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 of this 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:
- 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.
When your thyroid is not working properly, it has an impact on pretty much every system in your body. @avivaromm
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
- Difficulty sleeping
- Frequent or loose stools
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
- Decreased milk volume
- Unexplained weight gain, inability to lose the “baby weight”
- 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.
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The Classic Postpartum Thyroid Patterns
Approximately 20 to 30 percent of women with postpartum thyroiditis have the characteristic sequence of hyperthyroidism, which usually begins one to four months after birth and lasts two to eight weeks, followed by hypothyroidism, which lasts from approximately two weeks to six months, and then the thyroid recovers. About 20 to 40 percent have only hyperthyroidism, and the remaining 40 to 50 percent have only hypothyroidism, which begins two to six months after birth. For some women, hypothyroidism becomes chronic, especially likely if symptoms and labs haven't resolved within a year of onset.
The Thyroid Lab Testing You’ll Need
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 article and 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.
Moms who are struggling with Hashimoto’s on top of the normal stresses of taking care of a baby – it’s a whole new magnitude. @avivaromm
Prevention Starts During Pregnancy
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.
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.
- Read my blog post about Thyroid Problems After Pregnancy: Ending Unnecessary Postpartum Suffering
- Read my blog post about How Being a Good Girl Can be Hazardous to Your Health
- Read my blog post about what thyroid labs to ask for
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