Nutrition & Lifestyle >>
  Targeted Nutritional Interventions for Improved Cognitive, Cardiovascular, Gastrointestinal & Musculoskeletal Health

Lecturer: Danielle Citrolo, PharmD Karen E. Todd, RD

Lecture 1: Cognizin: A Novel Ingredient to Support Healthy Cognitive Function

Lecturer: Danielle Citrolo, PharmD, Karen E. Todd, RD

Lecture 2: Sustamine: A New Approach for Rehydration & Improved Electrolyte Balance

Lecturer: Danielle Citrolo, PharmD, Karen E. Todd, RD

Lecture 3: Pantesin: A Novel Form of Pantethine (Vitamin B5) to Support Heart Health

Lecturer: Danielle Citrolo, PharmD, Karen E. Todd, RD

Lecture 4: Setria: A Unique Form of Reduced Glutathione for Reducing Oxidative Stress

Lecturer: Danielle Citrolo, PharmD, Karen E. Todd, RD

Diagnostics >>
  Predictive Antibodies: Clinical Applications for Early Detection of Autoimmunity

Expires: 8/31/15Credits: 6

Lecturer: Aristo Vojdani, PhD, MSc, CLS Thomas Alexander, MD Chad Larson, DC, NMD (candidate)

Lecture 1: Predictive Antibodies

Expires: 8/31/15Credits: 1

Lecturer: Aristo Vojdani, PhD, MSc, CLS

Lecture 2: Gastrointestinal and Liver

Expires: 8/31/15Credits: 1

Lecturer: Thomas Alexander, MD

Lecture 3: Thyroid, Adrenal, Reproductive Organs

Expires: 8/31/15Credits: 1

Lecturer: Chad Larson, DC, NMD (candidate)

Lecture 4: Cardiovascular and Diabetes

Expires: 8/31/15Credits: 1

Lecturer: Thomas Alexander, MD

Lecture 5: Bone and Joint

Expires: 8/31/15Credits: 1

Lecturer: Chad Larson, DC, NMD (candidate)

Lecture 6: Neurological

Expires: 8/31/15Credits: 1

Lecturer: Aristo Vojdani, PhD

Healing Traditions >>
  Introduction to Ayurvedic Medicine: Clinical Principles in Maharishi Ayurveda


Topic 1: Introduction to the Theory and Practice of Maharishi Ayurveda


Lecture: Overview and History: Ayurveda and Maharishi Ayurveda
Lecture: Ayurvedic Physiology: The Role of Vata, Pitta and Kapha
Topic 2: Maharishi Ayurveda Modalities

Lecturer: Prerequisite: Topic 1

Lecture: Diagnostic Approach to the Patient
Lecture: Spices and Aromas
Lecture: Ayurvedic Herbology
Lecture: Daily Routine and Behavioral Guidelines
Lecture: Scientific Research on Maharishi Ayurveda
Topic 3: Fundamentals of Diet and Digestion

Lecturer: Prerequisite: Topics 1 & 2

Lecture: Fundamentals of Digestion and Diet - 1
Lecture: Fundamentals of Digestion and Diet – 2
Lecture: General Clinical Digestive Protocols
Lecture: Vata, Pitta and Kapha Digestive Protocols
Topic 4: Ayurvedic Approach to Common Chronic Disorders

Lecturer: Prerequisite: Topics 1, 2 & 3

Lecture: Obesity
Lecture: Metabolic Disorder Protocols
Lecture: Women’s Reproductive Health
Lecture: Menopause
Lecture: Musculoskeletal Disorders & Protocols
Holistic Perspectives >>
  Holistic & Integrative Medicine in Clinical Practice: An ABIHM Mini-Course

Lecturer: Mimi Guarneri, MD, FACC, ABIHM Patrick Hanaway, MD, ABIHM David Rakel, MD, ABIHM Scott Shannon, MD, ABIHM Wendy Warner, MD, FACOG, ABIHM

