supposed to be checked for? And then there's really nothing else after that. There's really no other, I mean, Acog may have said, like, hey, we should have better postnatal care, but didn't really provide any guidelines around it. It's like the first step that will take many, many, many years before something changes. I mean, truly that works. - Yeah, I mean, honestly, Acog has guidance. It's just a matter of implementing it and what that ought to look like. And actually, in some of their guidance, they've talked about implementing virtual like telemedicine visits and that your two week visit doesn't need to be in person. It can be over the phone, but it's just a matter of, like, what does that really look like? How do doctors get reimbursed for that time that they spend with patients? That's tricky. So yeah, so the Acog bulletins, it does provide guidance, but as of now, I have a 19-month-old at home, I'm on me a three. So when I had my last baby, you know, I went in at like six weeks and I was like, you're like, okay, good, you're still breathing. So you'll see you next year, right? Like, I mean, it was sort of just a brief sort of thing to make sure you're still kind of alive and it was kind of it. - Yeah. - Were you assessed for this kind of question? - Yes, I was gonna say they did screen. I mean, I think they do a pretty decent job at screening for postpartum depression. I think that OBGYNs are aware of that and compassionate to that for sure. But I also have this whole, what is postpartum depression? I mean, it's a very real thing, but like what's the cause? I think a lot of that is thyroid related in many instances or just nutrient deflation. So yeah. - Makes sense. Well, part of our goal today is to really bring awareness to something where I'm like, hey, I didn't actually know that it was its individual diagnosis. I thought it was under the umbrella of other thyroid conditions or it was like, hey, it just happens afterwards and now you're gonna have this now, essentially. So let's transition to some positive things because we like to be positive because we don't want to just be like, oh crap. - Yeah. - This sucks. So let's talk about a success story, either with postpartum thyroiditis. Can you share a story about like Hashimoto's, which is common? - Yeah. - Let's talk about remission and eliminating these issues if or some. - Yes, I just encourage anybody who has Hashimoto's that remission is a real thing and it is completely possible and I see it often. So one of the things that I do in my clinical practice is obviously I check, you know, I check a full thyroid panel. So what that means is TSH3T4, 3T3, reverse T3, thyroid proxies, thyroid globulin antibodies. So like those six labs I check, my thyroid pain will pretty much all my new patients as well because I want to catch any of these things that might kind of go under the radar. So one patient, I am thinking of in particular she came to me wanting to get pregnant. She had a history of recurrent pregnancy loss and she just wanted to make sure that she was doing everything she could to improve her chances of having a healthy pregnancy and maintaining a healthy pregnancy. So anyways we found that she had Hashimoto's. Her thyroid function was really not terrible. It was like you were to look at her CSH. It was still within her reference range but by fertility standards it was above the range that we would want. I think it was around 3.5. So we started her on thyroid medication and her case she was on armor. Armor is like a natural-descrated thyroid that's a combination of T4 and T3. But the point is is every time I see patients or at least every three months who have Hashimoto's I'm checking their thyroid antibodies. Even in like integrative medicine conferences that her people say it doesn't matter. Like when you check it once you know they have Hashimoto's it doesn't matter what it's going to be but I just disagree with that because what tells me I'm going in the right direction and my patient we're working together in the right direction is like I see their antibodies decreasing and there is a trend a downward trend and sometimes that can go away like three months. Sometimes it takes a lot longer. I mean I have a number of patients where you know maybe their TPO antibodies were like 700 we got them down to 200 but they're really like halted and can't go away. But this particular patient I'm talking about went from antibodies of like 350 down to 290 down to 200 down to 160 down to 130 and so on. So every time I saw her they decreased and now she's been in remission for years she had a healthy baby she just had her baby recently. But I just want to really sort of give encouragement to those people who have Hashimoto's that there is a way to put that into remission. But like we're talking all about thyroid now in this particular interview but like this is a whole other thing right this is like this is immune system stuff. So when we're talking about autoimmune stuff the approaches really like yes there's a genetic predisposition but there's an environmental trigger and there is some sort of like intestinal permeability leaky gut that's going on. And so with this particular patient really we just focused on her gut you know I work on all the environmental stuff too which is stuff you want to do whenever you're getting pregnant everybody should be working toward it right but like especially during pregnancy where you're eliminating the chemicals in your homes and things like that. So we worked on the environmental stuff but there was nothing super major like mold exposure in her case really what we did was we worked on her underlying digestive issues and you know over time like her food sensitivities improved and her autoimmune markers went down. Yeah and by the way these don't always present as digestive issues right so that's the annoying part. And that's the tricky part with people they're like I don't have any digestive issues like well Hashimoto's is really related to gut issues so I think we should still check this out but that's usually the situation. So I know I said we wanted to go positive and we will finish on a positive note but I forgot two things that I think are important. What is the mechanism? What do you think is going on with thyroid conditions that causes or creates a miscarriage? Yeah so that is a good question one I need to like really read about to be able to give you a super schooled answer but a piece of it is that the fetus so when you get pregnant you have a lot of hormone happening and when you have more estrogen on board you also make a lot more something called sex hormone binding glatulin. As you make more sex hormone binding glatulin that bind up free hormone which therefore means you're free T4 and you're free T3 are lower and so that plays a role. Baby's brain development relies very heavily on T4 specifically more so than T3 so that probably plays a role when there's an immune component like Hashimoto's. That probably plays a role as well like there's a lot of immune system kind of dysfunction that can happen around recurrent pregnancy loss. Yeah I don't know do you have anything