Thyroid Problems after Pregnancy

A young mother looking depressed and unwell

Post pregnancy thyroid problems are quite common for mothers just after giving birth. Surprisingly, the risk of a postpartum thyroid condition developing can be as high as twenty percent, with rates increasing in women who already have pre-existing conditions like diabetes. In fact, women who have experienced this condition before are forty percent more likely to develop it again. This article will help you understand the causes, complications and treatment methods to combat postpartum thyroid problems.

What is Thyroid?

 Thyroid gland in women

The thyroid is a small butterfly-shaped endocrine gland located in the anterior of the throat. Endocrine glands are those which produce hormones essential for the body, in this case, thyroid hormones, T3 and T4. These hormones are essential in metabolism that is in the cellular production of energy. They are also important in the regulation of body temperature as well as organ functioning.

How can Childbirth Affect your Thyroid Condition?

Thyroid problems after pregnancy are often underestimated and overlooked conditions. Due to this, it takes quite some time for mothers to be diagnosed correctly and receive the appropriate treatment. There are three main types of thyroid diseases:

1. Hypothyroidism

Hypothyroidism is due to the thyroid gland functioning at low levels, producing lesser thyroid hormones than required. Symptoms include fatigue, weight gain, constipation and body aches. Hypothyroidism can be controlled by administering the synthetic hormone, levothyroxine, which can make up for the lack of thyroid hormones. Levothyroxine has minimal to no side effects and can be taken indefinitely without any long-term complications. Approximately half the women with postpartum hypothyroidism develop a more severe case called Hashimoto’s Thyroiditis, which can be treated by increasing the medication dose.

2. Hyperthyroidism

Hyperthyroidism is caused when the thyroid gland overproduces hormones. It affects less than one percent of pregnant women. An autoimmune disease known as Graves’ disease is often the cause of hyperthyroidism. During pregnancy, this condition can cause preterm labour, hypertension, placental abruptions, uterine tearing, preeclampsia and so on. Treating hyperthyroidism involves a range of antithyroid medications, such as propylthiouracil and methimazole. The risks associated with these medications are rare but they can sometimes lead to birth defects. In order to avoid this, your doctor might recommend a minor surgery known as a thyroidectomy. In this case, the surgical procedure removes part of or the entire thyroid gland in order to avoid the symptoms of hyperthyroidism symptoms.

3. Postpartum Thyroiditis

Postpartum thyroiditis is a rare disease wherein a perfectly functional thyroid gland undergoes inflammation within the first few months after giving birth. It can take a few weeks to several months or even years to subside. This condition is tricky to diagnose as the signs are often confused with postpartum depression and stress that most new mothers go through after childbirth. While most mothers have their thyroid glands back to normal within a year or so after birth, some women might end up having complications for the rest of their lives.

Postpartum thyroiditis occurs in around five to seven percent of new mothers. Since the immune system attacks the thyroid during this condition, it first causes hyperthyroidism which then leads to hypothyroidism. This results in the increase in thyroid hormone concentrations in the bloodstream, leading to thyrotoxicosis. Its symptoms include stress, irritable behaviour, inability to tolerate heat, raise in appetite, sleeplessness, anxiety, increased or palpitating heart beats, body tremors and so on. In time the hyperthyroidism abates, which is due to a depletion in the levels of the thyroid hormones. After this, the symptoms of hypothyroidism set in. These are tiredness, dry skin, mood problems, reduced appetite, inability to bear cold, and so on. Postpartum thyroiditis hair loss is another common symptom that affects many women.

Since these symptoms match with postpartum depression, also known as the baby blues, this condition is often misdiagnosed. Treatment during the first phase of hyperthyroidism is often not required as the symptoms are tolerable and temporary. If they are unbearable, your doctor will prescribe you beta blocker drugs which can calm anxiety and reduce heart rate. Hypothyroidism requires hormone replacement therapy with levothyroxine, as already mentioned before.

Can Thyroid Medication Affect Milk Supply?

No thyroid medications, whether synthetic hormones or antithyroid drugs, can affect milk supply. However, the lack of medication will certainly have a negative impact on it. This is because both hypothyroidism and hyperthyroidism can affect the release of milk. In both these conditions, there is an influx of certain hormones like FIL, known as the feedback inhibitor of lactation. This results in the reduction of lactation, which subsequently leads to the reduction or stoppage in the milk supply entirely. A simple treatment technique involves massaging the breasts slowly downwards while moving towards the nipples. This has been known to stimulate the production and release of breastmilk.

Can Thyroid Medication Pass into the Breastmilk and Affect your Child?

Hypothyroidism medication, levothyroxine, is completely safe, as it is found in breastmilk at negligible levels or not at all. However, hyperthyroid drugs like propylthiouracil and carbimazole require monitoring of the baby’s thyroid functions. This is because it can cause neonatal hypothyroidism in infants. Radioactive iodine treatment is not recommended while breastfeeding your child.

How Common is Congenital Hypothyroidism and Hyperthyroidism in Newborns?

1. Congenital Hypothyroidism

In most cases, congenital hypothyroidism is due to an underdeveloped thyroid. This condition is extremely rare, occurring in less than one percent of all babies. Some of the causes include

  • Iodine-deficient maternal diet is when the mother does not have enough iodine in her diet, which is an essential requirement for the foetus’ thyroid gland in the production of the thyroid hormones. It is common in regions of the world which lack iodine in their diet, for example, the Garhwal Hills in Himachal Pradesh. Babies born with hypothyroidism usually receive treatment to fix this condition, but it often resolves by itself.
  • Thyroid Medications Sometimes maternal thyroid drugs can cause temporary congenital hypothyroidism, but this kind usually vanishes a few days after childbirth.
  • Genetic Causes In rare instances, congenital hypothyroidism can be caused by genetic defects in certain genes. This leads to malfunctions in the synthesis of the thyroid hormones.

The symptoms of congenital hypothyroidism include puffed faces, inflamed tongues, dull appearance, constipation, dry skin and hair, jaundice, fatigue, refusal to eat, and so on.

2. Congenital Hyperthyroidism

This disease is uncommon in newborns. It can be caused by maternal Graves’ Disease, in which the thyroid-promoting antibodies enter the placenta and affect the baby’s thyroid gland development. In other cases, the condition can be temporary and is known as transient gestational hyperthyroidism. Around five percent of babies are known to have this condition.

While most mothers recover from post pregnancy thyroid conditions, around thirty percent of women tend to experience thyroid problems permanently. This might mean long-term medications. If you have recovered from postpartum thyroiditis, it is recommended that you go through testing at least once every two years. It is important to have a support system during this time, especially since postpartum periods come with a host of potential problems in addition to thyroid diseases. Make sure your family, partner and friends are aware of your conditions, so that help can be accessed whenever you require it.

Also Read: Thyroid during Pregnancy