Everything You Need to Know About Thyroid and Fertility with guest Dr. Christine Maren

(upbeat music) Welcome to the Ag Whisperer Show, a podcast exclusively designed to create more reproductive health awareness and discuss your fertility preservation options. Here's your host, the Harvard Educated Fertility Specialist, Dr. Amy. (upbeat music) - Hi everyone, welcome to the Ag Whisperer Show. I am beyond excited to have thyroid expert, Dr. Christine Marin, on today's show, "Hi Christine." - Hi. - Thank you for joining us today. Fertility and thyroid is something that so many of my patients ask me about. So it is so great that I finally have an expert on my show. - I'm so happy to be here. It's one of my favorite things to talk about. - What? - So tell us, why is it one of your favorite things to talk about? Tell us about you where patients can find you. Tell us more. - Thyroid is just near and dear to my heart. I'm a thyroid patient myself, so is my sister and my other sister and my mom and my mother-in-law and so many other women I know. But besides my family, just so many patients. And really, I see people change their lives and change their family's lives when they get their thyroid treated the right way. I just think it's a big deal in terms of quality of life, really. - So you have a very personal story related to it. But tell us more about why you also went into medicine and what specialty you're in. - Yeah. - Correct. - So that's a blast from the past. I actually was a finance major, a little known fact about me. I graduated from the University of Colorado School of Business. And during that time, I studied abroad in Mexico. And I also did an honors program called Presidents Leadership Class. And both of those things just really instilled in me a sense of service. And as cliche as it sounds, I just really wanted to help people. My goal was just to find a profession where I was really helping people. And I remember sitting in finance class and my friends down next to me and hoping for the newspaper and who's reading about the stock market. And I was like, I could care less about that. And I was actually a group business instructor and I was like reading about health and fitness and nutrition. And I was just really into that. And I just figured out like my, I'm more into the sciences. I started taking a organic ham from a strain. I loved it. Most people dread that class and I loved it. So I just, I did my pre-med studies. I finished my finance degree, but I did my pre-med studies and then went on to med school. But I picked osteopathic school. I was really in this very holistic mindset, just part of my upbringing. I went to undergrad and Boulder and was surrounded by acupuncture and raky and stost like being just in this holistic mindset was just already part of me. But I also had a hormonal struggles myself when I was in college. And the thing that helped me was acupuncture. So I already gravitated to this more sort of holistic path. Yeah. And then where do you practice? I practice in Colorado now, actually in licensed in Colorado, Michigan, in Texas. So I have a virtual practice in all those states. Long story, but I went to med school in Chicago. My husband was a military doctor and we traveled around because of that. But he's that on military now and we're settled in Colorado. I'm back home. That's great. And so you shared a little bit about having a personal connection to the thyroid. Do you also have a personal connection to fertility? That you'd be willing to share? Yeah. Much of my story really started with pregnancy struggles. So in residency, I had my first daughter. My husband and I actually got pregnant pretty easily. But I had a lot of weird complications that were unexpected. I had gestational diabetes, which freaked me out. I really dove into nutrition at that point. I was checking my blood sugar four times a day because I was really determined. I didn't want to go on medications. And I wanted to have a healthy pregnancy. But I also just wondered why what was going on. But you fast forward a couple of years, my husband actually deployed. And he came home and we were on a timeline. I was ready to have my second baby. And it took us a while to get pregnant. Not super long. It was like a four month kind of thing, longer than the first. And then I had a miscarriage. And I just really felt like my intuition told me there's something wrong with me. Something's going on. And it happened again. And at that point, I was like, all right, I got to figure out something's going on with my body. And indeed it was. That was my deep dive into functional medicine and when my professional personal lives collided. And I became a functional medicine patient. I of course saw a fertility doctor who's wonderful. But ultimately my diagnosis was unexplained in fertility. And I felt there's got to be an explanation somewhere. Part of that was definitely related to my thyroid low progesterone. I used progesterone with that second pregnancy and had a son. And I got my health back after that and worked really hard. And I was feeling really good. And I was like, cruise in a long feeling awesome. And then I got surprised. Baby, number three. So she's wonderful. And I love her to death. But it's just that kind of testament to me like I tell my patients when you get your health back often your fertility comes back to. Obviously there's a lot of factors there. But under a lying health is one of them. Yeah, I agree. So let's talk a little bit more about fertility and the thyroid gland. But let's just start off with the basics. Can you just talk to us about the thyroid gland? Yeah. So this thyroid gland is just a gland right near your napkin. It's a really important gland