I met Cynthia when she was pregnant with her second baby. It had taken her 6 years to decide to get pregnant again because she had such a devastating experience of postpartum depression after her first baby was born – all because of a missed diagnosis of Hashimoto’s thyroiditis.

Within 6 months of giving birth to baby number one, she’d gained 25 pounds on top of the 50 she’d gained in pregnancy. She was exhausted all of the time, and felt terrible that she was often too depressed to truly enjoy her baby. Everyone told her, “Oh, it’s just normal. You’re a new mom.”

After a year of suffering she started to wonder if she was crazy – and if she was ever going to recover. She finally found a doctor who appropriately diagnosed her with hypothyroidism, got her on medication, and her life was once again hers. But the trauma was so great that she was terrified to have another baby for fear that she’d go through that again.

Cynthia’s story may be on the extreme in terms of the 75-pound weight gain, but I’ve heard some version ofWhat New Moms Need to Know About Their Thyroid on Natural MD Radio with Aviva Rommthis story hundred of times.

Hypothyroidism, which primarily affects women, is a notoriously under-diagnosed condition. The fact that
the symptoms are so similar to what a woman might feel in the postpartum period – fatigue, overwhelm, hair loss, trouble losing baby weight, anxiety, and trouble sleeping, makes it even more likely that the diagnoses will be overlooked, with symptoms chalked up to “it’s normal to feel that way when you have a baby.”

Know the Symptoms

If you test positive for this in the first trimester or early second trimester, you are at a 40% to 60% higher risk that you could develop postpartum thyroiditis, which is why, in my opinion, it’s so worthwhile for all women to get checked for this antibody in their early pregnancy labs. If you know that you have this elevated antibody, you can start to do things to improve your antibodies.

Postpartum thyroiditis is going to show up in one of 3 ways:

  • Hyperthyroidism
  • Hypothyroidism
  • Or hyperthyroidism that lasts for a few weeks and then turns into hypothyroidism

Therefore, knowing the symptoms of both ends of the thyroid function spectrum can keep you alert to the possibility that you might be having a thyroid problem. It helps to think of your thyroid as the gas pedal on your car. Indeed, it is your thyroid that controls the rate of your energy use and metabolism, body temperature, heart rate, sex hormones, cognitive function, and it impacts mood and even cholesterol storage.

Hyperthyroidism

Hyperthyroidism is like having your foot pedal to the metal. You’re in overdrive. You’re amped up. And that explains the symptoms:

  • Nervousness, anxiety and irritability
  • Rapid heartbeat and palpitations
  • Intense appetite – famished, hungry all the time
  • Weight loss
  • Sweating
  • Difficulty sleeping
  • Fatigue
  • Frequent or loose stools

Hypothyroidism

Hypothyroidism is exactly the opposite. It’s like you can’t even make your foot press down on the gas pedal – your foot just won’t do it because you’re just too tired, you’re so run down, you’re so fatigued or exhausted. That explains the symptoms, too:

  • Fatigue or downright exhaustion
  • Depression
  • Decreased milk volume
  • Unexplained weight gain, inability to lose the “baby weight”
  • Constipation
  • Carpal tunnel syndrome, tendonitis, joint or muscles aches
  • Puffy face
  • Increased sensitivity to cold
  • Muscle weakness
  • Heavier than normal menstrual periods
  • Dry or brittle hair and nails, hair loss (can be confused with telogen effluvium by doctors)
  • High cholesterol

Moms tell me that postpartum hypothyroidism is like taking care of a baby with one hand, and pushing an 18-wheeler up Mount Kilimanjaro with the other. Impossibly exhausting.

Thyroid Lab Testing You’ll Want to Get

While I’m firmly opposed to medical over-testing, in the case of autoimmune thyroid disorders my motto is “test don’t guess.” When you get your standard first trimester prenatal blood work done, ask to have your TPO checked. If you test positive, you can both take preventative steps during pregnancy, which I’ll share in a minute, and you can be more prepared so that if you do have symptoms, you can get appropriate treatment ASAP.

If you’ve already had your baby, and experience any symptom of hyperthyroidism or hypothyroidism, go to your primary care provider and ask her to check your TSH, Free T4, Free T3, and your thyroid antibodies (this time get TPO and Anti-thyroglobulin antibody). See my article here on what your lab values should be.

I always recommend that when you’re getting checked for thyroid issues, also get checked for other things that can make you feel really exhausted. For example, iron deficiency anemia, especially if you lost a lot of blood at the birth or if you had heavy postpartum bleeding. That can make you feel really tired. It can make you feel depressed. It can make it harder to lose weight. You can also get checked for vitamin B-12 and vitamin D at the same time. Vitamin B-12 deficiency can make you very tired, and typically if you’re deficient in iron, you may also be deficient in B-12 and also vitamin D. Treating all of those at the same time is a good idea and bumping up your nutrition and using the appropriate supplements.

