Dr. Jolene Brighten, Guest
Many New Mothers Develop Postpartum Thyroid Conditions
Fatigue, weight loss or gain, anxiety and irritability are all just part of being a mother, right? Not necessarily. In fact, when these symptoms persist, they may be a sign of a bigger underlying issue.
While we expect there to be some level of fatigue, many mothers find themselves in my practice after being told their severe exhaustion, debilitating anxiety and fluctuations in weight are just part of being a mom.
The truth is, all of these symptoms may be a sign of postpartum thyroiditis, a condition that affects an estimated 1 in 12 women worldwide and is almost 6 times more likely to occur in women who have positive anti-TPO antibodies.
With anywhere between 10-17% of new mothers (that’s hundreds of thousands of women every year) developing a postpartum thyroid condition, it is a wonder this isn’t screened regularly in new mothers—especially in those women who have risk factors.
Risk For Developing Postpartum Thyroiditis:
- Previous postpartum thyroid condition
- History of hypothyroidism prior to or during pregnancy
- History of elevated TPO antibodies preconception or during pregnancy
- History of other autoimmune conditions, especially Type I Diabetes
- History of depression, especially postpartum
What Does Postpartum Thyroiditis Look Like?
Hyperthyroidism, the state of having too much thyroid hormone, often develops 1-4 months after birth and is the main presenting condition in an estimated 20-40% of women. In some cases, this will be the only presenting symptoms, but in the majority of cases, hypothyroid symptoms follow. In other women (approximately 50% of cases), hypothyroid symptoms will develop in the absence of hyperthyroidism. The most common time to see hypothyroid symptoms is between 2 weeks to 6 months postpartum.
Hyperthyroidism often goes undiagnosed due to the early presentation and the fact that sleep disruption, anxiety (especially about baby’s health), and feeling more stressed can be common for a new mother. Similarly, hypothyroidism can present with fatigue and depression around the same time we classically see postpartum depression develop. Does that mean your symptoms aren’t real? Not at all!
- Weight loss
- Sleep disturbance
- Loose stools
- Heat intolerance or feeling flushed
- Racing heart or heart palpitations
- Decreased milk supply
- Muscle aches/ Joint pain
- Dry skin
- Cold intolerance
- Changes in voice
- Weight gain
- Carpal Tunnel
- Loss of the lateral 3rd of your eyebrows
Regardless of how postpartum thyroiditis first presents, many women also experience a swollen, non-tender thyroid and may even have difficulty swallowing. I can remember the discomfort I experienced with just swallowing liquids and the sense of always needing to clear my throat.
What To Do If You Suspect Postpartum Thyroiditis:
Have Appropriate Lab Testing: I recommend having TSH, free T3, free T4, Reverse T3, Anti-Thyroglobulin and Anti-TPO antibodies tested at 3-6 months postpartum, sooner if symptoms arise. In my practice, I test women beginning at 4-8 weeks postpartum if there was an elevation of Anti-TPO antibodies prior or during conception, family history of a thyroid condition, previous history of postpartum thyroiditis or if the patient has a history of other autoimmune conditions (like Celiac or Type I Diabetes). In some patients, I recommend testing as early as 2 weeks postpartum, but find that many mothers will not have significant enough changes in their thyroid markers at that point to rule in or out postpartum thyroiditis.
In addition to the thyroid lab panel, I also recommend the following labs:
- CRP: A marker of inflammation
- CBC: Screens for anemias
- Ferritin: The storage form of iron. Iron is necessary for thyroid hormone production.
- B12, Folate, Homocysteine: Gives information about B vitamin utilization.
- Vitamin D3: Important vitamin in immune system and thyroid health. Knowing your vitamin D status will help you determine how much vitamin D is necessary for supplementations.
Depending on your symptoms, additional lab testing may be appropriate.
Selenium 200 mcg daily has been shown to lower thyroid antibodies and is an important nutrient for thyroid hormone production. If you are currently pregnant and at risk, you can begin selenium during your pregnancy.
Do NOT Begin Iodine! While iodine is necessary for thyroid hormone synthesis, it can aggravate autoimmunity when taken in excess. All pregnant women should receive about 300 mcg of iodine daily, which includes food. Iodine is necessary for fetal development as well as your thyroid health, but once baby is born, adding extra iodine is of little help to postpartum thyroiditis and can actually cause harm.
Begin Fish Oil. Omega-3 fatty acids, especially EPA, reduce inflammation in your body. I generally recommend patients begin with 1,000-2,000 mg of total Omega-3s daily. Some patients require more, but it is important to check in with your doctor before exceeding levels of 2,000 mg.
Consider Thyroid Medication. While no one likes the idea of beginning a medication, sometimes they are necessary. If your symptoms are robbing you of your life, talking to your doctor about beginning a thyroid medication may be necessary. Left untreated, symptoms can progress and become debilitating. Common thyroid medications include Levothyroxine (synthetic T4), Cytomel (synthetic T3), and Natural Dessicated Thyroid (NDT) such as Armour, Nature-Throid and WP Thyroid. If you do begin medication, remember, this may not be permanent. In fact, 70-80% of women recover normal thyroid function after the first year postpartum. Working with an experienced practitioner who treats the whole person can help you reverse your autoimmunity and regain full thyroid function.
Find the Root Cause. While childbirth may have triggered your postpartum thyroiditis, there are other factors involved in the development of this condition. I encourage you to find a Naturopathic or Functional Medicine practitioner who will help you explore gut health, chronic viruses, heavy metal toxicity, environmental toxins, food sensitivities and lifestyle factors that may be contributing to your autoimmunity.
Approximately 20-30% of women will develop a lifelong thyroid condition after postpartum thyroiditis. If you’ve ever had postpartum thyroiditis, you have approximately 40-50% risk of developing it again with subsequent pregnancies— at which point, it may become permanent.
My intention is not to scare you with this information, but rather, I want you to be informed and able to advocate for yourself. Many doctors are of the mindset that postpartum thyroiditis is a transient inconvenience, when in fact, it is a very serious condition.
About the Author
Dr. Jolene Brighten is a Naturopathic Doctor. Before earning her Doctorate of Naturopathic Medicine at the National University of Natural Medicine, she received a BS in Nutrition Science and completed graduate coursework in Molecular Nutrition at Cal Poly, SLO. She is a Holistic Pelvic Care™ specialist and has trained extensively in Biotherapeutic Drainage, Integrative Women’s Health, and chronic disease management. She’s also a certified yoga instructor and a mother to one beautiful boy. She shares more about postpartum thyroid disease and natural treatments to reverse autoimmunity in her bestselling book, Healing Your Body Naturally After Childbirth: The New Mom’s Guide to Navigating the Fourth Trimester. Be sure to check out Dr. Brighten’s website here, and follow her on Facebook, Twitter and Instagram.
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