Lecture 1: The Science of Connection

Lecturer: Erminia “Mimi” Guarneri, MD

Lecture 2: Introduction to Functional Medicine

Lecturer: Patrick Hanaway, MD

Lecture 3: Placebos, Nocebos & the Healing Power of Intention

Lecturer: David Rakel, MD

Lecture 4: Holistic Approaches to Adult Psychiatry

Lecturer: Scott Shannon, MD

Lecture 5: Menopause: A Powerful Transition

Lecturer: Wendy Warner, MD, FACOG, ABIHM

Practice Development >>
  2015 Heal Thy Practice: Transforming Patient Care Conference

Lecturer: Erik Lundquist, MD Pedram Shojai, OMD Niki Fox Decker Weiss, NMD Mark Menolascino, MD Jill Carnahan, MD Jim LaValle, RPh Mette Dyhrberg Bridget Briggs, MD Miriam Zacharias, MS, LPSN Jacques Simon, Esq Tom O'Bryan, DC Sylva Dvorak, PhD Scott Minton, PhD

Lecture 1: Journey of an Integrative Physician--Key Lessons Learned

Lecturer: Erik Lundquist, MD

Lecture 2: Opportunities in Corporate Wellness

Lecturer: Pedram Shojai, OMD

Lecture 3: Insurance-Based Integrative Medicine

Lecturer: Erik Lundquist, MD, Niki Fox

Lecture 4: Practice Development Roundtable Q&A

Lecturer: Mark Menolascino, MD, Erik Lundquist, MD, Niki Fox, Pedram Shojai, OMD

Lecture 5: New Perspectives on Inflammation

Lecturer: Decker Weiss, NMD

Lecture 6: Fire on the Brain: Impact of Inflammation on Cognitive Function

Lecturer: Mark Menolascino, MD

Lecture 7: Making Clinical Sense of the Microbiome

Lecturer: Jill Carnahan, MD

Lecture 8: Cracking the Metabolic Code

Lecturer: Jim LaValle, RPh

Lecture 9: How to Build a Cash-Pay Practice

Lecturer: Jill Carnahan, MD

Lecture 10: Choosing Ancillary Services for Improved Outcomes & New Revenue

Lecturer: Mark Menolascino, MD

Lecture 11: HolisTech: IT Tips for Renewing the Patient-Practitioner Relationship

Lecturer: Mette Dyhrberg

Lecture 12: Implementing Genomics into Your Practice

Lecturer: Bridget Briggs, MD

Lecture 13: The PEACE Process: Practice-Building Tips from Prosperous Practitioners

Lecturer: Miriam Zacharias, MS, LPSN

Lecture 14: Medicolegal Update for Integrative Practitioners

Lecturer: Jacques Simon, Esq

Lecture 15: The Neurological Underbelly of the Gluten-Free Lifestyle

Lecturer: Tom O’Bryan, DC

Lecture 16: Ritual & Neural Pathways for New Practice Paradigms

Lecturer: Sylva Dvorak, PhD

Lecture 17: Building Metabolic Bedrock: Nutritional Principles for Effective Management of Cardiovascular & Nervous System Dysfunctions

Lecturer: Scott Minton, PhD

Lecture 18: Assessing Chronic Fatigue in Clinical Practice

Lecturer: Bridget Briggs, MD

  2014 Heal Thy Practice: Transforming Patient Care Conference

Lecturer: Jeff Gladd, MD, CHAIRMAN Susan Blum, MD Tom O'Bryan, DC Shayma Kazmi, MD, RPh Mark Tager, MD James Maskell Derrick DeSilva, Jr, MD Jacques Simon, Esq Sarath Malepati, MD Ron Hoffman, MD Joel Evans, MD Anita Teresa Boeninger, RYT Melissa Crispell Joseph Hickey, MD Mette Dyhrberg Thomas Blomseth Christiansen Lillie Rosenthal, DO Mark Menolascino, MD Georgia Tetlow, MD Aimon Kopera, MD & Peter Evans, PhD

