Thyroid Problems After Pregnancy: Postpartum Thyroiditis

A Look at Postpartum Thyroiditis

Close-up of a mother and her sweet baby boy with a pacifier in his mouth.
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It's common for women to feel tired, experience mood swings, and have a variety of other symptoms in the months after childbirth. But for some women, symptoms can become troublesome and may point to a thyroid problem known as postpartum thyroiditis.

Overview

Postpartum thyroiditis is an inflammation of the thyroid that initially occurs in the first year after childbirth, miscarriage, or induced abortion.

It's considered a variation of autoimmune thyroiditis, also known as Hashimoto's thyroiditis.

Who Is at Risk?

If you have been pregnant, you can develop postpartum thyroiditis. The condition is fairly common, and it's estimated that approximately 7% of women develop the condition. The risks are higher if you have the following conditions and thyroid markers:

  • Up to 25% of women with type 1 diabetes develop postpartum thyroiditis.
  • Up to 25% of women with elevated antithyroid antibodies who also have normal thyroid hormone levels may develop postpartum thyroiditis.
  • Up to 50% of women with elevated anti-peroxidase (anti-TPO) antibodies may develop postpartum thyroiditis.
  • Postpartum thyroiditis is also far more common in a woman who has had a previous episode of the condition.

Prevention

According to research summarized in UpToDate, selenium supplementation may help prevent postpartum thyroiditis in some women.

Here is an excerpt:

"Selenium supplementation may decrease inflammatory activity in pregnant women with autoimmune hypothyroidism, and may reduce the risk of postpartum thyroiditis in women who are positive for thyroid peroxidase (TPO) antibodies. This was illustrated in a trial of 151 TPO-positive women randomly assigned to receive selenium (200 mcg daily) or placebo (beginning at about the 12th week of gestation). Postpartum thyroiditis occurred in 22 of 77 women (29%) in the selenium group, compared to 36 of 74 (49%) in the placebo group [28]. The routine clinical application of this supplementation requires further study."

Should you take selenium supplements? That's a question for you and you doctor to decide, and that conversation should take place before you start taking them. 

Typical Course 

The most common course for postpartum thyroiditis is mild hypothyroidism starting from two to six months after your baby is born. The hypothyroidism then resolves as your thyroid normalizes. The next most common presentation is mild hyperthyroidism, which begins one to four months after delivery, after which your thyroid normalizes.

In some women, mild hyperthyroidism begins one to four months after delivery and lasts two to eight weeks. It then shifts into a period of mild hypothyroidism for several weeks to several months, and then your thyroid normalizes.

While some cases of after postpartum thyroiditis resolve over time, there is a strong risk that you will continue to have a thyroid condition. It's estimated that as many as half of the patients with postpartum thyroiditis will, within four to eight years, develop persistent hypothyroidism, a goiter, or both.

Symptoms 

There are a number of symptoms of postpartum thyroiditis that can appear during both the hyperthyroid and hypothyroid phases of the condition. These include:

  • Decreased milk volume in breastfeeding women
  • Hair loss
  • Fatigue
  • Goiter (enlarged thyroid gland) that is painless
  • Depression, anxiety, and moodiness

Symptoms during the hyperthyroid phase of postpartum thyroiditis are usually milder versions of general hyperthyroidism symptoms, including anxiety, muscle weakness, irritability, heart palpitations, fast heartbeat, tremor, weight loss, and diarrhea.

The symptoms during the hypothyroid phase of postpartum thyroiditis are milder versions of general hypothyroidism symptoms, including sluggishness, dry skin, difficulty losing weight (or weight gain), constipation, low body temperature, and puffiness in the eyes, face, and hands.

Diagnosis

Your doctor will typically run several blood tests to diagnose postpartum thyroiditis. In the hyperthyroid phase, your blood tests typically show low TSH, and high-normal or elevated T4 and T3. In the hypothyroid phase, your TSH will be elevated, and T4 and T3 will be low or low-normal. Thyroid peroxidase (TPO) antibody levels are likely to be elevated in the majority of postpartum thyroiditis sufferers, especially during the hypothyroid phase.

In some cases of postpartum thyroiditis, an ultrasound is performed, and typically will show enlargement of your thyroid gland.

Postpartum thyroiditis and autoimmune Graves' disease can both cause hyperthyroidism your baby is born. While postpartum thyroiditis is a far more common cause of hyperthyroidism, it is still important not to miss Graves' disease. UpToDate has details on how to distinguish postpartum thyroiditis from Graves' hyperthyroidism, which can also begin during the postpartum period:

"The key differences are that hyperthyroidism in postpartum thyroiditis is usually mild (both clinically and biochemically), thyroid enlargement is minimal, and Graves' ophthalmopathy is absent. In contrast, women with Graves' hyperthyroidism are more symptomatic, have higher serum thyroid hormone concentrations, more thyroid enlargement, and may have Graves' ophthalmopathy. The distinction between postpartum thyroiditis and Graves' hyperthyroidism may be difficult unless the woman has new-onset ophthalmopathy. The two disorders can often be distinguished by reevaluation in three to four weeks. By that time, most women with postpartum thyroiditis will have improved, whereas those with Graves' hyperthyroidism will be unchanged or worse."

In some cases, a radioiodine uptake test is done to differentiate postpartum thyroiditis from Graves' disease. (Note, however, that this test is not performed if you are breastfeeding.)

Treatingment

In most cases, you will not need treatment for postpartum thyroiditis during either the hyperthyroid or the hypothyroid phases. Symptoms are usually mild, and the condition frequently resolves on its own, within several months to as much as a year after your baby is born.

If your symptoms of hyperthyroidism are uncomfortable, your doctor may prescribe a beta blocker such as propranolol or atenolol. (Breastfeeding is not suggested while taking beta blockers, however.) Antithyroid drugs are not used for hyperthyroid symptoms in postpartum thyroiditis.

If hypothyroidism during postpartum thyroiditis is causing you significant symptoms, experts recommend thyroid hormone replacement treatment. Typically, after three to six months on the medication, your doctor will rcommend stopping the medication, so that you can be tested again to determine if your postpartum thyroiditis has resolved.

A Word from Verywell 

After you have had postpartum thyroiditis, you have a substantially increased risk of developing it again in future pregnancies. When planning pregnancy, or when you are pregnant, make sure that your doctors are aware of any past thyroid issues.

After your postpartum thyroiditis resolves, you still face a substantially increased risk of developing hypothyroidism or a goiter later. Some experts estimate that as many as half the women who have hypothyroidism in postpartum thyroiditis will be permanently hypothyroid within seven years.

After you have had postpartum thyroiditis, you should have your thyroid evaluated annually. Specifically, you should get blood tests to evaluate your thyroid function, due to your increased risk of developing permanent hypothyroidism or goiter.

Source:

Burman, Kenneth. "Postpartum thyroiditis." UpToDate. Accessed: March 2017.

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