How to Have a Healthy Pregnancy with Thyroid Disease: A Functional Medicine Approach

Pregnancy is a transformative journey, and for women with thyroid disease, it requires some extra intention and care. Whether you're navigating hypothyroidism, Hashimoto’s, or another thyroid imbalance, the good news is—with the right preparation and support—you can have a healthy pregnancy and a thriving baby.
As a functional medicine practitioner, I’ve worked with many women who are either trying to conceive or are already pregnant and managing thyroid conditions. Here’s what I want you to know: preparation is key, hormone balance is everything, and small, consistent choices make a big impact. Let’s walk through the three essential stages of pregnancy with thyroid disease: preparing to conceive, managing your thyroid during pregnancy, and optimizing your nutrition and lifestyle throughout.

1. Start Preparing 6 Months Before Trying to Conceive 
One of the most powerful things you can do to support a healthy pregnancy is to begin your preconception journey at least six months in advance. Think of it as creating fertile, hormone-balanced soil for your baby to grow in.

Focus on a Whole Foods Diet
Start by eating a nutrient-dense, whole foods-based diet rich in antioxidants, protein, healthy fats, and fiber. Avoid inflammatory foods and minimize toxin exposure by choosing organic when possible, drinking from glass or stainless steel instead of plastic, and cooking with cast iron or stainless steel pans instead of non-stick cookware.

Clean Up Your Beauty & Home Products
Everyday exposures to endocrine-disrupting chemicals can impact hormone function. Begin swapping conventional personal care and cleaning products for low-tox, natural alternatives. What you put on your body matters just as much as what you put in it.

Take a Quality Prenatal (with Folate, Not Folic Acid)
Many conventional prenatals contain folic acid, a synthetic form of vitamin B9 that can be harder to metabolize, especially in women with MTHFR gene mutations. Look for a prenatal that includes methylated folate (5-MTHF) instead.

Balance Your Progesterone Levels
Progesterone is crucial for fertility and early pregnancy. It supports implantation and helps sustain the pregnancy through the first trimester. Without enough of it, miscarriage risk increases. It's for this reason that I recommend getting your levels tested if you have dealt with some of these symptoms:

• PMS
• Heavy periods
• Ovarian cysts, breast cysts, or endometrial cysts
• Headaches or migraines around menses
• Infertility
• Miscarriage in the first trimester

But here’s the kicker: your thyroid and progesterone are deeply connected. You need adequate thyroid hormone to convert cholesterol into pregnenolone (the precursor to progesterone). And when progesterone is low, your thyroid hormone needs actually increase. It’s a delicate dance.

Here are some natural ways to support progesterone production:

• Chasteberry (Vitex): 500–1000 mg/day
• Vitamin C: 750 mg/day
• Manage stress: Progesterone is a stress-sensitive hormone. Meditation, gentle movement, quality sleep, and setting boundaries all matter.
• Limit caffeine and alcohol: These can suppress progesterone levels and interfere with hormonal balance.

Check Your Thyroid Labs & Optimize Before Conception
Most conventional doctors only check TSH, but that’s not enough. Ask for a full thyroid panel, including TSH, Free T4, Free T3, Total T3, Total T4, Reverse T3, and thyroid antibodies. Ideal preconception ranges for TSH and Free T4 are:

• TSH: 1.0–2.0
• Free T4: 1.0–1.5 ng/dL

If your levels are suboptimal—even if they’re technically “normal”—it’s worth working with a practitioner who understands functional ranges to get you where you need to be before conceiving.


2. Monitor Thyroid Function Closely Throughout Pregnancy 
Pregnancy places a higher demand on your thyroid, especially in the first trimester when your baby is completely dependent on your thyroid hormones for development.

Get Your Thyroid Labs Checked Every 6–8 Weeks
Even if your thyroid levels were perfect pre-pregnancy, they can shift quickly as your body adjusts to growing a baby. It’s not uncommon to need a dosage increase if you're on thyroid medication.

Symptoms like fatigue, hair loss, or constipation during pregnancy are often dismissed as “normal,” but they may be signs your thyroid needs more support. Trust your intuition and get retested regularly.


3. Nutrition, Cravings & Movement: Be Mindful, Not Restrictive 
Eating for Two Doesn’t Mean Eating Double.
Pregnancy is not a reason to indulge every craving. For women with a healthy pre-pregnancy weight, calorie needs only increase by:

• +340 calories/day in the second trimester
• +450 calories/day in the third trimester

These ranges are lower if you are overweight prior to conceiving: 200-300 calories/day during the second and third trimester

Additional calories should come from nourishing whole foods: quality protein, healthy fats (like avocado, olive oil, and nuts), legumes, vegetables, fruits, and whole grains. Not sugary snacks and processed treats.

Cravings Are Clues
Instead of labeling cravings as indulgent or shameful, see them as your body’s way of communicating:

• Craving citrus? You might need more Vitamin C—try increasing foods like bell peppers and berries, or supplementing.
• Craving chocolate? That may signal a magnesium deficiency. Consider adding magnesium-rich foods (like pumpkin seeds or leafy greens), or a bioavailable supplement like magnesium glycinate, malate, or threonate. Avoid citrate, which is less effective at raising serum levels.

A helpful lab test? RBC Magnesium, which reflects your cellular magnesium stores more accurately than standard serum testing.

I personally struggled with low RBC magnesium during my pregnancy—and increasing my dose (spread throughout the day) made a big difference in my energy, mood, and muscle cramps.

Stay Active
Gentle movement is one of the best things you can do for yourself and your baby. Whether it's prenatal yoga, Pilates (my favorite), strength training, or cardio, staying physically active supports hormone balance, reduces stress, and can lead to an easier delivery and recovery.



Final Thoughts
Having thyroid disease doesn’t mean you can’t have a vibrant, healthy pregnancy. It does mean you’ll need a little more proactive care—and that’s where functional medicine shines.

By preparing in advance, working with a knowledgeable provider, optimizing your hormone levels, and nourishing your body with intention, you’ll be giving your baby the best possible start!

If you’re ready for personalized support to optimize your thyroid and hormones for pregnancy, I’d love to help. Reach out to learn more about my Integrative Thyroid Solution, a 4-month program designed to help women with thyroid issues reclaim their energy, balance their hormones, and prepare their bodies for pregnancy and beyond.