Lecture 1: The Immune System Recovery Plan

Lecturer: Susan Blum, MD

Lecture 2: Identifying Food Sensitivities: From Tunnelvision to Macrovision

Lecturer: Tom O'Bryan, DC

Lecture 3: Blum Center for Health: An Integrative Medicine Practice Model

Lecturer: Susan Blum, MD

Lecture 4: Projecting Your Expertise

Lecturer: Tom O'Bryan, DC

Lecture 5: Genomic Medicine: The Future of Cancer Care

Lecturer: Shayma Kazmi, MD, RPh

Lecture 6: Total Engagement: How Practitioners Can Go From Grumpy to Great

Lecturer: Mark Tager, MD

Lecture 7: Get the Word Out & Get the Patients In: Online & Offline Strategies for Local Patient Acquisition

Lecturer: James Maskell

Lecture 8: Nutrient Depletion: The Hidden Epidemic

Lecturer: Jeff Gladd, MD

Lecture 9: The Implications and Impact of Polypharmacy on Aging

Lecturer: Derrick DeSilva, Jr, MD

Lecture 10: Emerging Perspectives in State & Federal Regulatory Actions Related to the Practice of CAM

Lecturer: Jacques Simon, Esq

Lecture 11: The Antibiotics Problem: Our Problem, Our Responsibility

Lecturer: Sarath Malepati, MD

Lecture 12: Media as Medicine: Lessons Learned at the Crossroad of Clinical Practice & Broadcast Media

Lecturer: Ron Hoffman, MD

Lecture 13: If I Dared to Dream….The Future of Holistic & Integrative Medicine

Lecturer: Joel Evans, MD

Lecture 14: Credentialling & Certification Roundtable: Making Sense of New & Established Credentials in Integrative Healthcare

Lecturer: Jeff Gladd, MD, Mark Tager, MD, Joel Evans, MD

Lecture 15: Moving Forward: Mind-Body Practices for Empowerment & Change

Lecturer: Anita Teresa Boeninger, RYT

Lecture 16: Breakout Session A: Identify Hidden Immune Burdens with Lymphocyte Response Assay (LRA) Test of Immune Resilience

Lecturer: Melissa Crispell, Joseph Hickey, MD

Lecture 17: Breakout Session B: Know Thy Patients: Using Technology to Facilitate Health Improvement

Lecturer: Mette Dyhrberg, Thomas Blomseth Christiansen

Lecture 18: Breakout Session C: Rediscovering the Joy in Medicine—How to Thrive in a Broken System

Lecturer: Lillie Rosenthal, DO

Lecture 19: Alumni Trackout A: A Practice Transformation Toolkit for The Era of Personalized Medicine

Lecturer: Mark Menolascino, MD

Lecture 20: Alumni Trackout B: Self-Care & Resilience During the Transition

Lecturer: Georgia Tetlow, MD

Lecture 21: Alumni Trackout C: Tech Tips & Tools for Building Your Web Presence

Lecturer: Jeff Gladd, MD, James Maskell

Lecture 22: Alumni Trackout D: Technology & the Consumer Revolution—A Platform for Holistic Lifestyle

Lecturer: Aimon Kopera, MD, Peter Evans, PhD

Lecture 23: Taking Action & Moving Forward: Practical Steps for Practice Transformation

Lecturer: Derrick DeSilva, Jr, MD

  PRACTICE ESSENTIALS—Activating the Three Key Drivers of Practice Success

Lecturer: Tim Brolus

LECTURE 1: Practice Essentials Driver #1: Business Development

Lecturer: Tim Brolus

LECTURE 2: Practice Essentials Driver #2: Creating a WOW Experience

Lecturer: Tim Brolus

LECTURE 3: Practice Essentials Driver #3: Administrative Excellence

Lecturer: Tim Brolus

  2013 Heal Thy Practice: Transforming Patient Care Conference

Lecturer: Erik Goldman Jeff Gladd, MD Shilpa Saxena, MD Michael Gaeta, Lac Chad Larson, NMD, DC Steven Masley, MD David Perlmutter, MD Marcela Dominguez, MD Erin Martin, DO Richard Jaffe, Esq. Deanna Minich, PhD Harry Massey Miriam Zacharias James Maskell John La Puma, MD Tina Beaudoin, ND Mette Dyhrberg & Thomas Blomseth Christiansen

