The potential aftermath of postpartum thyroiditis
Postpartum thyroiditis is a condition that affects the thyroid gland in the postpartum period. It typically occurs within the first year after giving birth and it can manifest in 2 ways:
1. An initial phase of HYPERTHYROIDISM (an overactive thyroid function): this can occur anytime from 4-8 weeks after the birth. The thyroid gland gets very inflamed and there is destruction of thyroid cells. Due to this, excessive amounts of thyroid hormones are released into the bloodstream.
This creates the 'hyper' thyroid state with the following symptoms:
Nervousness, anxiety, irritability, anger
Restlessness; difficulty relaxing or sitting still
Increased heart rate - palpitations, rapid pulse
Sweating - especially at night
Weight loss - unexplained weight loss or difficulty gaining weight despite an increased appetite
Fatigue - despite increased energy
Tremors - fine tremors in the hands
Heat sensitivity - feeling overly sensitive to heat
If you're thinking that some of these symptoms sound a lot like early motherhood, I agree! I also wonder how many mums write off (some of) these symptoms as just being in the trenches of early postpartum?
This hyperthyroid phase may be the result of the autoimmune response that attacks and damages thyroid tissue.
BLOOD TESTS:
On a full thyroid blood test, you’ll see a high T4 hormone level, a high T3 hormone level, a low TSH (thyroid stimulating hormone) level, and often no thyroid antibodies.
This phase is fairly fast to resolve and can improve with naturopathic treatments, and/or anti-thyroid drugs or carbimazole. The latter drug blocks the way your body processes iodine and therefore reduces the amount of thyroid hormones produced.
2. This is followed by a HYPOTHYROID phase (underactive thyroid function)
This usually occurs several months (>1 year) after the hyperthyroid stage. The thyroid gland becomes underactive and its overall production of thyroid hormones is lowered. This is because of a depletion in the cells that produce the thyroid hormones; a result of the initial attack.
This creates the 'hypo' thyroid state with the following symptoms:
Fatigue - profound fatigue or extreme tiredness (regardless of sleep quality)
Weight gain - unexplained weight gain, or difficulty losing weight
Depression – low mood, sadness, or even clinical depression
Dry skin - dry, flaky skin, brittle nails
Cold sensitivity - feeling excessively sensitive to cold temperatures, cold feet
Constipation - lack of urge for bowel movement and/or difficulty passing stools
Joint and muscle pain
Thinning hair - dry, brittle hair that breaks easily and sheds excessively
Puffy face
BLOOD TESTS:
On a full thyroid blood test, you’ll see a low T4 hormone, a low T3 hormone and a high TSH, with or without thyroid antibodies.
Not all mothers with postpartum thyroiditis will progress through both these phases. The severity and duration of each phase can also vary from mother to mother. Sometimes there is a 3rd phase around 6-12 months for mothers with known Hashimoto's thyroiditis with hypothyroid symptoms manifesting.
TREATMENT & RECOVERY
In many cases, postpartum thyroiditis resolves on its own without the need for medication or treatment. For those with mild symptoms, healthcare providers may choose to monitor the condition over time to see if it stabilises or improves without intervention.
Medications
If the symptoms are significant or the hypothyroid phase is prolonged, thyroid hormone replacement therapy (eg. levothyroxine) may be recommended. This medication provides the body with the thyroid hormone (T4) it's not producing adequately due to the autoimmune thyroiditis. The dosage is adjusted to maintain thyroid hormone levels within the normal range.
Carbimazole/PTU may be prescribed for the hyperthyroid phase. Some mothers are also prescribed beta-blocker medication when symptoms like rapid heart rate and anxiety are prominent.
Although these medications do not address the underlying thyroid dysfunction, they can help relieve some of the discomfort of symptoms.
Naturopathic Treatment
This does focus on the underlying thyroid dysfunction through the following:
Food as medicine; nutrient-dense, whole food diet with a focus on those foods rich in the thyroid essential nutrients, plus exclusion of potential immune drivers such as gluten, and perhaps dairy
Decrease the inflammation and stress on thyroid gland through selected nutraceuticals* such (e.g. antioxidants, NAC/glutathione, myoinositol, selenium, zinc, vitamin D, vitamin C)
Address the autoimmune component; identify the drivers and work to modulate the immune response using nutraceuticals and herbal medicine. This often involves working on the gut too.
Check and optimise thyroid nutrients*, eg. selenium, iodine, iron, vitamin D, zinc
Herbal medicines: there are certain herbs can support either the hyper or hypo stage.
*Always ensuring products and doses are breastfeeding-safe is applicable
The majority of mums with postpartum thyroiditis will return to normal thyroid function within 1-2 years. Although some do go on to develop chronic thyroid disorders, with the severity of these varying widely. Postpartum thyroidtis may eventuate to a diagnosis of chronic Hashimoto's thyroiditis or other autoimmune thyroid disorders.
THIS IS WHY it's so important to have full thyroid testing (TSH, T4, T3, Thyroid antibodies, Reverse T3) done at intervals (~6 months) after the initial postpartum thyroiditis diagnosis, even if medication was taken and symptoms improve.
Testing helps keep a close eye on things and if need be, treatment/s (naturopathic and/or medications) can be implemented sooner than later.
Being vigilant can help catch any longstanding effects of postpartum thyroiditis and more importantly, preserve the health and function of the thyroid gland as much as possible!
If another pregnancy is planned, mums are at an increased risk of experiencing postpartum thyroiditis again. This is a lot of stress on the little thyroid gland.
FROM THE CLINIC:
Recently I had an initial consultation with a mum of 3, who had her last baby nearly 6 years ago. She developed postpartum thyroiditis after her 2nd and 3rd pregnancies, and had been on thyroxine (T4) medication ever since.
She booked in to see me as she was feeling exhausted, anxious and was experiencing ongoing hair loss, constipation, heavy periods, brain fog and weight gain. She assumed it was “just part of being a mum of 3 under 10!”
We did some baseline thyroid blood tests (plus some nutrients like iron, vitamin D and zinc) and discovered she had a very sluggish thyroid function, wasn't utilising her thyroid medication very well and had very high thyroid antibodies that were damaging her thyroid gland! (still) She was also low in iron, vitamin D and zinc - all required by the thyroid to function optimally. We also tested her iodine level (via a urine test) as iodine is an essential component for making thyroid hormones. I wasn’t too surprised when her results came back as very low.
This was a huge breakthrough for her, and she felt everything she had been feeling had now been validated. I went on to devise a holistic Treatment Plan for her with a step-by-step approach. Instead of treating her individual list of symptoms (mentioned above) we began supporting her thyroid gland. Because so many of her symptoms were related to her underactive thyroid function.
We went on to correct her nutritional deficiencies/insufficiencies and support her body to utilise her T4 medication more efficiently. We did some vital work on her digestion and her gut microbiome, as both are strongly linked to the autoimmune component of Hashimotos thyroiditis. I supported her immune system, helping to modulate the autoimmune response. We improved her diet and reduced the 'inflammatory load’ on her body, also through her diet and supplements.
We also began addressing her stress load and supported her nervous system and adrenal health. Because this all affects thyroid health too.
Within 1-2 months, she began to feel some positive changes. When we did the first lot of follow-up blood tests around 3-4 months, her antibodies had begun to decrease and her thyroid hormones were beginning to look better. We still had some work to do (given how long this had probably been going on for her) but we were definitely heading in the right direction!
It is possible for some to get their Hashimotos hypothyroidism into remission - and this was our goal!