Ep. 143: Preventing Miscarriage by optimizing Thyroid with functional med/NaProTechnology, with Amanda Frederick, FNP
Caitlin:
Welcome to the Woven Well Podcast. I'm your host, Caitlin Estes. I'm a certified fertility care practitioner with a master of divinity degree. Each episode will cover a topic that helps educate and empower you and your fertility while honoring the deep connection your fertility has with your faith. Let's get started.
Caitlin:
Welcome back to the Woven Well podcast. I am so thrilled to continue to introduce you to quality restorative reproductive medicine professionals. It can feel so overwhelming and intimidating to be out there trying to convince your local OBGYN to dig a little deeper or respect your wishes or work harder for your reproductive health goals. If you can simply work with someone who already values those things. So much easier. This feels especially true when it comes to preparing for pregnancy issues like insulin resistance or low progesterone or certain thyroid conditions sometimes go unnoticed or devalued when they can actually play a role in getting and staying pregnant. So today I've invited NaPro Technology-trained family nurse practitioner, Amanda Frederick, to talk about the thyroid and the role that it plays in pregnancy so that you can know for yourself. Amanda works at Fiat Integrative Health in Franklin, Tennessee and prioritizes NaPro technology for women's health, breastfeeding education, and functional medicine. She's especially passionate about optimizing thyroid function for fertility and working to prevent recurrent pregnancy loss. That makes her the perfect guest for today's episode. Amanda, welcome to the show.
Amanda Frederick, FNP:
Thanks so much for having me, Caitlin.
Caitlin:
I would love for you to introduce a little bit about yourself to listeners and maybe why what you do would be different from the average healthcare encounter.
Amanda Frederick, FNP:
Absolutely. So, I'm a family nurse practitioner. I've been in practice for about 10 years and I'm certified in NaPro technology, which is root cause medicine in women's health that seeks to get at the root cause of the issues and restore health. And I also practice functional medicine and so I like to bring those two together with a little bit of traditional medicine and kind of have an integrative approach. I'm also international board certified lactation consultant. So I bring that into my practice as well. I have a special interest in recurrent pregnancy loss and thyroid function. And so those are big passions of mine, especially in terms of women who are seeking pregnancy.
Caitlin:
Yeah. And that root cause approach to find out why the issues are there and treating it at its source is so different than what you would get in an average OBGYN office or any sort of healthcare professional. So you mentioned lots of different things that you're passionate about, and thyroid, I know, is one of those and that's what we're going to talk about today. So can you explain a little about the thyroid and why it even plays a role in reproductive health?
Amanda Frederick, FNP:
Absolutely. So the thyroid is responsible for a lot of processes in the body. It affects almost every organ system. And so when it comes to reproductive health, it regulates many aspects of the menstrual cycle, estrogen and progesterone function and production also has an impact on ovulation. So people with poorly functioning thyroid may have light menstrual cycles, moderate menstrual cycles that are painful or heavy menstrual cycles, or they might not ovulate at all depending on how bad the thyroid function is. And that carries over into symptoms in their everyday life. And may also carry over into pregnancy. So risk for miscarriage is higher in people with thyroid dysfunction, as well as cognitive impairments in baby, and other things in further trimesters.
Caitlin:
Yeah, I was going to ask if there are certain signs that we should be on the lookout for to know if we have thyroid issues or not. Because I think a lot of times, especially when I talk with clients, I'll ask them, have you ever had any thyroid issues or have you ever been diagnosed with a thyroid disorder? And they'll say, no, I had thyroid checked, and it's fine. And, sometimes that's the case, sometimes it's not. But their symptoms are usually what gives it away.
Amanda Frederick, FNP:
For sure. And I hear that a lot. Oh yeah, my thyroid is fine and 9 times out of 10 it's absolutely not. So a lot of the symptoms are quality of life symptoms, like fatigue, especially people who have crushing fatigue at a certain time of day. Brain fog, joint pain, weight gain that cannot be explained. Things like dry skin or hair loss, depression, constipation. And what I see more often than not is women who have first trimester losses that can't be explained or a really hard time just achieving pregnancy where it takes months and months and months. And so a lot of times I see people come in where they have those two factors in their history and you check their thyroid and it's abnormal.
Caitlin:
And I think it's so important that you talked about symptoms that you can experience just in everyday life that we may not realize are related to thyroid. That fatigue, especially how often do we maybe as women, but also maybe as human beings, think, oh, well it's normal to be tired. I work all day, I come home, I, you know, care for my kids or I work in the community or make dinner, whatever it is. It's hard. And so they feel tired, but there is a different level to the fatigue that should be considered. And you also listed some specific symptoms that you could experience as a woman who is having cycles or maybe some issues with her cycles. So what would be the optimal thyroid functioning for menstruating women and maybe for pregnancy? I know those are two different things, but I'm curious about both.