Lecture 1: Primary Care at the Tipping Point: Key Findings from HPC’s 2013 Physician Survey

Lecturer: Erik Goldman

Lecture 2: Facing Fears & Moving Forward: Transforming Inner Obstacles to Success

Lecturer: Jeff Gladd, MD

Lecture 3: The Need for Implementing Functional & Integrative Medicine in Primary Care

Lecturer: Shilpa Saxena, MD

Lecture 4: Practical Steps for Implementing Group Visits in Primary Care

Lecturer: Shilpa Saxena, MD

Lecture 5: Asset Creation & Asset Protection—Improving Patient Care & Practice Success

Lecturer: Michael Gaeta, LAc

Lecture 6: Are Chemicals & Infections Contributing to Your Patients’ Clinical Complaints?

Lecturer: Chad Larson, DC, NMD

Lecture 7: Evidence-Based Weight Loss: How to Make it a Viable Part of Your Practice

Lecturer: Steven Masley, MD

Lecture 8: The Leading Edge of Functional Neurology—Modifying the Risk Factors for Cognitive Disorders

Lecturer: David Perlmutter, MD

Lecture 9: Integrative Medicine in a Concierge Model: Tips for Making the Transition

Lecturer: Marcela Dominguez, MD

Lecture 10: The TrueMed Model of Independent Integrative Practice

Lecturer: Erin Martin, DO

Lecture 11: Medicolegal Intensive: Key Legal & Regulatory Issues in Integrative Medicine

Lecturer: Rick Jaffe, Esq

Lecture 12: The Future of Personalized Lifestyle Medicine: Application to the Clinic

Lecturer: Deanna Minich, PhD

Lecture 13: Mapping the Human Energy Field

Lecturer: Harry Massey

Lecture 14: Thrive: Fast Track Your Holistic Practice Without Losing Your Shirt, Your Mind, or Your Soul

Lecturer: Miriam G. Zacharias, MS, LPSN

Lecture 15: Leveraging Your Time: Using Video for Effective Patient Education & Motivation

Lecturer: James Maskell

Lecture 16: Helping Men Refuel: Implementing Lasting Lifestyle Strategies for Adult Males

Lecturer: John La Puma, MD

Lecture 17: Breakout Session A: Know Thy Patients: Using Technology to Facilitate Health Improvement

Lecturer: Mette Dyhrberg, Thomas Blomseth Christiansen

  2012 Heal Thy Practice: Transforming Patient Care Conference

Lecturer: Philippa Kennealy, MD Erminia “Mimi” Guarneri, MD Steven Masley, MD Corey Evans, MD Aristo Vojdani, PhD Aristo Vojdani, PhD Michelle May, MD Miriam Zacharias, PhD Tim Brolus Sara Gottfried, MD Molly & Bruce Roberts, MD Hans Vink, PhD Alan Dumoff, JD, MSW James Maskell & Miriam Zacharias Bethany Hays, MD Jaclyn Chasse, ND Jeff Gladd, MD Chris Shoffner

Lecture 1: Practicing Like a Healer, Thinking Like an Entrepreneur

Lecturer: Philippa Kennealy, MD

Lecture 2: Practice Management Lessons Learned from the Scripps Center for Integrative Medicine

Lecturer: Erminia “Mimi” Guarneri, MD

Lecture 3: Integrative Strategies for Cardiovascular Disease Risk Reduction

Lecturer: Steven Masley, MD, Conference Chairman, Founder & Director, Masley Optimal Health Center, St. Petersburg, FL.