else to add? I don't really have anything else to add. I just thought well hey it was part of the stories and it came up with your case study as well and I thought you know we should just talk about it a little bit and I think it's reasonable that you don't have like there is no one answer there probably and just like with fertility it's like well your body has got some stuff going on shunting resources away from this because it doesn't think that it's working you know like your body is trying to protect you typically. Yeah always yeah and I do want to say to like for so for women who are on thyroid medication we know in conventional medicine like as soon as you get pregnant your thyroid myths need to be increased usually by like 25% because of that affects on the lighting glybulin so we know that pregnant women require a higher dose of thyroid medication. Yeah it's good to have a really solid relationship with any provider that you have and this is like why would you know that otherwise right and so yeah it's great to have a great provider. Something that we also did not discuss very much is we were talking about postpartum and how people have nutrient efficiencies and stress is increased but I really like to say like oh it's not just I like to talk about the physiology that's going on a stress. Yeah. What's the physiology that's happening with increased stress that is creating the cascade of thyroid issues. Okay so your HPA access refers to when we talked about earlier the TSH that comes from your so hypothalamus and pituitary HP and then A is adrenals which said to top your kidney but it's HPATG so hypothalamus, pituitary adrenal, T is thyroid, G is gonans or ovaries so that whole access can be very sensitive to stress and so there can be HP access dysfunction which plays a role with all of this and it's also the reason why thyroid and hormones and adrenals are all linked. Yeah totally I love it that was good enough for me and so hypothalamus pituitary adrenal access also linking into communication between thyroid and gonans so TG not to be confused with thyroid globulon antibody switch. Yeah, I should have said this before. I know people were like madly scribbling because we've had this conversation with other people or like in other settings not even on the podcast where people are like oh I was scribbling those out really quickly I'm like okay I've got notes I'll put them in the show notes okay this is what you test for the thyroid panel and it's what to ask for. So finally let's end on some other positive notes. We talked about a lot of things wonderful interview. Look forward to having you back but if someone is hearing this and they're like oh crap like I feel like that was me and or whatever like what is your gut reaction pen intended if someone was like gosh this woman's talking to me what would you tell her so her life can be better today or she can move toward awesomeness today like is there is something she can do now. I mean I think get your thyroid tested and if your provider won't do it you can either find a provider who will or you can order it yourself. That becomes a little bit troublesome because they need order yourself and you're like how do I interpret this this is not like this is I'm a doctor I do this for a living like I do it every day right so that can be hard but at the very least you can either find reassurance or find a little bit more confirmation like hey this isn't right so yeah so generally I say you know just find a doctor who's willing to work with you and at the very least they could order a free t4 and a free t3 and some thyroid antibodies. Reverse t3 maybe they want to do that and that's not the end of the world but I'll tell you you make sure your free t3 is in the threes because some people were like get this full thyroid panel and they come to me and they're like I did it and I'm good and I'm like but you're not your free t3 is like 2.4 and the reference range we didn't talk about this earlier but the reference range for free t3 is like really big and it goes down I think it's 2.2 is the lower limit of that reference range but that's really low and people feel pretty terrible with the free t3 of 2.2 so like get your free t3 in the threes if it's in the threes like you're pretty stellar and if you're fatigue then keep finding out why is it iron deficiency is it mitochondrial dysfunction is it hormone imbalance there's other things that can cause similar symptoms and that's why I think testing is such a big deal. Totally and you might hit one roadblock but it's not impossible to do by any means you can get it yourself and you can take it back to your doctor if you'd like or to someone who looks at them and you know you can look at the same set of labs with different eyes and see different things so yeah okay so dr. Christine where can people find you online? So I'm at drkristinemarin.com to maren and you'll find me on instagram at the same so drkristinemarin and also stay tuned for haymommy.com or haymommy.life if you're on instagram because that's gonna have lots of awesome information we have a really really great thyroid article that's gonna kick butt and we'll tell you everything you need to know so we are super excited to launch that very soon and we've been working on a lot behind the scenes as my business partner and I so I'm working with another physician who's an MD 100 carosco so yeah it's gonna be exciting and we really hope we're gonna help lots of women have a healthier and happier mommyhood. I love it and just so people know it's possible this is maybe live when by the time the interview publishes and haymommy is spelled H-E-Y and then it's ma m-i which is yeah a little different than you some people would totally so yeah I do have those handles in the show notes as well so those will be there for you and what a noble cause thank you so much for your diligence and your work in this area because we all know how important and underserved it is and I just really appreciate when people find those areas and take action so thank you so much for sure thank you. 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I'm so thankful to have a product I love as much as Manitoba Milling Flax seed as a sponsor for this episode of the Lestress Life Podcast. For quick access to links and discount codes mentioned in this and all other episodes, check the show notes or go to christebiglar.com/shop. One of the best gifts you could give us at the Lestress Life is your feedback. We are paid in podcast reviews. If you enjoyed this or any other episode, please leave us a review. In the iTunes store or from your podcast app, just search for Lestress Life as if you're not already subscribed. Click on the banana face image, scroll to the bottom where it shows the text of other reviews and write a review. While you're there, hey, make sure you hit subscribe. For Android or Stitcher users, you gotta go to the desktop site and search for Lestress Life and then scroll down to leave a review. Stitcher doesn't load Apple reviews on their site, so if you want, you can leave a review in both places. 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