that produces thyroid hormone. Maint thyroid hormone controls a lot of things in our body. When we talk about fertility and hormones, it regulates ovulation. And for hypothyroid, it might not ovulate. It's also important with our period. So people who have a regular periods might have problems with thyroid for that reason. But thyroid also regulates metabolism. So when we think about things like blood sugar, cholesterol, weight, thyroid's in charge of that. Also gut health. They talk about gut health all the time. And thyroid regulates your gut viscera. So your organs, like your intestine-- this is why people with hypothyroidism are often constipated-- but it's telling our body, like, gut motility and digested enzymes and all that kind of thing. It's just a really important glands that I think is under-appreciated sometimes. Yeah. And what are some of the most common thyroid issues that you did mention hypothyroidism? Yeah. What are some other ones? Yeah. So hypothyroidism is the most common. And then the reason for that is Austin Hashimoto's. Which is an autoimmune disease which causes a thyroid condition over time. So Hashimoto's is an immune system problem. But then over time can cause hypothyroidism. Not everybody I see. Some people are overtly hypothyroid and are identified by their primary care doctor because their TSH is very high and it's very obvious. But many people, it's less obvious. Their labs aren't super crazy and they might not be for a decade. But they're still struggling with hypothyroid type symptoms. So sometimes, like I mentioned, that can be autoimmune and it can also be related to different nutrient deficiencies. Iodines actually a player. That's a bit controversial. It is an important nutrient that affects our thyroid function. Yeah. And then what are some of the symptoms of a thyroid disorder? You mentioned sometimes people are struggling. Can you describe the struggles that someone with a thyroid disorder might have? So aside from infertility in irregular periods and constipation, it's like cold intolerance, this feeling of like cold to the bone. Like you can't really warm up. A weight gain resistance. So not everybody with a thyroid disorder is overweight. But sometimes people can't lose weight because they have hypothyroidism, hair loss, thinning hair, thinning of the outer third of the eyebrow, dry skin. Sometimes muscle aches, depression, mood is a big one. Sometimes people also have episodic anxiety. What else? If somebody's wearing like a traceable, like I wear my aura ring and can follow my heart rate. Like you might have a slow heart rate or a low body temperature, which goes along with that cold intolerance. And just this overwhelming feeling of fatigue and exhaustion. So if you're listening to us right now, now is a time to get out a paper and a pen. 'Cause what I want you to do now, Christine, and just talk to us about what test should someone be sure to ask for from their doctors? Yeah, a TSH, that's what you're gonna get. And I would always ask for a free T4 and a free T3. Now, a lot of people are resistant to a free T3, but I'll explain more. But I find that to be really helpful. I also like to look at a reverse T3. And I always order thyroid proxidase and thyroid glibulin antibodies. Because if it is autoimmune in nature, that is a nice thing to know. There's, I have a different approach when it is autoimmune than when it's not. And when residency in my commensual training, I ordered a TSH and then I was taught to sometimes order a TSH with reflex. And that means if the TSH is abnormal, then you'll also get a free T4. But really like normal for a TSH, there's a big gap there. There's 0.5 to 4.5 are the general reference ranges for that. And many would argue that the upper limit of normal might be more like two and a half. - Good. - And I'd love to get into this a little bit in more detail. You mentioned something that I think people will wonder about is what is the difference between if you have the thyroid antibody as versus if you don't when it comes to management of your thyroid? - So this is my approach in functional medicine. Whenever there's an autoimmune disease, there's this triad that we know about. This is research from Alessio Fisano, but basically the triad of autoimmune is a genetic predisposition, environmental trigger, intestinal permeability. So intestinal permeability is a big one. It has to do with gut health. It's often this sort of like leaky gut is like the name that sort of goes around, but you're really looking dive into the scientific literature. It's just about intestinal permeability. And often that's about underlying gut infections and gluten sensitivity. - Great. Thank you. So is there really a connection between thyroid and fertility? - It can someone I know in your personal experience, you felt like there was, but I think so many patients go to their doctors and sometimes they get the eye rule. So tell us more about the facts related to that. - Yeah. When we're talking about the upper limit of normal for TSH, what's established in the literature is foreign a house, but we'll give a little leap when some are trying to get pregnant. And then the upper limit of normal is maybe two and a half, right? So we're like a little bit more strict about it when some you've actually trying to get pregnant. And that's because your thyroid is such a big deal with not only getting pregnant, first of all, ovulating so that you can get pregnant, but also maintaining a healthy pregnancy. Yeah, I think there's a huge deal. And I think that a lot of people who are functionally hypothyroid aren't identified always because if we just look at TSH and we don't see what 3D4 and 3D3 are, those people get