Your Thyroid During the Postpartum Period

The 12 months after giving birth can feel like a roller coaster under the best circumstances.  Sleep deprivation and fluctuating hormones combined with the stress of adding a newborn to the household leave new mothers and veterans alike feeling elated one moment and tearful and anxious the next.  In the midst of all this fluctuating emotion changes in how a woman’s thyroid is functioning are often missed.  

The thyroid is a butterfly-shaped gland in the neck.  When it is functioning properly your thyroid keeps the rest of your body humming along at an appropriate clip.  But if the thyroid starts making too much or too little thyroid hormone the body can speed up or slow down, leading to symptoms.

The postpartum period (the 12 months after giving birth) is physically and emotionally stressful.  Additionally, the immune system is shifting.  All these changes make new thyroid problems especially common.  However, the symptoms of thyroid diseases are so vague that they are often missed by women and their doctors.

Postpartum thyroiditis is among the most common thyroid issues during this time.  This inflammatory process causes a brief period of hyperthyroidism.  During this time which typically lasts from 4 to 6 weeks, a woman may feel especially energetic.  She may lose weight easily.  But she can also have palpitations, feel jittery or anxious and have trouble sleeping.  Because these symptoms are temporary, they have often passed before a woman sees her doctor.  

Then the thyroid shifts and becomes sluggish.  Suddenly, the same woman feels tired all the time,  and often depressed.  She may struggle with weight loss or may regain some of the weight she so easily lost a few weeks before.  And in nursing mothers, milk supply may decrease.  This time can last for several weeks or even months, and in some women represents the beginning of permanent hypothyroidism.  

This is typically the phase of thyroiditis that brings women to their doctor.  However, some women assume fatigue and depression are just normal postpartum changes.  Those women who do seek help are often told new mothers are always tired and many have “baby blues.”  An examination may be unrevealing.  Only lab tests can determine if thyroiditis is present.

When should you see your doctor if you think you have postpartum thyroiditis?  I tell my patients, if baby is sleeping at 3 a.m. and you are awake staring at the ceiling, feeling like a motor is running inside you, it is time to have your thyroid levels checked.  If you are feeling tired even after getting a few consecutive hours of sleep or you are experiencing depression, it is always worth asking to have your thyroid levels checked.  Your PCP or obstetrician should be able to check thyroid levels.

Treatment varies widely among physicians.  Some physicians will wait to start treatment as this may hasten the thyroid to start functioning properly on its own.  Others will prescribe thyroid hormone, to help improve the symptoms of fatigue and depression, even if they think it will only be needed temporarily.  Neither option is right.  What is most important is to discuss with your doctor why they are choosing one course of action over the other, and that you are comfortable with the plan.

The postpartum months are full of change and challenge.  However, if it feels too exhausting or overwhelming it is always right to seek help.  Postpartum thyroiditis may be one cause of these feelings and treatment may be appropriate.

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