Thyroid Problems After Pregnancyby Mary Shomon Patient Advocate
When you have just had a new baby, it’s common to feel exhausted, experience disrupted sleep, struggle with your weight, lose hair, and go through periods of depression or anxiety. The period after childbirth is, after all, one of significant hormonal change. That also makes it a timeframe, however, when it is more likely that you will show signs and symptoms of a thyroid condition known as postpartum thyroiditis.
Postpartum thyroiditis is a form of thyroiditis — inflammation of your thyroid gland — that takes place in the year after childbirth, miscarriage, or abortion.
What is Your Risk of Postpartum Thyroiditis?
Experts estimate that as many as 7 percent of women develop postpartum thyroiditis after pregnancy. You are at even greater risk of postpartum thyroiditis if:
You have type 1 diabetes. As much as 25 percent of women with type 1 diabetes are diagnosed with postpartum thyroiditis.
You have elevated antithyroid peroxidase (TPO) antibodies, indicative of Hashimoto’s disease. Up to 50 percent of women with elevated TPO antibodies — even with a normal thyroid stimulating hormone (TSH) level — develop postpartum thyroiditis.
You have a personal or family history of thyroid problems.
You have had postpartum thyroiditis after previous pregnancies.
What Are the Signs and Symptoms of Postpartum Thyroiditis?
Some of the most common signs of postpartum thyroiditis include:
Decreased milk volume in breastfeeding women
Inability to breastfeed
An enlarged thyroid gland (goiter), with neck swelling and discomfort
Rapid weight gain or weight loss
Inability to lose weight
In some cases, mild postpartum depression may be a symptom of postpartum thyroiditis as well.
As you can see, the challenge is that some of the symptoms of a thyroid problem after pregnancy are also common in new mothers. If you have recently had a baby and are experiencing these symptoms, your doctor may dismiss your symptoms as pregnancy and child-birth related. If that happens, specifically request or push for a complete thyroid evaluation to rule out a thyroid dysfunction as the cause of your symptoms.
What is the Typical Course of Postpartum Thyroiditis?
Typically, postpartum thyroiditis begins in the early months after childbirth. Most commonly, you will start out experiencing some hypothyroid symptoms, which can include fatigue, weight gain (or difficulty losing weight), constipation, puffiness in your hands, feet, and face, hair loss, and depression.
Over time, your thyroid starts to swing back toward normal, and then moves into mild overactivity or hyperthyroidism, usually around six months after your baby is born. At that point, you may notice an elevated heart rate, heart palpitations, anxiety, insomnia, diarrhea, and weight loss.
Following the hyperthyroid period, your thyroid typically slows back down, and normalizes, usually within a year after your baby is born.
How is Postpartum Thyroiditis Diagnosed?
If you have risks for, signs, and symptoms of postpartum thyroiditis, you should have a complete thyroid evaluation, including blood work. Common findings include:
High or high-normal TSH, and low or low-normal T4 and T3 during the hypothyroid phase
Low or low-normal TSH, and high or high-normal T4 and T3 during the hyperthyroid phase
Elevated TPO antibodies are common throughout the course of postpartum thyroiditis
If you are diagnosed with hyperthyroidism after pregnancy, make sure that your doctor does not diagnose you with or treat you for Graves’ disease without further evaluation and testing. While hyperthyroidism can be a symptom of Graves’ disease, after pregnancy it may also be this hyperthyroid phase of postpartum thyroiditis and does not require permanent treatment, as it may resolve itself in the course of the condition.
Note: If you in fact have Graves’ disease, you are likely to have more acute symptoms, as well as a large goiter, eye-related symptoms, and elevated thyroid stimulating immunoglobulins (TSI) — all indicative of Graves’ disease. A more conclusive Graves’ disease diagnosis can be made using a radioiodine uptake (RAI-U) test. This test is not typically done, however, if you are breastfeeding.
How is Postpartum Thyroiditis Treated?
When your symptoms are mild, and thyroid levels are borderline — as is often the case in postpartum thyroiditis — you may not receive treatment. The assumption is that your thyroid will normalize over time, and your symptoms will lessen and eventually disappear, usually within a year.
If your symptoms are more severe, your doctor will provide treatment.
The treatment for the hypothyroid phase is a thyroid hormone replacement drug like levothyroxine. Usually, you will be periodically rechecked, and your doctor will likely attempt to wean you off the medication over time, under the assumption that your thyroid will return to normal function.
Antithyroid drugs are not typically used or recommended during the hyperthyroid period of postpartum thyroiditis. The treatment for the hyperthyroid phase is typically beta-blockers such as propranolol or atenolol. These drugs help relieve some of the more acute hyperthyroid symptoms.
If you have postpartum thyroiditis, you should have frequent thyroid monitoring, ideally every two months in the year after childbirth.
What Are the Long-term Thyroid Risks After Postpartum Thyroiditis?
After you have had postpartum thyroiditis, you are at significantly greater risk of having the condition again after future pregnancies. According to researchers, 70 percent of women who have previously had postpartum thyroiditis develop it again in subsequent pregnancies. Make sure your physician is aware of your past thyroid history after childbirth.
Also, it’s important to know that as much as half the patients with postpartum thyroiditis go on to develop permanent hypothyroidism and/or goiter. This means that you are at a far greater risk of developing a thyroid condition in the years after childbirth. Make sure that you have regular thyroid examinations and screening, annually at the minimum, and be on the lookout for any signs and symptoms of thyroid dysfunction.
Note that some research suggests that if you have elevated TPO antibodies, supplementation with selenium before and during pregnancy may help reduce your risk of developing postpartum thyroiditis and hypothyroidism after your pregnancy.