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How to Prepare for Pregnancy With Hypothyroidism

Learn what essential steps to take before you try to conceive with hypothyroidism in this article.
How to Prepare for Pregnancy With Hypothyroidism

Mary Shomon

Patient Advocate

Medically Reviewed by:
Medically Reviewed by:

When you've decided to become a parent, nothing is more important than ensuring a healthy pregnancy and a healthy baby! If you are being treated for hypothyroidism and plan to have a baby, there are some essential steps to take before you try to conceive. These steps can make all the difference to a healthy pregnancy with hypothyroidism.

How to prepare for pregnancy with hypothyroidism

Start planning six months in advance

Whenever possible, experts recommend that you start planning at least six months before you try to conceive. This time allows you time to test supplement any missing nutrients, ensure that your thyroid levels are optimal for fertility, and develop a thyroid management plan with your thyroid doctor.

Optimize your thyroid levels for fertility and early pregnancy

Guidelines from the American Thyroid Association (ATA) recommend your doctor should adjust your dosage of thyroid hormone replacement medication so that your thyroid-stimulating hormone (TSH) level is below 2.5 mIU/L before you conceive. If your TSH levels are higher, your doctor should raise your thyroid hormone replacement dosage and recheck your levels until your TSH level is 2.5 or less.

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Ensure that you are not iodine deficient, and supplement with iodine

Iodine is the critical building block for thyroid hormone, and during early pregnancy, your need for iodine increases significantly. If you are hypothyroid and have not had your thyroid surgically removed or disabled due to radioactive iodine (RAI) treatment, consider testing for iodine deficiency before conception. If you are low in iodine, your thyroid doctor can recommend an appropriate level of iodine supplementation. Typically, an iodine/iodide combination formula such as Iodoral or Lugol's solution is the recommended form.


If your iodine levels are not deficient, the ATA Guidelines still recommend that you supplement with a multivitamin or prenatal vitamin that includes at least 150 μg of iodine. If you are taking a vitamin before conception, be sure to check the label, as many over-the-counter and prescription prenatal vitamins do not include iodine. The ATA recommends that you continue taking a vitamin with iodine throughout your pregnancy and while breastfeeding.

Take the right kind of folic acid

Before conception and during pregnancy, folic acid is a crucial nutrient to help prevent neural defects in your baby. According to the National Institutes of Health, up to 25 percent of the U.S. population has a methylenetetrahydrofolate reductase mutation, also known as an MTHFR genetic mutation. Among other effects, the MTHFR mutation makes it hard to metabolize folic acid effectively.


MTHFR mutation is more common in people with autoimmune diseases and thyroid conditions. Before pregnancy, you can have genetic testing to determine if you have the MTHFR mutation. Experts recommend taking a particular methylfolate form of folic acid before and during pregnancy if you test positive. This form of folic acid will help prevent neural tube defects in your baby.


If you haven't had MTHFR testing, many practitioners recommend that you still take methylfolate in place of regular folic acid. This methylfolate works for all women, including those with the MTHFR mutation.

Confirm your pregnancy as early as possible

In a woman without a thyroid condition, as soon as conception occurs, the thyroid gland starts to enlarge and begins to increase the production of thyroid hormone by as much as 50 percent. This increase is essential for your developing baby, whose thyroid is still developing and will not produce thyroid hormone until the start of the second trimester.


If you have hypothyroidism, it is essential to confirm your pregnancy as early as possible so that you can increase your thyroid medication dose right away. Early confirmation can help reduce your risk of a thyroid-related miscarriage, or if the pregnancy continues, reduce the risk of developmental deficits in your baby. Don't wait for a missed period.


It would be best if you started pregnancy testing soon after you try to get pregnant. Some home pregnancy tests are so sensitive that they can confirm pregnancy as early as seven days after conception.

Have a plan to increase your thyroid medication dosage

Consider preconception planning with your practitioner. Work with them to have a plan in place for an agreed-upon dosage increase of your thyroid medication to start as soon as you have a positive pregnancy test. In some cases, practitioners will recommend that you increase your dose by as much as 50 percent after confirming your pregnancy.

Get retested as soon as your pregnancy is confirmed

As soon as you have confirmed your pregnancy and started on your predetermined dosage increase, you should coordinate with your practitioner to check your thyroid levels. That way, you can quickly ensure that your TSH levels are not exceeding the ATA Guidelines' recommendation to maintain your TSH level between 0.1 and 2.5 mIU/L during your first trimester.


There's no reason a woman with Hashimoto's thyroiditis and/or hypothyroidism can't have a healthy baby! Paloma Health thyroid doctors have experience supporting women's thyroid health from preconception through pregnancy. Schedule a consultation with a Paloma Health thyroid doctor to develop a personalized treatment plan today.

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Mary Shomon

Patient Advocate

Mary Shomon is an internationally-recognized writer, award-winning patient advocate, health coach, and activist, and the New York Times bestselling author of 15 books on health and wellness, including the Thyroid Diet Revolution and Living Well With Hypothyroidism. On social media, Mary empowers and informs a community of more than a quarter million patients who have thyroid and hormonal health challenges.

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