missed. We get them very least. You got to ask for TSH, 3D3, 3D4, but know that you want to be in the upper limit of what's considered normal when we talk about 3D4 and 3D3. And in the lower range of what's considered normal when we talk about TSH. So moving forward, I'll be adding 3D3 to my panels because right now I just do TSH and 3D4. So thank you for your advice. And truly, just being in the normal range isn't enough. You want to look at the whole pattern. So being so true and 3D3 is really, it can fluctuate a lot. So check it. Timing is really important. So if you have a patient who is on thyroid medication, if it's leave with a rock scene, I like to check their labs before they take their medication. If it's like armor or some natural desiccated thyroid or even cytomel, which is synthetic T3, I like to take their thyroid labs after they take their medication between four to six hours. But that timing is everything when we're talking about 3D3. Otherwise, it's like all over the map. And it's really hard to know what's going on. But if somebody 3D3 is like 2.5, 2.2, that's way too low. They should be in the threes. It'll feel like they'll feel much better if they're in the threes. Super. Well, I hope this is helping a lot of people right now. And then what is the connection between thyroid and pregnancy? Yeah. So in that first trimester, especially, it's really important to have optimal levels of thyroid function, especially T4. The fetus really means dizzy optimal levels of T4. Not so much T3. So it's a balance. But there's increased rates of miscarriage. And then throughout pregnancy, you can have increased complications like hypopressure, preterm labor, pregnancy loss, basically. And pre-conception, how long should a woman wait to try and conceive? If let's say she's been diagnosed with hypothyroidism, is just making sure your TSH isn't normal enough? Or should there be a period of time where it's normal for a set number of weeks or months before she should try? What is your advice related to that? I would say just get it normalized. If you're switching medication, your TSH is like going all over the place, get on the right dose of medication, find out what your dose is. Because as soon as you get pregnant, you're going to need to increase that dose by 30%. And it's really hard to know what dose to increase by 30%. If you don't even know your dose of baseline. And it's a big deal for a successful pregnancy. And how often do you recommend a woman get her levels checked if she's doing that, signing the right dose for her body? So if she's pregnant, I would do it every four weeks. If she's trying to get pregnant, probably every six. It takes TSH a bit to normalize. So if you switch your thyroid medicine and take it two weeks later, your TSH won't have adjusted yet. The fall weeks at the minimum, probably six weeks. Right. And then what happens postpartum? So after you've delivered a baby, what happens with thyroid function? Yeah. So a lot of different things can affect thyroid function at that point. So number one, I think about is autoimmune. I like to screen all of my patients. I think every woman should really be screen for thyroid conditions postpartum. So auto-neunity is something we know is triggered by pregnancy. That is a huge risk factor is having a baby. And so looking for any sign of Hashimoto's. But the other thing that can happen postpartum, and often this is four months later, but postpartum thyroid I guess. That might not be quite as common, but it's common. It happens. And so somebody like super anxious and they lose all their baby weight and they can't sleep, even though they're super tired. And they're hypothyroid because they have postpartum thyroiditis often. And then they tank and they're so tired. And everybody's like, "Yeah, you're a new mom." Of course you're tired. So we just, we got to be aware of these things. I think in screen and not, I mean, often many of the symptoms of hypothyroidism are the symptoms of pregnancy or being a new mom. Yeah, it's exhausting sometimes. It's tiring, but looking at those labs is simple and it's not super expensive. The other piece that I think about postpartum is just a lot of stress and adrenal than may end. So our HPA axis, that's our hypothalamus, pituitary adrenal thyroid gonad, HPA TG. Access can really be influenced when we're waking up every two hours to breastfeed and all this. So just really understanding, okay, there's a lot of stress. Sometimes I'll use adapted genetic supplements for postpartum. Also postpartum depletion. There's a lot of nutrients that are a big deal with thyroid function. And so women might be struggling postpartum, maybe even postpartum depression, even the American thyroid association agrees. We should screen everybody who has postpartum depression for thyroid disorders. At what point should a woman have her thyroid checked after she's delivered to make sure that she's not dealing with postpartum thyroid issues? Yeah, so my thought would be six weeks and six months. And then probably again, at a year. Perfect. So when your diagnosis something, I think sometimes people get worried that number one, they should worry. And then number two, that they need to be on something for the rest of their life. I feel like that's the number one question I get asked. Now that I've been diagnosed with this, do I really have to take this for the rest of my life? And a lot of people don't want to. What kind of advice would you have for patients who are worried about that? Yeah, I think it depends. Not everybody does have to be on it for the rest of their life, but often people do. And I think if you have some underlying autoimmune Hashimoto's isn't addressed, yes, your dose is going