Postpartum Thyroiditis: All You Need to Know

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Congratulations, you’re a new mom! If you’re like most new mothers, you’re too busy with middle of the night feedings, diaper changing, and simply marveling at your beautiful baby’s ten tiny fingers and ten tiny toes to pay much attention to your health. 

Let’s face it: After childbirth, most of us are tired and brain fogged, not to mention toting around some extra baby weight we want to shed. It’s also normal to go through some anxiety and emotional ups and downs—especially if it’s your first baby!

But if you are going through extreme exhaustion, having a major problem sleeping, or anxiety and depression are making it hard to even care for your baby, you may be going through more than normal “baby blues”.

Here’s the deal: The hormonal demands of pregnancy and childbirth put your thyroid through the wringer. As a result, some new moms develop a temporary condition called postpartum thyroiditis. 

Your Risk for Postpartum Thyroiditis

Around 7% of women develop postpartum thyroiditis with no known risk factors. But your risk is much higher if:

• You have a history of thyroid problems in the past, especially a history of postpartum thyroiditis after an earlier pregnancy, miscarriage, or abortion. 
• You have family members with thyroid problems.
• You have elevated Hashimoto’s antibodies—known as thyroid peroxidase (TPO) antibodies. About 50% of women with elevated TPO antibodies go on to develop postpartum thyroid problems.
• You have type 1 diabetes. Around 25% of women with type 1 diabetes also develop postpartum thyroiditis after pregnancy. 

Signs and Symptoms of Postpartum Thyroiditis

The signs and symptoms of postpartum thyroiditis are similar to (but usually far more intense than) the normal after-effects of childbirth. How do you know that you might have postpartum thyroiditis? 

• You aren’t producing any milk to breastfeed, or you are producing so little that you need to supplement with formula, or your baby is hungry and losing weight
• You are significantly depressed, and maybe even diagnosed with postpartum depression (PPD)—or you’re so anxious—and it’s getting in the way of your daily functioning and ability to care for and enjoy your baby
• You are losing noticeable amounts of hair
• You are exhausted, far beyond what’s normal for a new mother
• Even when there’s time to sleep, your sleep is disrupted, or you have insomnia
• You notice an enlargement in your neck, or have swelling, sensitivity, or discomfort in your neck area
• You lost weight very rapidly after childbirth (unusually fast); or the opposite (you can’t lose a pound), or maybe you’re even gaining weight.

Some other common symptoms include constipation or diarrhea, severely dry skin, puffiness in your hands or feet, puffiness around your eyes, dry eyes, and loss of outer eyebrow hair. 

Postpartum thyroiditis symptoms are like a seesaw. The condition usually starts off with a slowdown of your thyroid gland (hypothyroidism) in the weeks or months after childbirth. This is when everything is sluggish, your weight gets stuck, and you can feel tired, puffy, and down in the dumps. 

A few weeks or months later, the thyroid switches into overdrive (hyperthyroidism). You may lose weight rapidly or have insomnia. You can feel extremely anxious, with a rapid heart rate and even heart palpitations. 

Over time, many women will eventually see their thyroid swing back to normal (usually at around the one-year point after childbirth). The hypothyroid and hyperthyroid stages of postpartum thyroiditis can, however, be truly debilitating, and may warrant treatment to help you feel your best. 

If you are experiencing any of the above symptoms, it’s time to see your doctor for a thyroid check-up. It might be tempting for you—and your doctor—to write off many of these symptoms as “normal” for a new mother. When the symptoms are mild or temporary, they can be normal. But why risk having an undiagnosed case of postpartum thyroiditis, especially given the fact that you could feel this way for months (even up to a year!) after your baby is born? There’s no reason to suffer needlessly, especially at a time when you need your energy and focus for your new baby. 

Getting Diagnosed

Diagnosis of postpartum thyroiditis typically requires several tests: 

• Thyroid Stimulating Hormone (TSH) 
• Free Thyroxine (Free T4)
• Free Triiodothyronine (Free T3)

You’re looking for a pattern that suggests hyperthyroidism (lower TSH, higher Free T4, higher Free T3), or a pattern that suggests hypothyroidism (higher TSH, lower Free T4, lower Free T3). 

Because pregnancy can be a trigger for autoimmune thyroid disease, if your levels are borderline or out of the reference range, you should also have thyroid antibody tests. 

• If your levels fall towards hyperthyroidism, the Thyroid Stimulating Immunoglobulin (TSI) and TPO antibodies tests can help diagnose Graves’ disease or Hashimoto’s thyroiditis. 
• If you are more in the hypothyroid range, a TPO antibodies test can show if you have underlying Hashimoto’s thyroiditis.

Treatment

If your symptoms are mild, and your levels aren’t outside the reference range, your doctor may recommend simply monitoring your thyroid. Over time, symptoms should become less noticeable and eventually your thyroid should return to normal. 

If your symptoms are debilitating and your blood tests show an imbalance, your doctor can prescribe treatments, including: 

• For the hypothyroid phase of postpartum thyroiditis: A thyroid hormone replacement drug, like levothyroxine (Synthroid, Levoxyl), or natural desiccated thyroid (Nature-throid, Armour). 
• For the hyperthyroid phase of postpartum thyroiditis: A beta blocker drug (like propranolol or atenolol) to help lower thyroid hormone, slow heart rate, and reduce palpitations. (Note: Antithyroid drugs like methimazole or PTU aren’t used to treat the hyperthyroid phase of postpartum thyroiditis.) 

IMPORTANT TIP: Because thyroid function fluctuates during the different phases of postpartum thyroiditis, you should have your thyroid levels checked often during your treatment for postpartum thyroiditis, so the dosage can be adjusted, or treatment stopped entirely when appropriate. 

UP NEXT: A GUIDE TO OPTIMIZING YOUR THYROID MEDICATION

Into the Future

Keep in mind that once you’ve had postpartum thyroiditis, you’re at a much higher risk of recurrence. Research shows that 70% of women with postpartum thyroiditis will get it again in a future pregnancy. 

Additionally, around 50% of women with postpartum thyroiditis end up developing full hypothyroidism. And it’s not necessarily going to happen in the year after childbirth—it may be up to several years later. 

Therefore, even if your postpartum thyroiditis is resolved, make sure that you still have a periodic thyroid exam from your doctor (along with a thyroid blood test panel) so that if you do develop hypothyroidism, you can be diagnosed and treated as quickly as possible.