Lecture 4: Exercise Stress Testing in Primary Care

Lecturer: Corey Evans, MD

Lecture 5: From Leaky Gut to Autoimmunity: Next Generation Assessment Tools

Lecturer: Aristo Vojdani, PhD

Lecture 6: Lessons Learned on the Path to Integrative Private Practice

Lecturer: Jeffrey Gladd, MD

Lecture 7: Mindful Eating: An Essential Ingredient for Sustainable Lifestyle Change

Lecturer: Michelle May, MD

Lecture 8: Time Management Tactics to Enhance Practice Productivity

Lecturer: Miriam Zacharias, PhD

Lecture 9: The Three Key Drivers for Practice Success: A New Mindset for Activating Your Potential

Lecturer: Tim Brolus

Lecture 10: The Care & Feeding of a Sustainable, Independent, Women’s Health Practice

Lecturer: Sara Gottfried, MD

Lecture 11: The Integrative “Specialist” Consultant: A New & Effective Practice Model

Lecturer: Molly & Bruce Roberts, MD

Lecture 12: The Endothelial Glycocalyx & Prevention of Cardiovascular Disease

Lecturer: Hans Vink, PhD

Lecture 13: Top Ten Medicolegal Mistakes Integrative Practitioners Make….And How to Avoid Them

Lecturer: Alan Dumoff, JD, MSW

Lecture 14: Beyond Marketing: Why the Internet Should Be Holistic Medicine’s Best Friend

Lecturer: James Maskell & Miriam Zacharias

Lecture 15: The Circle Process, Staff Satisfaction & the Successful Integrative Practice: Lessons Learned from the True North Clinic

Lecturer: Bethany Hays, MD

Lecture 16: Office-Based Supplement Dispensing

Lecturer: Jaclyn Chasse, ND

Lecture 17: Creating Your Ideal Practice

Lecturer: Jeff Gladd, MD

Lecture 18: Changing How We Pay for HealthCare

Lecturer: Chris Shoffner

Botanical Medicine >>
  Coming soon
Chronic Disease Care >>
  Coming soon

HTP 2015 San Diego

Holistic Primary Care | Holistic Education Exchange |  Heal Thy Practice Conference

  • icon nutrition
    Nutrition & Lifestyle
  • Healing Traditions
    Healing Traditions
  • Botanical Medicine
    Botanical Medicine
  • icon perspectives
    Holistic Perspectives
  • Diagnostics
  • Chronic Disease Care
    Chronic Disease Care 
  • Practice Development
    Practice Development

Thyroid Problems Often Underlie Infertility, Pregnancy Complications

Thyroid dysfunction is a well documented, but often overlooked, factor in both male and female infertility. It can also have severe consequences during pregnancy, leading to miscarriages, premature birth, fetal death, low birth weight, gestational hypertension and developmental problems for offspring.

It makes good clinical sense to make thyroid function screening a standard practice during preconception planning and prenatal care.

Thyroid disorders are common in the general US population, with a 2010 review finding the prevalence of thyroid disorders as follows: Hypothyroidism 4.6%, Hyperthyroidism 1.6% and Autoimmune Thyroiditis (AITD) 5.13% (Golden S, et al. J Clin Endocrinol Metab. 2009; 94(6): 1853-1878).  However, hypothyroidism, in particular, remains highly under-diagnosed.

The standard reference range for thyroid stimulating hormone (TSH) varies among labs but is generally considered to be 0.5-4.0mIU/L, despite the recommendations in 2002 by the American Association of Clinical Endocrinologists (AACE) to narrow the range to a more optimal 0.3-3.0 mIU/L (AACE Medical Guidelines. Endoc Prac 2002; 8(6): 457-467).  This newer reference range has particular consequence in fertility studies and for treatment guidelines during pregnancy.  

The American Endocrine Society and other major international thyroid organizations have endorsed international guidelines recommending screening of pregnant women. The impact of hyper- and hypothyroid states during pregnancy is well documented in a recent paper by Alex Stagnaro-Green, MD, and colleagues (Stagnaro-Green A, et al. Thyroid 2011; 21(10): 1081-1125).