Amanda Frederick, FNP:
Absolutely. And I treat them as one and the same. Okay. Because fertility is health. And so whether that's your intention or not, if your body can do it, your body's in an optimal state.
Caitlin:
Oh, that's such a good way to phrase it. I love that. That's what the reproductive system is made to do. So you want it to be able to do it in a healthy way regardless of whether you're trying to conceive. Totally with you.
Amanda Frederick, FNP:
Exactly. So the normal range of thyroid parameters differs depending on what provider you talk to, what school of thought they're coming from. And the testing is, there's a wide range of testing as well. So a lot of providers check TSH, free T4, which are two common blood tests. I usually like to do a more well-rounded look at what the thyroid is doing to assess the function, checking free T3, total T3, reverse T3, and thyroid antibodies. Because Hashimoto's thyroiditis is one of the most common conditions, especially among women in the United States. And a lot of times you can't see it, especially in its early stages, unless you check the thyroid antibodies and it can wreak havoc on pregnancies. And so I like to know that right off the bat. So these ranges, there's kind of a standard range for what is normal.
Amanda Frederick, FNP:
There's a pregnancy range for what is normal based on your trimester. And then functional medicine has their own idea of what is normal for function. And so I like to kind of merge all these things. I don't much care for what is normal outside of pregnancy because I want to make sure that whether you want to or not, your body could get pregnant if it wants, if you wanted to. And so I look a lot at those first trimester ranges and NaPro technology in general, has always looked at the thyroid more in a more focused way than maybe is typical. And so I kind of merge NaPro with what functional medicine suggests for these ranges. And I'm a little bit more strict when it comes to the thyroid stimulating hormone in part because of what I've seen in practice. A lot of women don't feel well when the thyroid stimulating hormone is at 2.5, which has always been the upper limit in functional medicine.
Amanda Frederick, FNP:
And in NaPro, I've not met a woman who really feels all that well when her TSH is there and have also had more miscarriages in this range. And so in my practice, I've lowered it down based on some of the literature that's out there, as well as talking with some other fertility providers. And we have TSH of 1.5 or less for especially women trying to conceive. And as far as my practice goes, the rate of miscarriage has been lower since I did that and people feel better. So that's kind of how I've continued to operate. And I like to do look at the numbers, but also look at the function and how people feel because if I'm only treating numbers, I'm not doing my job because women need to feel good too. And so I like to take those two in assessing what the optimal thyroid function is.
Caitlin:
I appreciate that so much. I have clients who have said, oh, my TSH came back normal and that normal range is so wide, but they're feeling miserable. And so they deserve to work with someone like you who's going to say, Hey, how you feel is actually more important than what the test says as far as normal or abnormal. You're treating the person not just the lab results by themselves. I think that's so good. And that's comes from the fact that you have functional medicine, NaPro technology, you know, all your experiences together to give them this kind of experience, which I know that it's very, very beneficial to them. So you mentioned that Hashimoto's is one of the most common thyroid issues that women can have. I'd love to hear a little bit about what that is or maybe if there are any others that are also very common that women should be on the lookout for.
Amanda Frederick, FNP:
For sure. So Hashimoto's is an autoimmune thyroid condition. It comes with elevated thyroid antibodies. And unfortunately if a woman has elevated thyroid antibodies, it puts her at higher risk for miscarriage. And a lot of these women with Hashimoto's have symptoms of thyroid dysfunction, but their thyroid numbers are normal often for a long time while their antibodies are elevated. Now, often over time, especially it seems like every five years or every decade of reproductive life, they can develop abnormal numbers, they can develop more symptoms, but it's always a risk for miscarriage. And it can also just overall be a risk for not feeling well. And that is an extremely common condition. It's probably one of the primary conditions that I see. And then the other one that's pretty common in women in the United States is just hypothyroidism. That is not autoimmune. Whether that's overt hypothyroidism where the numbers are very abnormal, or what I see more often, which is subclinical hypothyroidism, which kind of flies under the radar where the numbers are just slightly suboptimal or just a little out of range. But in pregnancy, that can play a huge part.
Caitlin:
That is so important to know and to have those resources. So I appreciate you sharing that. When you talked about the TPO antibodies and sometimes it's very high numbers, I'm curious, is there ever a result a TPO antibody result that's okay? Like is it okay to have 50 or 500? Is there a difference between the two? One is okay. One's not. Or any is a sign that treatment needs to be included?
Amanda Frederick, FNP:
Well, there's definitely differing schools of thought on that as well. I usually operate under standard lab ranges where your TG antibodies are supposed to be one or less. And I operate under that. And your TPO antibodies, most labs will say nine or less. I prefer it to be zero, but I'm not going to necessarily make a huge deal about it if it's eight. As long as the other labs are normal.
