Postpartum Thyroiditis
April 5, 2009 by Angela White, J.D., breastfeeding counselor
Filed under health of the mother
Up to 10% of women experience thyroid problems after giving birth. Postpartum thyroiditis causes fluctuating thyroid hormone levels, first with a period of hyperthyroidism (overactive thyroid with excess thyroid hormone) which might then resolve back to normal or dip into a period of hypothyroidism (low thyroid function). Note that this is different from postpartum Graves’ Disease, which is autoimmune hyperthyroidism in which antibodies attack the thyroid and cause it to overproduce thyroid hormone.
Photo by Jyn Meyer
Symptoms of Postpartum Thyroiditis
Symptoms of hyperthyroidism include anxiety, insomnia, weight loss, increased heart rate, fatigue, and weakness. Hypothryoidism causes fatigue, unexplained weight gain or inability to lose weight, coarse and dry skin and hair, constipation, and depression. Lots of new mothers are tired and might attribute any of the other symptoms to the demands of caring for a baby! Fortunately simple blood tests can determine whether there is indeed an underlying thyroid condition, and mothers experiencing any unusual and ongoing symptoms should contact their doctors.
How Postpartum Thyroiditis Affects Breastfeeding Women
Nursing mothers should work to protect the breastfeeding relationship with three key considerations throughout the process: (1) compatible diagnostic testing, (2) compatible treatment and medications, and (3) management of milk supply, both oversupply and low supply.
Lucky me, I have hit the statistical jackpot and had both postpartum Graves’ Disease and now postpartum thyroiditis. The first doctor I saw wanted me to pump and dump my milk for an uptake scan and encouraged me to wean altogether. Needless to say I sought a second opinion. As MyThyroid.com explains:
The diagnosis is often made clinically, and as many women are still breastfeeding at the time of presentation, it is not generally desirable or necessary to stop breastfeeding for an uptake or scan as the diagnosis can usually be made on clinical grounds alone. Obviously, breastfeeding women should not have tests with radioactive isotopes as small amounts of the isotopes can be passed along in the breast milk, which is to be avoided.
Thyroid medications (both antithyroid medications used to suppress thyroid function and thyroid supplements used to boost thyroid levels) at appropriate doses are compatible with breastfeeding. Thyroid function can affect the milk ejection reflex and hence it can cause low milk supply. My experience has been the opposite — I had significant oversupply when I had undiagnosed Graves’ Disease. This time with the low thyroid function I have not experienced low milk supply.
Your Experience
Have you dealt with postpartum thyroid issues? What was your experience? How did it affect breastfeeding, if at all?
I actually have hypothyroidism, which was diagnosed about five years before the birth of my son. In both cases (hypo and hyper), it is important to get diagnosed early! I made sure to manage my care (with a doctor), and as a result have been nursing over two years. I suppose I am a lucky one, but a lot of that luck is a result to caring for myself.
Maria, I agree that it is important to get diagnosed early and be proactive in your own care. As I’m sure you know, it is particularly important to have normal thyroid levels when trying to conceive and when actually pregnant.
I’m glad to hear you haven’t had any problems!
Oh, I am so glad to see someone educating women on PPT! I have a strong family history of Hashimoto’s Disease (autoimmune hypothroidism, the opposite of Grave’s). I have had thyroid function bloodwork on a regular basis over the years, and never fell out of “WNL”, but was always on the low side. After the birth of my daughter, I lost weight very quickly (about 27 lbs in less than 6 weeks), but certainly wasn’t complaining about that! I did have a terrible time with nursing, never having enough. My daughter lost a significant amount of weight, and I needed to supplement. I tried all the mechanical fixes for undersupply (pumping, pumping more pumping, nursing all the time, etc.), herbs, etc, and it never helped much. Finally a LC told me to have bloodwork done and my midwife called me to say I was hyperthyroid. I went to a supposedly breastfeeding friendly endocrinologist, who didn’t think that my PPT was significant enough to cause undersupply, and although sympathetic, didn’t seem to think that nursing was important in the grand scheme of things. He opted to do nothing, since he figured that my thyroid would settle down eventually. This is usually standard treatment for PPT as I found out, but it was really frustrating! Within a few months, I was indeed hypothyroid, and was diagnosed with Hasimoto’s Disease (a simple bloodtest was necessary). I started taking synthroid and felt much better, but it did not improve my supply issues. I found out much later (while I was weaning) that the PCOS i have was probably the major cause of my undersupply. That could and shoul dhave been addressed from the beginning, but no one seems to have a good understanding of the influence of hormones on nursing. A really GREAT resource is “A Breastfeeding MOther’s Guide to Making More Milk”. It talks about thyroid issues, PCOS, breast reduction, etc. I didn’t get this book until after I weaned, but now I know what to do next time! I may not have been able to nurse exclusively like I planned, but I did nurse for 6 months (with supplementation to keep my daughter’s weight healthy). And I did not just accept that I couldn’t nurse, I researched and asked questions and just kept going on my quest to find out WHY I couldn’t nurse exclusively. My advice to moms who are struggling is, Don’t give up. Nursing doesn’t have to be an all or nothing proposition, and don’t just accept what others tell you, do your research, read and talk to every LC, LLL leader, midwife, mom, etc who will talk to you about your problem. A lot of the time, it is treatable, if you know what is going on. Even if its not going to work out the way you want it to, the knowledge you gain is useful for the next baby, or another mom who is going thru the same problem.
