Hypothyroidism and Fertility: The Royal Connection

January 31, 2024

Imagine the thyroid gland as the queen of your body, reigning over a vast queendom of hormones. Just like a wise ruler, she communicates with the rest of your body, instructing it on how to function optimally. However, just like any ruler, she can’t do it on her own and she needs support. Today, we will focus on hypothyroidism, a condition characterized by low thyroid hormone levels, and her regal role in the realm of fertility.

The simplest way to understand how hypothyroidism impacts your queendom of hormones is to understand that hypothyroidism is a condition of an underactive thyroid gland. When the queen herself is slow functioning, the entire queendom follows suit and works slowly as well. This is why we often see symptoms of weight gain (slow metabolism), constipation (slow digestion), fatigue (slow energy production), depression (slow brain waves), fewer periods (slow menstruation/ovulation), cold hands/feet (slow circulation), and dry skin/hair (slow to retain moisture).

Hypothyroidism’s Influence on Fertility:

  1. Menstrual Dissonance: Hypothyroidism often disrupts the menstrual cycle, causing irregular periods and, in some cases, anovulation (lack of ovulation). When we are unable to ovulate, we are unable to conceive. 
  1. FSH and LH: Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) act as royal commanders, overseeing the grand ovulation production. Now, these commanders don’t make decisions on their own; they listen to cues from thyroid hormones, which are like messengers in your body. If you have hypothyroidism, it can disrupt the messages the commanders receive. When FSH and LH get mixed-up signals due to thyroid issues, it can affect the entire process of fertility from ovulation to egg quality/production and even increase risk of miscarriages if you were to conceive. 
  1. Ovarian Follicle Quality: Thyroid hormones play a pivotal role in determining the quality of ovarian follicles, where eggs mature. Hypothyroidism may lead to suboptimal follicles and reduced fertility prospects.

Navigating the Thyroid-Fertility Connection: Lab Ranges and Lifestyle

Thyroid Function Tests and Optimal Ranges:

  • TSH (thyroid-stimulating hormone): Main thyroid hormone from your brain that communicates with the rest of your body.
    • Optimal range: 0.45 to 2.5 mIU/L.
  • Free T3 (fT3): The active thyroid hormone that our organs utilize.
    • Optimal range: 2.5 to 4.4 pg/mL 
  • Free T4 (fT4): The most prevalent thyroid hormone that is produced by our thyroid gland.
    • Optimal range: 0.9 to 1.8 ng/dL (nanograms per deciliter).
  • Anti-TPO (Thyroid Peroxidase) Antibodies: Sign of autoimmune Hashimoto’s Hypothyroidism.
    • Optimal range: Less than 9 IU/mL.
  • Anti-TG (Thyroglobulin) Antibodies: Sign of autoimmune Hashimoto’s Hypothyroidism.
    • Optimal range: Less than 4 IU/mL
  • Vitamin D: Deficiency can lead to Hypothyroidism and symptoms.
    • Optimal range: 60-100 ng/mL (People of Color: 80-100 ng/mL)

To optimize thyroid health and enhance fertility, consider these practical steps:

Medication and Hormone Restoration:

  • If diagnosed with hypothyroidism, consult a healthcare professional. Medications like levothyroxine, Armour, Nature-Throid, NP-Thyroid, compounded T4/T3 are all different medication options so if your doctor hasn’t spoken to you about all of these, make sure you bring them up and ask about them if you are on Levothyroxine and still having symptoms. There is NO shame in medication and often a medication is essential in supporting the thyroid in reclaiming her throne!

A Nutrition Plan Fit for Royalty:

  • Embrace a thyroid-friendly diet rich in iodine, selenium, and zinc. Incorporate seafood, nuts, seeds, and leafy greens into your culinary palette to nourish the queen.
  • Make sure you are eating enough food! I see too many women under eating and that can often be one of the leading causes of Hypothyroidism. Aim for about 2000-2500 quality calories with around 100 grams of protein per day. This helps optimize blood sugar and reduce carbohydrate cravings. 
  • Avoid gluten! This is HUGE for Hypothyroidism and I wrote a whole blog post on that so you can learn more here

Regal Lifestyle Choices: A queen must take care of herself in order to reign over an entire queendom.

  • Prioritize stress reduction techniques such as meditation and yoga.
  • Ensure adequate sleep, focus on quality, and engage in non sleep rest activities. 
  • Engage in calm and strong exercises like strength training, yoga, barre, pilates, and walking. If intense exercises cause you to feel more tired then it may be time to cut back on those activities until your thyroid levels are more optimal and you feel better. 

Supplemental Support:

  • Under professional guidance, consider supplementing with the following supplements to fortify the queen’s health and maintain a flourishing queendom.
  • Black Seed Oil: Found to reduce thyroid antibodies and optimize TSH levels.
  • Selenium and Zinc: Essential nutrients for the conversion of fT4 to fT3. 
  • Fish Oil: High in Omega-3s to reduce inflammation and support autoimmune Hypothyroidism
  • You can find the full list of supplements I generally recommend in my Fullscript dispensary

Understanding the intricate connections between hypothyroidism and fertility is paramount for those embarking on the journey to parenthood. Hypothyroidism, characterized by low thyroid hormone levels, can disrupt menstrual cycles, ovulation, and overall reproductive health.

Embracing a holistic approach that includes a thyroid-friendly diet, stress management, potentially medications, and lifestyle adjustments can support you in optimizing your fertility and overall health. Your dreams of parenthood can become a reality as you nurture the queen organ in your body – your thyroid. 

This month in the Mahan Membership, we’re going to go deeper into Hypothyroidism and I’m going to answer any questions you have in the community forums and live Q&A on Thursday, February 1st at 12:30 PM EST.  

If you’re ready to dive deeper into your personal health and optimize your fertility as a couple, schedule your FREE fertility discovery call with your partner. IT TAKES TWO on this journey to conception and I am here to support both of you as you enter your path to parenthood! 

written by:


  • Dr. Hanisha Patel

    I aspire to see a world where great health is not only achievable but the norm. For most of my life, I dealt with constipation, abdominal pain, asthma, allergies, joint pain, back pain, irregular menstrual cycles, chronic nasal congestion, dry skin, migraines, fatigue, inability to focus, and memory issues. I thought all of these things were just the reality I had to live with until I discovered Naturopathic medicine.

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