Be forewarned – what is recommended in conventional medicine is drastically different than what I think is optimal for women. In conventional medicine, the recommendation is frequently to hold off on treatment, and then retest in 6 or 12 weeks or so and see if the levels are still off.
A lot of doctors are also taught that you don’t need to treat new moms until the TSH is above 10. In my practice, I treat if a woman is symptomatic above 2.5. We’re talking about a fourfold difference right there. It’s really important to push that with your doctor; there is good evidence for treating “subclinical hypothyroidism” for everything from improving cognitive function to lowering cholesterol.

In my experience, not treating aggressively leads postpartum women to have basically 6 to 12 weeks of hell and then some because it can take weeks to get on the right medication at the right dosage for you. I am very low on the medication prescribing scale. I don’t even have a prescription pad. But when it comes to Hashimoto’s, particularly for new moms, the inability to produce enough breast milk if you’re trying to breastfeed, if you are unable to connect with your baby, if you’re depressed, if your body image is down because you can’t lose the weight or you’re gaining weight, not only to mention the potential for high cholesterol, I personally recommend starting low-dose medication and titrating up until the TSH and FT4 normalize. Proper treatment is life-transforming for new moms. I talk more extensively about how long to stay on thyroid medication, and specifically when and how to try to wean off, in this podcast. Most women who develop autoimmune thyroid disease in the postpartum will have a remission within a year; however, if at one year you are still hypothyroid, which is the most common problem to persist, there’s a 54% chance that you will remain so.

Steps You Can Take During Pregnancy to Prevent Postpartum Thyroiditis

The one therapy that has shown consistently good results for preventing postpartum thyroiditis in women with high antibodies during pregnant, whether or not they have been diagnosed with Hashimoto’s disease, is giving selenium during pregnancy, which seems to act as an anti-inflammatory in pregnant women with autoimmune hypothyroidism. It can actually reduce the chances of developing postpartum thyroiditis after baby is born. The typical dose is 200 micrograms daily, and you can start it in the first trimester.

You can also start an anti-inflammatory diet, removing common triggers of thyroid autoimmunity including gluten and gluten cross-reactives, and dairy. You can actually do an elimination diet while you’re pregnant as long as you’re making sure to get plenty of protein, vegetables, and good quality fats at each meal.

There are also other inflammatory triggers. Stress in itself is a big inflammatory trigger, but so are things like environmental toxins, particularly plastics from drinking out of plastic water bottles or storing or heating our foods in plastic containers, so be as thoughtful as you can. You don’t want to go drive yourself crazy, but really, truly being as thoughtful as you can with your cosmetics and your body products is important. Have them be BPA-free, phthalate-free, and paraben-free, particularly if you’re at risk.

Going Forward

If you are pregnant and you know you’ve had Hashimoto’s or postpartum hypothyroidism in the past, it’s really important to get tested and possibly be on medication from the get-go with the next pregnancy. If you do find that you stay hypothyroid indefinitely after baby, then you want to work with your primary provider to find the right medication for you so that you can live your life optimally without struggling with miserable exhausting symptoms that also keep you from being the mom you want to be.

You can Subscribe to the Podcast on iTunes or Soundcloud

“Seeing moms who are struggling with Hashimoto’s on top of the normal stress and fatigue of taking care of a baby – it’s got a whole new magnitude.” – Aviva Romm

Show Notes:

  • How thyroid problems affects your physical and cognitive energy
  • Why thyroid problems can make you doubt yourself as a mother
  • What is postpartum thyroiditis
  • The other root causes of Hashimoto’s that may be playing a role
  • What is transient hyperthyroidism
  • Why women should get checked for thyroid peroxidase antibody during their pregnancy
  • The risk of postpartum thyroiditis becoming permanent
  • The difference between hypo- and hyperthyroidism

“When your thyroid is not working properly, it has an impact on pretty much every system in your body.” – Aviva Romm

  • How hypothyroidism can lead to high cholesterol
  • What other tests you should look into when getting your thyroid tested
  • Who should get tested and how
  • Who is at high risk for developing postpartum thyroiditis
  • The difference between what I recommended and what traditional medicine recommends
  • What you can do to prevent developing postpartum thyroiditis
  • The value of a low inflammation diet
  • Why you have to find the best way to find your life optimally

Links Mentioned:

“It’s really important to be able to insist that you get this testing.” – Aviva Romm

References

American Thyroid Association, Thyroid in Pregnancy. (n.d.). Retrieved March 28, 2016, from http://www.thyroid.org/professionals/education-research/pregnancy-and-hypothyroidism/

Azizi F. The occurrence of permanent thyroid failure in patients with subclinical postpartum thyroiditis. Eur J Endocrinol 2005; 153:367.