However, undiagnosed and untreated hypothyroid conditions have serious consequences for women in general.  For one, subclinical hypothyroidism is a risk factor for atherosclerosis and myocardial infarction comparable to other major CVD risk factors (Hak AE, et al. Ann Intern Med 2000; 132:270-278).  Regardless of pregnancy status, thorough screening for thyroid dysfunction and carefully tailored treatment can prevent a multitude of sequelae.   

Hypothyroidism & Infertility

In women, a low functioning thyroid can lead to ovulatory dysfunction, especially if it is severe enough to cause a delayed response of LH to GnRH. This leads to corpus luteum inadequacy. Prolactin may be increased in these cases, due to TRH stimulation of both TSH and PRL.  For this reason, women most commonly present with oligomenorrhea and amenorrhea, but some have polymenorrhea, and menorrhagia.  

These menstrual irregularities are three times more common in hypothyroid women than in the general population.  They are usually due to high levels of estrogen with relatively low levels of progesterone, causing breakthrough bleeding with anovulatory cycles. Some of these women also have low levels of clotting factors, which contribute to bleeding irregularities (Krassas et al.Endocr Review. 2010; (5):702-55).

Elevated TSH has been observed in 4.6% of cases of female infertility (Grassi G, et al.  Gynecol Endocrinol 2001; 15:389-396). Thyroid autoimmunity also contributes to thyroid related infertility, even in the absence of elevated TSH, which logically increases the known risk.  In a review of several studies, AITD was significantly more prevalent in infertile versus fertile women (Krassas et al. 2010).

Thyroid Assessment in Infertile Women

Primary hypothyroidism is characterized by low levels of available thyroid hormones (T3 and T4). This causes the TSH level to rise.  Many health practitioners test thyroid function using a stand-alone TSH test, but particularly in cases of infertility it is vital to look at a more complete panel that includes TSH, FFT, and the anti-Tg and anti-TPO antibodies.

Hashimoto's (autoimmune) thyroiditis is the most common cause of hypothyroidism in the US, where iodine deficiency is uncommon.  Consider testing for anti-thyroglobulin antibodies (anti-Tg) and anti-thyroid peroxidase antibodies (anti-TPO), when evaluating for hypothyroidism, especially if a patient presents with clinical symptoms but appears “euthyroid” (using the older reference ranges) on the initial TSH test. This is even more reason for adopting the newer, narrower TSH reference range: it may help to identify many at-risk women.

Hypothyroidism with ART

Infertile couples frequently resort to assisted reproductive technology (ART), usually after having had no success with other methods such as ovulation induction, endoscopic alleviation of tubal obstruction or endometriosis, and intrauterine insemination (Krassas et al. 2010).  ART involves controlled ovarian hyperstimulation (COH), which downregulates the pituitary-gonadal axis and utilizes recombinant FSH to promote growth of multiple oocytes. This is followed by a high dose of hCG to cause ovulation.  

The principle is to induce a high level of E2, similar to that seen in the second trimester of pregnancy, but this can have significant consequences for the thyroid. The estrogen surge increases T4-binding globulin (TBG), which increases the demand for thyroid hormone and can raise TSH levels significantly (Muller AF, et al. J Clin Endocrinol Metab. 2000; 85: 545-548). This can be problematic in women who already have AITD.

A 2004 study by Poppe et al., which followed TSH and T4 levels into the first trimester, showed that women with AITD have a markedly greater increase in TSH and a greater drop in T4 after COH, compared to those without AITD (Poppe K, et al. J Clin Endocrinol Metab. 2004; 89:3808-3812).  This is an important factor to consider in ART treatment failure. High TSH levels are associated with greater rates of miscarriage and fetal death (Benhadi N, et al. Eur J Endocrinol 2009; 160: 985-991).  Whether COH-related hypothyroidism remits after pregnancy ends or it propels patients into lifelong hypothyroidism is a good subject for future long-term studies. 