Jennifer, I second your book recommendation. And you make an excellent point about the knowledge you gain helping with the next baby. I’m glad to hear you got to the bottom of your supply issue. Good for you!
I found out my thyroid was off after the birth of our first son. It corrected itself. But after the second pregnancy the doctor diagnosed Hashimoto’s Hypothyroidism. For me, it means I take medication daily and get blood work regularly to check for an imbalance. If it wasn’t for the post-partum hair loss, that triggered me to investigate this, I might have never figured this out. So thankfully, the pregnancies gave me the chance to get this under control.
I was just diagnosed with PPT for the second time. Hair loss, increased weight loss rate and increased heart rate were my first clues. This definitely affected my ability to breastfeed with my first child – we made it eight months but had to supplement often during the last two. I am now working with a lactation consultant to monitor supply and baby’s growth. One suggestion she had was to use nutritional yeast (a b complex vitamin supplement) to encourage overall health and hopefully, lead to continued success with breastfeeding. I think more women need to be made aware of PPT – I spent many weeks after my first child feeling like I was losing my mind when really it was just my thyroid (thank goodness!).
Thank you for posting this! After I had my baby, I lost way too much weight (still am 15lbs underweight), lost handfuls of hair, and felt like I was going crazy. I asked my doctor if it was my thyroid and she quickly dismissed it and did no tests. 7 months postpartum I went back and she did test my thyroid, and diagnosed me with hyperthyriod. I have a follow up appointment, and I’ll make sure she is aware of PPT! I strongly encourage anyone who thinks they may have PPT to be your own advocate and keep asking your doctor for the test. I wish I would have been more persistent sooner.
My doctor says we just have to wait and see what happens with my thyroid…I wondered if I should see someone else, or if there is medication I should be taking for hyperthyroid? Thanks!!
Hi Carly! Did your doctor run the blood test for TSI (Thyroid Stimulating Immunoglobulin, the anti-thryoid antibodies present in postpartum Graves’ Disease as opposed to postpartum thyroiditis)? That test can be run instead of doing a radioactive uptake scan (which would require pumping and dumping for a certain number of hours). You definitely want to rule out (or in) Graves’ Disease which can be treated rather than waiting to see what happens. I am not sure what the normal plan is for postpartum thyroiditis. Seven months seems like a long time to be in the hyper phase (I was hypo by then) but I simply do not know enough about it. A second opinion certainly wouldn’t hurt especially since you are unhappy with how the doctor dismissed your concerns initially. Good luck!
Hi,
am a mom for the first time and my son is 4 months old, i have been sick since i had him !i almost went CRAZY my blood pressure hit 160/120! I almost had a stroke that day!! they kept on dismissing me ,my Gynecologist diagnosed me with PPD and put me on Zoloft but it made it worst!! so i stopped it after a week of feeling drunk! (COLD TURKY) and i was still sick and my heart rate was 144 at some point last week! finally my family physician found out after a series of tests that i have HYPERTHYRODISM!! ohh i was crying FINALLY someone knows what’s wrong with me …i dont know what happens from here i suppose to see an specialist ASAP, i went to the Er today because i couldn’t breath!!! and my heart rate was so high too. Am glad that someone shared their experience and i hope that you all feel well!!
i know that all of as wanted to be done after they have their precious one. Oh well is not always as we plan!
Hi,
So happy to see other posts and know that I am not crazy. My baby is 4 months old, and although felt well for the first couple of weeks, I went down hill after that. I have been ill for months. I knew I had a hyperthyroid, and was watching my weight loss, but I did not know all the other symptoms. I am suffering from depression, anxiety and worst of all insomnia. Not to mention my milk supply is suffering, and thus my baby is nursing ALL the time. At night I am so over heated! My husband thought I was going crazy. I finally went back to the doctor today and she assured me I am not crazy, it’s probably the PPT. I take Ativan periodically to help get a good night sleep.