Beardmore KS, Morris JM, Gallery ED. Excretion of antihypertensive medication into human breast milk: a systematic review. Hypertens Pregnancy 2002; 21:85.

De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97:2543.

Landek-Salgado MA, Gutenberg A, Lupi I, et al. Pregnancy, postpartum autoimmune thyroiditis, and autoimmune hypophysitis: intimate relationships. Autoimmun Rev 2010; 9:153.

Mazokopakis EE, Papadakis JA, Papadomanolaki MG, et al. Effects of 12 months treatment with L-selenomethionine on serum anti-TPO Levels in Patients with Hashimoto’s thyroiditis. Thyroid 2007; 17:609.

Negro R, Greco G, Mangieri T, et al. The influence of selenium supplementation on postpartum thyroid status in pregnant women with thyroid peroxidase autoantibodies. J Clin Endocrinol Metab 2007; 92:1263.

Nicholson, W.K., Robinson, K.A., Smallridge, R.C., Ladenson, P.W., Powe, N.R. Prevalence of postpartum thyroid dysfunction: a quantitative review. Thyroid 2006;16(6):573–82

Nicholson WK, Robinson KA, Smallridge RC, et al. Prevalence of postpartum thyroid dysfunction: a quantitative review. Thyroid 2006; 16:573.

Premawardhana LD, Parkes AB, Ammari F, et al. Postpartum thyroiditis and long-term thyroid status: prognostic influence of thyroid peroxidase antibodies and ultrasound echogenicity. J Clin Endocrinol Metab 2000; 85:71.

Premawardhana LD, Parkes AB, John R, et al. Thyroid peroxidase antibodies in early pregnancy: utility for prediction of postpartum thyroid dysfunction and implications for screening. Thyroid 2004; 14:610.

Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E.N., Soldin, O.P., Sullivan, S., and Wiersinga, W. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Retrieved from http://thyroidguidelines.net/pregnancy

Stagnaro-Green A, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Negro R. High rate of persistent hypothyroidism in a large-scale prospective study of postpartum thyroiditis in southern Italy. J Clin Endocrinol Metab 2011, 96:652–657

Stagnaro-Green A. Approach to the patient with postpartum thyroiditis. J Clin Endocrinol Metab 2012; 97:334.

Stagnaro-Green A, Abalovich M, Alexander E, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011; 21:1081.

23 Comments

  1. Thank you so much for all of the work you , it’s really incredible . I love listening to Natural MD radio as well .I was also told that my thyroid function was fine , of course I forgot to ask for the values but only TSH was tested. Instead the focus at my appointment was on my BMI and my mental health and symptoms were unaddressed at 8 months postpartum . I’m now 14 months postpartum after delivering my surrogate daughter 5th pregnancy and I am still feeling really out of sorts , I’ve noticed this to be the case after both of my surrogate pregnancies in which were conceived via IVF , lots of hormones used and they were both female. With both I gained 25lbs (which felt impossible to get rid of due to the fatigue and depression )AFTER I gave birth and my eyebrows are almost non existent and am / was completely fraught with chronic anxiety , depression and mental confusion . I’m glad I now have the tools and knowledge for not only my own health issues but the women and families I care for as a midwife Thanks again .

    • Hi Shelley,

      Thank you for sharing your story AND your incredibly kind words. Aviva sees every message! Sending you big healing love your way!!

      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  2. Hi, Aviva, I love your articles. I feel fatigue, I wake up a lot during the night. I have a baby, he is 1 year old and I still feel drained, exhausted, but mainly because of poor sleep. I got tested for TSH only and had 1.7, which as you say would be fine. Do you think I should get a full panel with other thyroid hormones or is that result for the TSH enough to discard any thyroid dysfunction? Thanks!

    • Hi Camila, Sounds like poor sleep is the issue because that’s a pretty good TSH. So I’d probably work on sleep, make sure your iron is good, and if in a few months you’re still wiped out, you can retest. Warmly, Aviva

  3. Hypothyroidism is definitely not fun. I was a newly singled parent working full-time, trying to be a good mom and I thought that was the reason I was exhausted and easily depressed 🙂 I thought, that is just the way it is!
    I went for a yearly physical and turns out my TSH was 189!! My cholesterol was also higher than normal.
    I was forcing myself to function (for my kids) but was too tired to eat (so was very thin not overweight) and no one even knew how I was feeling.
    I now take excellent care of myself and am not afraid to ask for help when I need it. I feel great!

