Guide to Postpartum Thyroiditis: Why you may not be feeling like yourself!
Updated April 2023
Entering the postpartum period can be incredibly exhausting. Not only are you raising a human being, but you're also in recovering! Moreover, you're likely exhausted from a lack of sleep, worried about producing enough milk, losing hair, having difficulty losing weight and may be experiencing symptoms of postpartum depression. Many of the symptoms that new moms experience are also seen in thyroid conditions - like postpartum thyroiditis.
Postpartum thyroiditis is a thyroid condition that occurs in women who previously had a thyroid disease or just delivered a baby. This is a disease of the thyroid gland, a butterfly-shaped gland located at the front of the neck which produces hormones that regulate metabolism and helps control the body's organs.
It’s important to know that postpartum thyroiditis can still happen if you’re taking thyroid medication like levothyroxine or if you’ve experienced a miscarriage/pregnancy loss.
Risk Factors of Postpartum Thyroiditis
You should be assessed if you have the following risks:
Personal or Family History of Autoimmune disorders
Type 1 Diabetes Mellitus
Chronic Viral Hepatitis
Lupus
Prior History of Gestational Diabetes
Anti-pituitary antibodies
Positive anti-thyroid antibodies (risk correlates with antibody levels, the higher the antibody the higher the risk)
History of previous thyroid dysfunction
History of previous postpartum thyroiditis
Family history of thyroid dysfunction
Phases of Postpartum Thyroiditis
During postpartum thyroiditis, you might switch between hyperthyroidism and hypothyroidism. Hyperthyroidism may occur 1-4 months after delivery, while hypothyroidism may occur 4-8 months after delivery.
Hyperthyroidism
Hyperthyroidism occurs when the thyroid is overactive and overproducing T3 and T4 (thyroid hormones), with a low thyroid stimulating hormone (TSH).
Symptoms of Hyperthyroidism
Anxiety
Fatigue
Heart palpitations
Insomnia
Irritability
Nervousness
Sensitivity to heat
Tremor
Weight loss
Signs of Hyperthyroidism
Shortness of breath
Increased appetite
Increased sweating
Fast heart rate
Frequent bowel movements
Fine, brittle hair
Thinning skin
Increased menstrual cycle length
Scanty menstrual flow
Hypothyroidism
Hypothyroidism occurs when the thyroid function is under active and isn't producing enough T3 or T4. Moreover, TSH level is elevated because it's trying to 'turn' the thyroid on and produce more hormones.
Symptoms of Hypothyroidism
Fatigue or low energy
Unexplained weight gain or
Difficulty losing weight
Constipation
Intolerance to cold temperature
Tender, stiff or weak muscles
Pain, stiffness or swelling in joints
Depression
Difficulty concentrating and impaired memory
Irritability
Decreased libido
Infertility
Signs of Hypothyroidism
Reduced resting body temperature
Goitre
Slow heart rate
Hair loss
Brittle nails
Dry skin
Heavy menstrual periods
Irregular menstrual periods
Lab Tests for the Thyroid
Diagnosing a thyroid condition involves both symptoms and blood work. Ideally women should be getting a thyroid function test prior to pregnancy (as the thyroid can have important implications in neonatal neurodevelopment), and in the postpartum as well.
TSH: Thyroid stimulating hormone is the best test for both hyperthyroidism and hypothyroidism. In hyperthyroidism, TSH will be decreased while in hypothyroidism TSH will be increased.
Optimal range for TSH is 1-2 mIU/L (non-pregnant patients)
Free T4: This is the storage form of the thyroid hormone.
Optimal range is 14-18 pmol/L (non-pregnant patients)
Free T3: This is the active form of thyroid hormone. The thyroid should be making T3 and the peripheral tissues (like the liver and kidneys) should be converting T4 to T3.
Optimal range is 5-6 pmol/L (non-pregnant patients)
Anti-TPO: This is the antithyroid peroxidase antibody, which will be elevated in autoimmune thyroid disorders. It signifies autoimmune thyroid disease, and the higher the level, the greater oxidative stress within the thyroid gland. It is an indicator of future thyroid disease.
Thyroglobulin:
When to Test
Consider having a thyroid panel done around 6-12 weeks postpartum for the following risk facors/situations:
High risk: previous PPT, Grave's disease, Hashimoto's thyroiditis on medication, known TPOAb positivity, abnormal TSH in pregnancy
Type 1 Diabetes
Non-thyroid autoimmune disease
Chronic Hepatitis C
Low milk supply or difficulty lactating
Postpartum depression
Monitoring your thyroid should take place on an annual basis if you’ve had postpartum thyroiditis and your thyroid has returned to ‘normal’
Next Steps
As I previously mentioned, in order to determine if you have postpartum thyroiditis it's best to look at your symptoms and blood work. Moms should also remember that many factors can affect the health of the thyroid - for instance an iron deficiency can decrease levels of thyroid hormone and prevent conversion from the inactive to active form. Plus, iron deficiency can also be a cause for fatigue and hair loss!
Because the thyroid plays such a critical role in our health, it's important to work together with a health professional (like a ND!) to go about healing and restoring normal thyroid function. With my patients, I take a look at their entire health history to see what exactly is being affected by suboptimal thyroid levels and how to go about healing - rather than tackling everything at once and potentially causing the body more stress.
So if you're a mom experiencing exhaustion, hair loss, depression or even a low body temperature - it could be because of your thyroid! Book an appointment with a ND because this doesn't need to be your new 'normal!'
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