Caitlin:
Sure. Well, I appreciate you answering that. I know there is such a variety of approaches to thyroid specifically, but that's why I value your perspective on it because you're bringing in so many. So for women out there who are looking at their health, maybe they're trying to conceive, maybe they're trying to figure out why they've experienced recurrent pregnancy loss and they're starting to look into thyroid specifically. What are ideal ways for them to monitor and maybe even treat suspected thyroid issues?
Amanda Frederick, FNP:
So the starting with lab work is usually where I start, especially if initial intake has recurrent miscarriage history, struggle trying to conceive, or what I often see, which is somebody told me one time my thyroid was kind of slow, but we didn't do anything about it.
Amanda Frederick, FNP:
And so from there, we can treat if necessary, if a woman wants to try to conceive and is planning to try to conceive, soon I go straight for prescription medication. Because once pregnancy occurs, or even if there's a risk of pregnancy occurring in a cycle, the stakes are high and we need to act fast. Now, if a woman is not trying to conceive, we can often do a lot of lifestyle modification supplementation, especially if the numbers are borderline, that can really get her on a good foot to try to get to the root cause of her thyroid condition and fix as much of as we can naturally.
Caitlin:
And that speaks to the importance of valuing your reproductive health throughout every phase and season of your life. If you are investing in your reproductive health during those years, when you're not trying to conceive and you're looking into improving your thyroid through those lifestyle changes that you're talking about, then maybe by the time you are trying to conceive, you won't need medication. Or maybe you'll need a lower dose of medication. So that full perspective can be really important and valuable to you. But I understand what you're saying. The importance of, even for someone who's not necessarily excited about taking medication, when the stakes are high for pregnancy, your goal as a family nurse practitioner is to prevent those early pregnancy losses if at all possible. And sometimes it takes a little bit of medication to do that.
Amanda Frederick, FNP:
Absolutely. And in pregnancy, the amount of work your thyroid has to do goes up by 30% the day you test positive for pregnancy. Wow. And so a lot of women will be trekking along with kind of borderline thyroid function, but when that extra stress comes from pregnancy, that's when the thyroid condition comes out, whether it's subclinical or a dip in numbers from Hashimoto's. And really, I actually check it once a week in early pregnancy because I've had a situation with a woman who had two losses, one at six weeks, the second one at six weeks. Third pregnancy, thyroid was beautiful. It's beautiful. We checked it beautiful. First week, we got to week number six, and that's when it went out of range, right? When she would've normally lost the pregnancy in every other pregnancy, treat it with thyroid medication, and things have gone better. So it does sometimes even take a dip a couple weeks into pregnancy. And so I take a pretty aggressive approach in the beginning that I want to make sure that we don't miss something subclinical in those early days when the baby's brain development and the baby's development is so dependent on the thyroid hormone being optimal. And if it's not, then you have negative outcomes.
Caitlin:
And you're talking about being aggressive, but being aggressive in a preventative sense, you're aggressively testing for changes, impossible issues so that you can meet them and prevent pregnancy loss.
Amanda Frederick, FNP:
Yes. Maybe proactive is the better word.
Caitlin:
Yes. I, well being aggressively proactive, I think it's okay to be aggressive because many, many women who have had those losses want to do anything that they can to prevent it from happening in the future. So they want to work with someone who prioritizes it as much as you do, and especially with NaPro technology. You know, I work with Creighton clients, so they're learning how to chart their cycles with the Creighton model system. And we'll often see signs on the chart that maybe they have some thyroid issues, and if they happen to conceive before those have been addressed, I will often say, congratulations. So glad you got a positive pregnancy test. Now go to your NaPro physician or nurse practitioner and ask for a progesterone test and a thyroid test, or, you know, trust your NaPro physician to guide on that. But if you're going to a local OBGYN that maybe doesn't have that functional medicine or restorative approach, then those are two things that are important to get tested early and tested often. So I appreciate that you do that. Absolutely. Well, Amanda, thank you so much for sharing your knowledge and your experience with us. I know it'd be beneficial to many who listen.
Amanda Frederick, FNP:
Well, thank you so much for having me, Caitlin. I really appreciate it.
Caitlin:
Listeners, if you're interested in more ways to improve your reproductive health and advocate for your needs, be sure to listen to our incredible archive of episodes and download any of the free resources that are available on our website. We'll make sure to have links in the show notes below. Go ahead and also leave a five star review on the podcast while you're there. It means so much to us because it reveals itself to others who are looking for episodes like this one. So we really need those five star reviews to get our name out there. As always, thanks for listening. As we continue to explore together what it means to be woven well.