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Thyroid issues and PPMDs

Posted Jan 27 2009 7:17pm
UGH- So on Tuesday my doc ran a thyroid test on me. Since I was diagnosed with Postpartum Thyroiditis in Jan. 08 and it had been a year (6 months longer than I should have waited for a re-test) he wanted to see if my condition had improved. Today I got the news that at a broad level I am still experiencing hyperthyroidism. I am kind of bummed. I wish that I would have retested sooner in case I could have felt better for the last 6 months by making some changes. I procrastinated. :( At any rate, I have been extremely fatigued lately which seemed strange to me at first. When I asked the LNP about it she said that I could perhaps be tired from my thyroid working so hard and that even though most women with cases of hyper are anxious and literally hyper that my fatigue could be related. I hope so...Last night I slept for 8 hours and then took a 1.5 hour nap this morning because I was so exhausted. I hate that I feel so low on energy in the morning. It makes me sad because that's the time I would like to be spending with L. playing and having fun. I am supposed to go in for a full screen next week; I will keep you updated on the results. In the meantime, please read up on the relationship between thyroid issues and the postpartum period...

Hyperthyroidism – or having an overactive thyroid gland – can pose special concerns during pregnancy. When the body delivers too much thyroid hormone, both the mother and the baby can suffer. Miscarriages, premature births, and intrauterine growth retardation can occur when the disorder goes undiagnosed or untreated. Pregnant women with hyperthyroidism can also develop high blood pressure, and are at greater risk of heart conditions.

Nearly all new mothers find that the weeks and months following the birth of a baby are difficult – most report some pain after childbirth, worry over the baby’s health, sleep deprivation, feeding anxiety, especially if the baby is not nursing well, fatigue, mental confusion, and of course, the infamous “baby blues.” While all these symptoms are normal, most disappear within a few months.

But some women suffer more intense, longer-lasting postpartum troubles that can threaten their own and their baby’s health – and these troubles may be directly related to the thyroid.

". . . as many as 10 percent of women may suffer thyroid problems after childbirth."

If you feel exhausted, depressed or are having trouble concentrating beyond the initial postpartum period, or you are really struggling more than other new mothers with debilitating fatigue, hair loss, and depression, you should ask your doctor to check your thyroid levels.

Postpartum thyroid difficulties are common – as many as 10 percent of women may suffer thyroid problems after childbirth. Thyroid disease can surface in someone who has never had thyroid problems before – or in women who have been previously diagnosed with hypo- or hyperthyroidism.

Let’s look at some of the more common questions and concerns about the thyroid in the postpartum period:

I’ve never had a problem with my thyroid gland before – but now I’ve been diagnosed with postpartum thyroiditis. What is it, how did I get it?

Postpartum thyroiditis is a condition in which the thyroid becomes inflamed and dysfunctional after delivery, due to antibodies. Antithyroid antibodies circulate in the body, causing either too much or too little thyroid hormone to be released. Too much thyroid hormone will cause you to have an overactive thyroid gland, while too little will result in an underactive thyroid.

Postpartum thyroiditis typically follows a pattern: at first, you become hyperthyroid, and might feel breathless, nervous, mentally confused, have unexplained weight loss, or trouble sleeping. This phase usually appears anytime between one and four months after the birth of the baby.

In the second phase, which usually shows up three to eight months postpartum, the body’s hormones are again out of whack. Instead of releasing too much thyroid hormone, the body releases too little, and you become thypothyroid. Symptoms of this stage might be depression, fatigue, weight gain or difficulty losing weight, and an enlarged thyroid gland or sensation of pressure in your neck. Checking your TSH levels will clue you – and your healthcare providers - as to what’s going on.

In my case, my postpartum TSH bounced around like a rubber ball. I went from hyperthyroid immediately postpartum, to the top of the normal range, nearing hypothyroid levels, just weeks later, back to hyperthyroid, and back to hypothyroid, with only tiny dosage adjustments. It appeared that my hormones were fluctuating wildly.

