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Postpartum thyroiditisBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/postpartum-thyroiditis/DS01212
Postpartum thyroiditis is an uncommon condition in which a previously normal-functioning thyroid gland — a butterfly-shaped gland located at the base of your neck just below your Adam's apple — becomes inflamed within the first year after childbirth.
Postpartum thyroiditis often lasts several weeks to several months. However, postpartum thyroiditis can be difficult to recognize because its symptoms are often mistakenly attributed to the stress of having a newborn and postpartum mood disorders.
For most women who develop postpartum thyroiditis, thyroid function returns to normal within 12 to 18 months of the start of symptoms. However, some women who experience postpartum thyroiditis develop permanent complications.
During postpartum thyroiditis, you might experience two phases. The inflammation and release of thyroid hormone might first cause mild signs and symptoms similar to those of an overactive thyroid (hyperthyroidism), including:
- Rapid heartbeat or palpitations
- Unexplained weight loss
- Increased sensitivity to heat
These signs and symptoms typically occur one to four months after delivery and last one to three months.
Later, as thyroid cells become impaired, mild signs and symptoms of underactive thyroid (hypothyroidism) might develop, including:
- Lack of energy
- Increased sensitivity to cold
- Dry skin
- Difficulty concentrating
- Aches and pains
These signs and symptoms typically occur four to eight months after delivery and can last from nine to 12 months.
Keep in mind, however, that some women who have postpartum thyroiditis develop symptoms of only hyperthyroidism or only hypothyroidism, but not both.
The exact cause of postpartum thyroiditis isn't clear. However, women who develop postpartum thyroiditis often have high concentrations of anti-thyroid antibodies in early pregnancy and after childbirth. As a result, it's believed that women who develop postpartum thyroiditis likely have an underlying autoimmune thyroid condition that flares after childbirth due to fluctuations in immune function. This underlying condition appears to be very similar to Hashimoto's disease, in which your immune system attacks your thyroid gland.
You might be at increased risk of postpartum thyroiditis if you have:
- An autoimmune disorder, such as type 1 diabetes
- A history of postpartum thyroiditis
- High concentrations of anti-thyroid antibodies
- A history of previous thyroid problems
- A family history of thyroid problems
While further research is needed, some studies have also shown a link between postpartum thyroiditis and postpartum depression. As a result, if you have postpartum depression your doctor will likely check to see how your thyroid is functioning.
For most women who develop postpartum thyroiditis, thyroid function eventually returns to normal — typically within 12 to 18 months of the start of symptoms. However, some women who experience postpartum thyroiditis don't recover from the hypothyroid phase. As a result, they develop hypothyroidism, a condition in which your thyroid gland doesn't produce enough of certain important hormones.
Preparing for your appointment
You'll likely start by seeing your family doctor or a general practitioner. In some cases, you might be referred to a doctor who specializes in the body's hormone-secreting glands (endocrinologist).
Here's some information to help you get ready for your appointment and know what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance.
- Write down any symptoms you're experiencing, including any that might seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements you're taking.
- Take a family member or friend along, if possible. Someone who accompanies you might remember something that you missed or forgot.
- Write down questions to ask your doctor.
Preparing a list of questions will help you make the most of your time with your doctor. For postpartum thyroiditis, some basic questions to ask include:
- What is likely causing my symptoms or condition?
- Are there other possible causes for my symptoms or condition?
- What tests do I need?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- What are the alternatives to the primary approach you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there restrictions I need to follow?
- Should I see a specialist?
- Is there a generic alternative to the medicine you're prescribing?
- Are there brochures or other printed material I can take with me? What websites do you recommend?
Don't hesitate to ask any other relevant questions you have.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- When did you begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Do you have a prior history or family history of thyroid disease?
Tests and diagnosis
If you have signs and symptoms of postpartum thyroiditis, your doctor will check to see how your thyroid is functioning. He or she will use blood tests that measure the level of thyroid-stimulating hormone (TSH) and the level of the thyroid hormone thyroxine. If you have risk factors for postpartum thyroiditis, your doctor will likely test the functioning of your thyroid three and six months after delivery.
If your thyroid test results are abnormal, your doctor will likely recommend further testing within one to two weeks.
In addition, if you develop postpartum thyroiditis, your doctor will likely check your thyroid annually afterward to see if you develop hypothyroidism.
Treatments and drugs
Most women who develop postpartum thyroiditis don't need treatment during the hyperthyroid or hypothyroid phases of their condition. However, your doctor will likely monitor how your thyroid is functioning through blood tests every four to eight weeks. This will help him or her track whether abnormalities resolve themselves or detect the development of hypothyroidism.
If you develop severe signs and symptoms of hyperthyroidism, your doctor will likely recommend treatment with a drug that blocks the effects of thyroid hormone on the body (beta blocker). Beta blockers typically aren't recommended for women who are breast-feeding. However, the drug propranolol might be recommended because in breast milk it's not as concentrated as other beta blockers.
If you develop severe signs and symptoms of hypothyroidism, you'll likely need thyroid hormone therapy for six to 12 months. This treatment involves daily use of the synthetic thyroid hormone levothyroxine (Levothroid, Synthroid, others). When you stop taking the medication your doctor will monitor you for the development of hypothyroidism. You might need blood tests after two months, three months, six months and then, if your test results remains normal, annually.
Coping and support
The postpartum period often brings physical discomfort as well as emotional ups and downs. If you're diagnosed with postpartum thyroiditis, work with your health care provider to determine how you can safely manage your condition and your role as the mother of a newborn.
While you might not be able to prevent postpartum thyroiditis, you can take steps to care for yourself in the months after childbirth. If have any unusual signs or symptoms after childbirth, don't assume they're related to the stress of caring for a newborn. If you're at increased risk of postpartum thyroiditis, talk to your health care provider about how to monitor your health.
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