to keep increasing. If you never address autoimmune component, because there will be continued destruction of the thyroid glands. But I think really if you're on the right dose of thyroid hormone, it can be such a gain change during quality of life that most people don't want to go off of it after they realize, oh my gosh, it was like the lights turned on. The depression is gone or listed. Or finally, I can lose the 10 pounds that I haven't been able to lose. Or my blood sugar looks better. Or my cholesterol. I just think when you're managing thyroid, there are so many benefits to optimal thyroid sanction. And I always think about this risk benefit ratio, right? So what are the risks? Yeah, there are risks to managing somebody on too much medication. I'm not making my patient type of thyroid, though. So there's really very few risks. There's a lot of benefits. And what do we want? I think, well, would I rather take a thyroid hormone or would I rather take a cholesterol medication, blood sugar medication, and an antidepressant? Oh, that's a great point for sure. So you mentioned your own thyroid journey. And you talked about something. You said, I worked really hard. So for people who want to know what they can do that's in their control to improve their own thyroid function, what can you share with us about that? Yeah. So I think a nutrition and lifestyle goes a long way. What does that mean? So in terms of nutrition, eating real whole foods, I'm gluten free. I eat a lot of vegetables and a lot of plants. I eat more of maybe like a plant-based paleo style diet. If you want to put a name on it, but I mean, I'm not super strict about that. But I am very strict about gluten free and dairy free. And I try to do low sugar. I still live, right? And still, I try to preach balance. But I think for many people, especially those of us who have antibodies or autoimmune disease, it's really important to be gluten free. And that really discos for Hashimoto's. Not necessarily somebody who just has suboptimal thyroid function, but really getting nutrient-densuit. So your thyroid relies on things like iron and salineum and zinc and vitamin A exercise. It's too improves your thyroid hormone receptor sensitivity. So all those things are big deal. I think in terms of lifestyle, it sleeps you just you. A lot of times what I see is what happens is your thyroid makes T4. The glands makes T4. It converts from T4 to T3 and your peripheral tissues. And some of it diverts to reverse T3. That's totally a normal thing our body does, but sometimes we divert a lot of it to reverse T3. And reverse T3 is like putting the brakes on, whereas pre-T3 is putting the gas on. And so when I see a ton of reverse T3 and thinking like high stress or not sleeping, inflammation, toxins, infections, all of this. So just that sort of healthy living is important. Also just that low-talk lifestyle. If you're wanting to become a mom, you might be already keyed into this because it's important during pregnancy, of course, and it's important for fertility and it's important for your baby. So really trying to get rid of some of the toxins that are in your home. I feel like this thyroid especially is a magnet for that. Things like fluoride and chlorine and plastics and teddy metals. All of those can worsen thyroid function. And everything that you have mentioned are the exact same things that I tell people that can improve embryo quality. You're right. Yes, totally. For those sperm and egg quality and thereby improve embryo quality. So very good advice to live by. The gluten-free aspect, I don't necessarily. I love how you said, "Preach balance." There are certain patients where gluten-free is important in others where it may not be. Yeah, and I think some people are probably better not going gluten-free. Just some, but sometimes what happened is people replace gluten with rice flowers and high sugar, gluten-free stuff. Like that stuff's not healthy. So there's a balance. If you have auto-immunity, go gluten-free. Thank you so much for all your amazing thyroid advice. Can you just tell us a little bit more about where patients and people in general can sign you and you have a podcast. I'd love for you to talk about that. Yeah, so I have a new project launching called HeyMani. Mani is M-A-M-I. And so that we are on Instagram at HeyMani.lyce and we're launching a podcast and loved having you on a guest. So we're as a guest. So we're super excited to launch that. It can be really good. And you can find me at Dr. Christine Marin on Instagram and on Facebook. I'm an Instagram a lot. And you'll find me there on my website, starttrecchristinmarin.com, and all my clinical information's there. Awesome. Thank you again. And thanks for joining us and for everyone who's listening. I'm going to have her on for a live Q&A sometime very soon to answer your thyroid questions and any questions you might have for her related to functional medicine, anything that she might have talked about today. So stay tuned for that. Thanks, Christine. I'll see you soon. All right. Bye. Thank you so much for listening and making the Eguisper show a part of your weekly routine. To find show notes and a full transcript for this episode, visit dramie.org and look under the blog tab. While you're there, you can find a link for the Eguisper newsletter, which keeps you in the know about fertility news. You can also find dramie and the Eguisper show on YouTube, Instagram or Facebook. If you'd like to learn even more, dramie offers classes at the Eguisper school, edgwisperschool.com or you can request a consultation on dramie.org. Thank you so much for tuning in and for sharing the Eguisper show with others. Keep sparkling and have a great day.