It's well known that the postpartum period can trigger a variety of thyroid and hormonal problems in women who have never had any thyroid problems prior to pregnancy. In someone who is already "hormonally compromised," it's even more likely that the postpartum period can be a period of hormonal upheaval.

If I have postpartum thyroid problems, will I have thyroid problems forever?

It's impossible to say. A majority of women will return to normal, several months to as much as a year after postpartum thyroid diagnosis, and will never have another problem. Otherh women have postpartum thyroid problems after every pregnancy, but otherwise things return to normal, until menopause. Some women – possibly as many as 30 percent, however – remain hypothyroid because their thyroid glands were too heavily damaged by the imbalance, or because the pregnancy has activated an inherent case of autoimmune thyroid disease.

For those who have a gradual return to normal, you and your doctor will need to do frequent TSH tests in order to monitor your drug dosages and gradually taper you off as your TSH returns to normal.

Keep in mind, however, that once you've had an episode of postpartum thyroid problems, you are much more likely to later develop a thyroid problem during a period of stress, subsequent pregnancy, or during menopause.

What can I take to treat this?

Patients who are hyperthyroid can take beta-blockers like Atenolol or Propranolol. In some cases, antithyroid drugs may be given. Again, choice of antithyroid drug -- Tapazole or PTU -- depends on whether you are breastfeeding, because breastfeeding mothers cannot take Tapazole.

Hypothyroid patients will be prescribed thyroid hormone replacement, such as Synthroid, Levoxyl, Unithroid, Armour, or Thyrolar.

Ever since I had my baby, I’ve been horribly depressed. Even though he’s six months old, and a wonderful, healthy baby, I don’t even want to get out of bed in the morning. Is this just postpartum depression, or is there something more going on?

It could be true postpartum depression, it could be sleep deprivation, it could be other hormones at work. The only way to find out is to talk to your doctor, and have some tests run.

In my case, when my daughter Julia was around five months old, I still couldn't shake the major exhaustion, and a gray, depressed feeling that had descended on me about a month after her birth. I went to my regular doctor, sure that I must be suffering from postpartum depression. The doctor, however, decided to run some hormone tests before recommending an antidepressant. It's a good thing she did, because she discovered that I had various hormonal imbalances in addition to my thyroid edging out of normal range into hypothyroid TSH levels again. She prescribed some natural hormone replacement and changed my thyroid hormone dosage, and soon, it was as if the fog had lifted and the world was a happy place again.

Fairly early on postpartum, pay close attention to symptoms of any hormonal imbalances, and have all your hormone levels tested periodically, including thyroid, progesterone, testosterone, and estrogen as well.

In order to correctly diagnose postpartum thyroiditis, your healthcare provider first needs to distinguish it from Graves’ disease. To diagnose Graves, he or she can perform a radioactive iodine update test, as well as taking TSH and T4 level readings. A diagnosis of Graves’ disease would show a high reading of radioactive iodine uptake, while postpartum thyroiditis would show a low one.

If you are nursing, you’ll need to stop for three to five days, since radioactive iodine can appear in breast milk.

I had postpartum thyroiditis after my first pregnancy, got treated, and felt back to normal in a few months. Now I’m pregnant again…is it likely to reoccur?

No one knows for sure. However, if you have a prior experience with postpartum thyroiditis, it is possible that you will get it again. Talk to your doctor about your chances, and be proactive in getting follow-up appointments and retests of TSH and T4 during pregnancy and after delivery.

Help – I’m desperately trying to nurse my new daughter, and it’s just not working out. She’s not having enough bowel movements or wet diapers, and she just doesn’t seem satisfied at the breast. I’ve checked with lactation consultants and they say the baby’s positioning is just fine, and that I just need to feed her more often. I don’t think I’m making enough milk. Could this have anything at all to do with my thyroid disorder?

It very well could have EVERYTHING to do with your thyroid disorder. Often, a period of low milk supply may in fact be a sign of postpartum thyroid problems. However, only a check of your TSH and T4 levels will uncover the truth. In the meantime, continue working with your lactation consultant. For in-depth information on breastfeeding with thyroid problems, see: Breastfeeding and Thyroid Disease.
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