Intrapartum Hypothyroidism 

During pregnancy, it is even more essential for a woman to have adequate thyroid hormone, as low levels can affect not only the outcome of the pregnancy, but also the health of the developing fetus. Yet subclinical hypothyroidism or “euthyroid” autoimmune thyroid disorders in pregnancy are even more easily missed, because of the normal suppression of TSH by hCG.  Slight TSH increases due to thyroid dysfunction may seem within normal range unless narrower reference ranges are utilized. 

Children born to women with low T4 or high TSH have shown developmental delays and significantly lower IQ (Mitchell ML and Klein RZ  Eur J Endocrinol2004; 151:U45-U48).  Iodine deficiency may underlie this phenomenon, since iodine requirements increase during pregnancy (Krassas et al. 2010).  This disorder is being assessed further to better understand the value of screening tests throughout pregnancy. Because hypothyroid states have such potentially dire consequences on the child, it makes sense to consider testing for T4 at intervals throughout pregnancy.

It is also important to test for autoimmune antibodies, even in euthyroid patients. The presence of either TPOAb or TgAb doubles the prevalence of preterm birth in euthyroid women (Stagnaro-Green et al. 2011). Pregnancy-induced hypertension (PIH) is also associated with low thyroid function, especially if the TSH level remains elevated throughout the pregnancy (Leung AS et al Obstet Gynecol 1993; 81: 349-353).

Keep in mind that during pregnancy, autoantibody titers may be reduced even while thyroid function is decreased. This can be a confounding factor in studies of AITD in pregnancy.  Reduced antibody output during pregnancy often has detrimental effects postpartum, as suppressed auto-antibodies may rebound and cause a postpartum thyroiditis.

Postpartum Hypothyroidism

Postpartum thyroiditis (PPTD) is one of the most common endocrine disorders in women, with prevalence between 5-9% in the general female population.  Additionally, 30-50% of women with PPTD develop permanent primary hypothyroidism within 10 years (Krassas et al. 2010).  One reason is that the autoimmune disease greatly reduces thyroid reserves, and the body is unable to compensate for the increased thyroid hormone requirement during pregnancy. After the immune tolerance of pregnancy, the autoantibody titers dramatically increase, creating an unexpected hypothyroid state.

PPTD can be transient or permanent, but occurs within the first year postpartum.  It may also occur after a loss of pregnancy of 5 to 20 weeks’ gestation. PPTD is very easy to miss, because many of the symptoms are considered to be “expected” or “normal” postpartum manifestations. These include fatigue, palpitations, weight loss, heat intolerance, irritability and depression, all of which are easily attributed to the lack of sleep and the stress of caring for a newborn.  There may be an association between PPTD and postpartum depression (Muller A, et al.  Endoc Rev 2001 Oct; 22(5): 605-630), though there is not currently sufficient evidence to prove this definitively.

The role of the thyroid in reproductive function is very a broad topic, with significant clinical implications. We clearly need more research in this field, as the rates of thyroid disease in the US seem to be increasing. Better detection and treatment of thyroid problems may be a key to restoring fertility for many couples struggling to conceive, and it could potentially reduce a large number of serious complications of pregnancy. 


Rhesa Napoli is a naturopathic medical student at National College of Natural Medicine, Portland, OR, with a focus on chronic diseases, especially those associated with the endocrine system. She is currently developing models to increase accessibility to affordable naturopathic healthcare.

Learn Predictive Antibody Testing & Earn CME!

Predictive antibody testing puts state of the art immunologic tools in the hands of practicing clinicians, enabling early detection of triggers & predisposing factors for many disorders---long before they become chronic and debilitating!

In this online course, you'll earn 6 AMA Category 1 credits as you learn how predictive antibody testing can revolutionize your care for patients with:

  • Gastrointesteinal + Liver
  • Thyroid, Adrenal, Reproductive Organs
  • Cardiovascular Disease
  • Diabetes
  • Bone and Joint Disorders
  • Neurocognitive Problems

Faculty: Aristo Vojdani, PhD; Thomas Alexander, MD; Chad Larson, DC, NMD