- What is postpartum thyroiditis?
- What are the causes of postpartum thyroiditis?
- Who are at the risk of developing postpartum thyroiditis?
- Occurrence rate of postpartum thyroiditis
- What are the symptoms?
- How to prepare for the appointment?
- Postpartum thyroiditis: diagnosis, treatment, and management
- Tips to prevent postpartum thyroiditis
The thyroid gland is an endocrine gland that is responsible for releasing the thyroid hormone. The hormone is responsible for controlling the body’s metabolism, and its imbalance can result in hyperthyroidism or hypothyroidism. This leads to a condition called thyroiditis.
Some women could develop this condition after delivery, even if they did not have it before.
What Is Postpartum Thyroiditis?
Thyroiditis is an inflammation of the thyroid gland. If this condition arises within the first year of delivery, it is called postpartum thyroiditis.
Thyroiditis affects 8% of women post-delivery (1). This condition first causes hyperthyroidism (secretion of excess thyroid hormone in the blood) followed by hypothyroidism (secretion of inadequate thyroid hormone in the blood) (2). Hyperthyroidism increases the metabolic rate, whereas hypothyroidism lowers the metabolic rate.
But what causes the thyroid gland to act abnormally? Find out next.
What Are The Causes Of Postpartum Thyroiditis?
Though the exact reason is not known, it is believed that the development of antithyroid antibodies during early pregnancy or after childbirth causes postpartum thyroiditis. Also, any underlying autoimmune thyroiditis condition in the woman, along with the immunosuppression of pregnancy, aggravates it post-delivery.
Postpartum thyroiditis can last for several weeks or months, and in some women, the thyroid functions regain normalcy within 12-18 months after the symptoms appear. While anyone can develop thyroiditis, some women are more prone to it than the others.
Who Is At the Risk Of Developing Postpartum Thyroiditis?
Women with the following conditions are at a higher risk of postpartum thyroiditis:
- Positive anti-thyroid antibodies (the risk increases with higher antibody level)
- Autoimmune disorders such as Type 1 diabetes
- Previous history of postpartum thyroiditis; the recurrence of thyroiditis occurs in around 42.4% of women (1)
- A family history of thyroid dysfunction
- An early history of thyroid dysfunction
So, what is the incidence rate of postpartum thyroiditis among women post delivery?
Occurrence Rate Of Postpartum Thyroiditis
It is evident that the anti-thyroid antibodies (TPO-Ab) titre increases with age in around 12-26% of women. If women are found to be TPO-Ab positive during the first trimester, then about 33-50% of them will develop postpartum thyroiditis compared to 0-5 % of women who are TPO-Ab negative.
Usually, the number of antibodies decreases during pregnancy due to immunosuppression. However, if women remain TPO-Ab positive even during the third trimester, then 80% of the pregnant population will develop postpartum thyroiditis (1).
Look out for the symptoms of hyperthyroidism and hypothyroidism to know if you’ve developed postpartum thyroiditis.
What Are The Symptoms Of Postpartum Thyroiditis?
A woman experiences two phases of postpartum thyroiditis. The first symptoms are of hyperthyroidism, which is subtle. Hyperthyroidism is associated with the initial inflammation of the thyroid gland that causes the release of excess thyroid hormone. The symptoms include (2):
- Weight loss
- Palpitations or rapid heartbeat
- Feeling warm
- Irritability (3)
- Loss of concentration
- Excessive hair loss (4)
Most women notice these symptoms between one and six months post-delivery and may experience them for around one to two months (1). These symptoms may be mistaken for the postpartum baby blues and the hormonal fluctuations happening inside your body.
The second phase, i.e., hypothyroidism will develop between three and nine months after delivery and will last for four to six months. It develops when the thyroid hormone gets depleted from the gland. The symptoms are severe and include:
- Weight gain
- Dry skin (3)
- Poor exercise tolerance
- Muscle pain
- Lack of energy
- Aches and pains
- Feeling cold
Hyperthyroidism can last for one year postpartum and get rectified on its own. However, some women may develop it as a lifelong condition. If you notice such symptoms, visit your doctor for diagnosis and treatment of the condition.
If you have an appointment scheduled with a doctor, then prepare for the visit.
How To Prepare For The Appointment?
