Hashimoto’s Disease: How It Could Affect Your Pregnancy

What Is Hashimoto’s Disease?

Hashimoto’s disease is an autoimmune disorder where the body’s immune system attacks the thyroid gland. Over time, this can cause inflammation and an underactive thyroid (hypothyroidism), leading to a host of health problems—including challenges during pregnancy. It’s one of the most common causes of hypothyroidism, especially in women of childbearing age.

The thyroid plays a vital role in regulating hormones that affect metabolism, energy levels, and even fertility. When the thyroid is compromised due to Hashimoto’s, the delicate hormonal balance required for conception and a healthy pregnancy can be thrown off.

Hashimoto’s Disease vs. Hypothyroidism

Let’s clear this up early: Hashimoto’s disease causes hypothyroidism, but they’re not the same thing.

Hashimoto’s disease is the root autoimmune condition. Your immune system mistakenly targets your thyroid.

Hypothyroidism is the result. Your thyroid gets damaged and can’t produce enough hormones.

Not everyone with hypothyroidism has Hashimoto’s, but nearly all people with Hashimoto’s eventually develop hypothyroidism. It’s crucial to understand this distinction because the underlying autoimmune aspect of Hashimoto’s can affect your fertility and pregnancy outcomes differently than non-autoimmune hypothyroidism.

Can I Get Pregnant with Hashimoto’s Disease?

Yes, you absolutely can get pregnant if you have Hashimoto’s. But it’s not always straightforward.

Women with untreated or poorly managed Hashimoto’s may experience:

1. Irregular menstrual cycles
2. Anovulation (not releasing an egg)
3. Increased risk of miscarriage
4. Difficulty conceiving

Thyroid hormones play a key role in ovulation, implantation, and supporting early fetal development. That’s why managing thyroid hormone levels before you get pregnant is essential. Ideally, your TSH (thyroid-stimulating hormone) levels should be in the optimal range for fertility (usually under 2.5 mIU/L).

Your doctor may prescribe levothyroxine, a synthetic thyroid hormone, to normalize your levels. Regular monitoring and lab work are crucial both before and throughout pregnancy.

How Hashimoto’s Affects Pregnancy

Pregnancy itself places increased demand on the thyroid. The body needs to make 30–50% more thyroid hormone to support the developing fetus, especially during the first trimester when the baby’s thyroid isn’t functioning yet.

If your thyroid can’t keep up—because it’s under attack from Hashimoto’s—the pregnancy could face complications such as:

5. Miscarriage
6. Preterm birth
7. Preeclampsia
8. Low birth weight
9. Developmental issues in the baby (especially neurological)

But here’s the good news: With proper management, most women with Hashimoto’s go on to have healthy, full-term pregnancies. That includes medication, a nutrient-rich diet, and regular thyroid function testing throughout all three trimesters.

Hashimoto’s Pregnancy Diet

1. Iodine and Selenium

Iodine supports thyroid hormone production.
Selenium reduces inflammation and supports thyroid antibody reduction.
Sources: seaweed (in moderation), Brazil nuts, fish, eggs.

2. Iron and Zinc

Both support ovulation and fetal development. Iron deficiency is common with Hashimoto’s.
Sources: red meat, spinach, lentils, pumpkin seeds.

3. Vitamin D

Low levels are often found in people with autoimmune diseases.
Sources: fatty fish, fortified foods, and sunlight (with doctor-approved supplementation if needed).

4. Gluten and Dairy (Maybe)

Many with Hashimoto’s find symptom relief by eliminating gluten and/or dairy, but it’s not universal. Some research suggests gluten may exacerbate autoimmune thyroid issues, especially if you have coexisting celiac disease.

5. Goitrogens

Foods like broccoli, cauliflower, and soy contain goitrogens that can interfere with thyroid function. Cooking usually reduces this effect. Moderation is key, not elimination.

General Rules:

• Eat whole, unprocessed foods.
• Balance blood sugar.
• Avoid inflammatory oils and added sugars.

Can Hashimoto’s Cause Miscarriage?

Unfortunately, yes. Research has shown that women with elevated thyroid antibodies (like TPO antibodies found in Hashimoto’s) are at increased risk for early pregnancy loss—even if their thyroid hormone levels are “normal.”

Thyroid antibodies can:

10. Interfere with implantation
11. Trigger immune system activity that disrupts early pregnancy
12. Contribute to placental problems

That’s why many fertility specialists recommend testing for thyroid antibodies during preconception planning. If antibodies are high, your doctor may increase your thyroid hormone dosage or suggest immunomodulatory treatments.

You can learn more about thyroid health in pregnancy from the U.S. National Institutes of Health.

Assisted Reproduction as an Alternative

If natural conception proves difficult, assisted reproductive technologies (ART) like IUI (intrauterine insemination) or IVF (in vitro fertilization) may be good options. In fact, many women with Hashimoto’s successfully conceive with a little help from reproductive endocrinologists.

What makes ART promising for Hashimoto’s patients:

• Controlled hormonal support
• Close monitoring of thyroid levels
• Ability to manage antibody levels during early implantation

Some clinics also recommend using immunotherapy protocols to manage elevated thyroid antibodies during IVF. This may include low-dose steroids or IVIG (intravenous immunoglobulin), though this is still an evolving area of practice.

If you're considering ART, the U.S. Centers for Disease Control and Prevention offers a good starting point for understanding your options.

Another excellent resource is the U.S. Office on Women's Health.

Managing Hashimoto’s Before and During Pregnancy

Here’s a quick rundown of best practices:

13. Get tested early – Know your TSH, T4, and antibody levels.
14. Take your meds – Don’t skip your thyroid meds, and take them on an empty stomach.
15. Test often – Especially in early pregnancy; TSH should be checked every 4–6 weeks.
16. Prioritize sleep, reduce stress – Stress can flare autoimmune symptoms.
17. Eat smart – Focus on nutrients that support thyroid and immune health.
18. Work with a team – Endocrinologists, OB/GYNs, and fertility doctors all play a role.

You can also explore more about autoimmune diseases and pregnancy at the U.S. Department of Health and Human Services.

Conclusion

Hashimoto’s disease doesn’t have to be a barrier to motherhood. With the right care, education, and support, thousands of women go on to have healthy pregnancies and thriving babies. Whether you conceive naturally or with help from assisted reproduction, the key is early diagnosis, consistent monitoring, and a proactive, holistic approach.

If you’re exploring parenthood through surrogacy or need help navigating fertility with Hashimoto’s, you don’t have to go it alone—our agency is here to walk with you every step of the way.