  4. Excellent Aviva! Thank you so much for all this incredible information. I have had a tough postpartum time with both my kids. I am now 2 years out from my youngest and feel like I am slowly climbing out of a hole. I have had my thyroid tested a number of times and it is always low but ¨normal¨. I am going to get retested and see if I can find a doctor who may look into it more seriously. Thanks again for all your well researched information.

  5. Hi Aviva,

    Thank you for this information. I have a story similar to the one you mentioned, though we only found out I had Hashimotos after a miscarriage. Thankfully I started thyroid meds, got pregnant again an delivered a healthy sweet baby girl at home this past August. I suffered a lot of symptoms after her birth and my thyroid Doctor did not want to see me or change my dosage until 6 weeks, which was almost unbearable. It has taken months to get my TSH under 2, and they don’t even try to address the antibodies. I’m gluten free now. Suffering from some post partum depression and painful muscle spasms and headaches, still nursing my now 7 month old and third child. Hoping for improvement and wondering if there is more that can be done. My quality of life is very sad at the moment. I love my children but hate suffering through the days with them when I should be enjoying them, any thoughts? Thank you!

    • Hi Robynn, So sorry to hear you had such a struggle. Thank you for writing! Sounds like you might need a meds dose adjustment — and also how’s your iron? Sleep? Are you MTHFR and needing methylfolate? Lots of questions — someone to consult with locally? Warmly, Aviva

  6. I’d like to add that a lack of vitamin D can be a cause of thyroid-like symptoms too.
    The two years after birth have been a torture for me; low weight, fatigue, sick all the time (I’d catch any cold and be sick for 3 weeks…), feeling depressed, feeling weak and achy, allergies going crazy. I tried acupuncture, herbs, supplements, to no avail. I went to the doctor one day, crying because I couldn’t see the end of it; he barely listened to me, and after a 5-min meeting I went home with a prescription for an anti-depressant (which I didn’t take, I could feel there was something else), and a basic blood-check for my thyroid, for which the results were within “normal” range – but I didn’t feel normal. I finally went to see another dr who did a Vitamin D check on me, and it turned out I was very low. After a 4-month treatment I’m feeling back on track – but the two years I’ve spent with my daughter have been such a hard time!

  7. I went undiagnosed with hypothyroidism for 5 months after having my daughter, I was always so tired I never had any energy I could barely clean or be overly active with bubs. My sleep went to shit along with my body, just so sore and achey 24/7. I put 50kg on in those 5 months and ended up having horrendous night mares about me cutting the fat right off my body. It’s nasty, they don’t talk to pregnant women about it or worn. The. Being advised I’d have to wait for 3 months after seeing a specialist before I could get medicated/help was terrifying. How much weight was I going to gain in those 3 months!

    • Hi Christina,

      Thank you for sharing your story and I am so incredibly sorry to hear what you went through! It is incredibly frustrating which is why Aviva is essentially making a movement to ensure the women get the support they need.

      Love,
      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  8. Great Great Article! This is an ever increasing problem that mamas need to be more aware of! I myself have struggled with this before and after my son was born. It’s great to have your articles and your insights as resources for us other doctors helping mamas across other fields! Keep up the great work, Doc!

  9. Pregnant women can also consume selenium-rich foods like Brazil nuts, Lima beans and chia, sunflower, sesame and flaxseeds. The seeds are especially versatile since they can be added to cereal, salads and smoothies.

  10. Any chance you could add a little more on hyperthyroidism? Especially towards the end the majority is towards hypo. And if I am coping ok with milk production etc, and don’t want medication, what do you recommend? I love all your stuff and its so helpful! Many thanks, Eva

    • Hi Eva,

      Aviva will be covering hyperthyroidism in her next book!

      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  11. Hi Aviva,
    Thanks for your book and constant encouragement. I was diagnosed with Hashimotos hypothyroidism in 2014 and have been taking thyroid med since then. My TSH levels were between 2 and 3. I delivered my first baby on December 2016 and my TSH levels went down to 0.01. My physician asked me to stop the med. By March 2017, I was feeling super tired found that my TSH levels went back high. Now, I understand why! I started reading your book and it is very informative. I am tired of doctors constantly telling me there is no cure for Hashimotos and I need to take tablets life long. Thanks for the hope which you try to spread that there is still something we can do. Though I take med now, I still feel extremely tired. I hope I will get better soon.My question is: I am still breastfeeding. Is it safe to take your Hashimotos supplements while breastfeeding?or should I wait till I stop breastfeeding to start a healing diet.

    • Hi Rose – all of the supplements in my book have a symbol that indicated pregnancy and or breastfeeding safety status for herbs and supplements. 🙂 Warmly, Aviva

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