Before you go to the doctor:
- Note down all the questions that you want to ask.
- Write down the symptoms you are experiencing.
- Make a list of the medicines that you are taking.
- Take a family member or a friend along with you so that you don’t miss out any points.
Besides clarifying your doubts, the doctor may also gather relevant information that helps with the diagnosis and treatment.
What to expect from the doctor
Here are some questions your doctor might ask you:
- When did the symptoms start?
- Are these symptoms occasional or continuous?
- How severe are they?
- Have the symptoms improved or worsened lately?
- Does anyone in your family have thyroiditis?
Questions to ask the doctor:
Here are some questions you may ask:
- Is my condition temporary or permanent?
- What tests do I need to get done?
- What are the causes of this condition?
- How long do I need to take the medications?
- Is there any alternative treatment for the condition?
- What are the restrictions that I need to follow during the treatment?
- How can I manage this condition?
Postpartum thyroiditis can be managed well if it is treated on time with the right medications.
Postpartum Thyroiditis: Diagnosis, Treatment, And Management
The first step is to check for the hormone levels followed by specific medications to cure the condition.
The doctor checks your records and family history of thyroiditis. Then a blood test is advised to check the level of the thyroid-stimulating hormone (TSH) and thyroxine. If the test results are abnormal, then further testing is recommended within one or two weeks.
Treatment is generally recommended based on the severity of the condition.
- In the case of mild symptoms, medication is not generally prescribed.
- For severe symptoms, medication is prescribed based on three phases of the condition: thyrotoxic, the hypothyroid, and the recovery phase.
- If you have hyperthyroidism (thyrotoxic phase), beta blockers are suggested to provide relief by slowing down the heart rate. Propylthiouracil can also be used in the first trimester (5) as it restricts the conversion of thyroxine to triiodothyronine.
- For hypothyroidism, thyroid hormone replacement medication (synthetic thyroid hormone levothyroxine, i.e., L-T4) is prescribed until the hormone levels are under control. Once you stop this medication, a blood test is done in two, three, and six months. If the test results remain normal, you only need an annual check-up unless the symptoms reappear.
This condition could be temporary in some women and permanent in others. However, once it is diagnosed, regular checkup of the thyroid hormone level becomes necessary. With medication, it is possible to get the thyroid gland back to normal in about 80% of the cases (2). It usually takes 12-18 months for the thyroid gland to start functioning normally.
However, women with positive antithyroid antibodies will need to take lifelong medication (i.e., thyroid hormone replacement therapy) for hypothyroidism.
The American Thyroid Association has issued guidelines for the management of thyroid disorders during pregnancy and postpartum. Here are some recommendations based on research and supporting evidence (6):
- Women, who are pregnant or breastfeeding should take approximately 250mcg of iodine every day.
- Women with hypothyroidism and undergoing L-T4 treatment with a suspected or confirmed pregnancy should receive an increased dose of roughly 20-30% of L-T4 followed by thyroid tests and result evaluations.
- Women taking propylthiouracil or methimazole should report the confirmed pregnancy news immediately to the doctor.
- A combination of an antithyroid drug and levothyroxine should not be used during pregnancy, except in the rare case of isolated fetal hyperthyroidism.
You might not be able to prevent the incidence of postpartum thyroiditis, but you can certainly take care to avoid it soon after delivery.
Foods To Eat To Avoid Postpartum Thyroiditis
Here are some foods you can include in the diet to prevent postpartum thyroiditis:
- Seaweed or vegetables such as kelp, kombu, and sea palm are a rich source of iodine and help boost the thyroid health (7).
- Antioxidant-rich foods like berries help reduce the inflammation of the thyroid gland. They can be consumed raw or in the form of smoothies and salads.
- Fish and lean meats are also a good source of iodine and help prevent postpartum thyroiditis.
- Engaging in light to moderate exercises is also helpful in regulating the thyroid functions.
It is not uncommon for women to experience mood disorders due to hormonal fluctuations post delivery. Postpartum thyroiditis is one such condition, but the recent developments in the clinical management of thyroid disorder have helped minimize the effect of such a disorder during and post pregnancy. Medical intervention, along with personal care at home, can help you deal with this condition.
If you have any experience to share, then let us know in the comment section below.