My sister had been experiencing extreme tiredness, weight gain, and hair loss which started around 3 months after the birth of her third child. Although these kinds of symptoms are also associated with giving birth and having a newborn in the house, she had a feeling that something extra was going on. She had some tests done and it turned out that she had an inflamed thyroid, also known as postpartum thyroiditis, a condition in which the thyroid gland becomes inflamed within the first year following childbirth. The precise cause of postpartum thyroiditis isn’t known although women who develop it tend to have high levels of anti-thyroid antibodies in early pregnancy and after the birth. This suggests that these women have an underlying autoimmune thyroid condition that flares up after childbirth due to changes in immune function.
Postpartum thyroiditis often has two phases. In the first phase the thyroid is overactive and in the second phase the thyroid is underactive.
What are the symptoms in the first phase?
In the first phase, the inflammation and release of thyroid hormones may cause symptoms that are similar to hyperthyroidism (overactive thyroid), such as:
- Rapid heartbeat or palpitations
- Unexplained weight loss
- Irritability
- Anxiety
- Fatigue
- Tremors
- Sensitivity to heat
- Insomnia
- Sweating
These symptoms tend to start within one to four months after childbirth and last for around one to three months.
As the thyroid cells become impaired due to inflammation, mild symptoms and signs of hypothyroidism (underactive thyroid) may develop. These include:
- Aches and pains
- Unexplained weight gain or inability to lose weight
- Brittle nails and dry skin
- Hair loss
- Depression
- Insufficient breast milk
- Sensitivity to cold
- Constipation
- Lack of energy
These signs and symptoms generally appear within the first four to eight months following delivery and they can last for up to one year.
Who is most at risk of developing postpartum thyroiditis?
You have a higher risk of developing postpartum thyroiditis if you have:
- Type 1 diabetes
- A personal or family history of thyroid disease
- Previously experienced postpartum thyroiditis
How is postpartum thyroiditis diagnosed?
If your doctor suspects you have postpartum thyroiditis, he or she will run some laboratory tests that will determine whether you are in the hyperactive or hypoactive thyroid phase.
- One of these tests will measure levels of the thyroid hormone thyroxine, also called T4.
- Another test will measure the levels of thyroid-stimulating hormone. It is this hormone that tells your thyroid to produce T4 and triiodothyronine, also called T3.
- You might be asked to undergo a test in which you swallow a small amount of radioactive iodine and this is then taken up into the thyroid. Thyroid cells are the only cells in the body that can absorb iodine.
- And finally, levels of anti-thyroid antibodies in your blood may be measured. When the thyroid is inflamed it can cause your immune system to release antibodies into your bloodstream.
How is postpartum thyroiditis treated?
In the first phase (hyperthyroidism) you normally don’t need treatment as the symptoms are mild and only last a short duration. However, if your symptoms are extreme, you doctor might prescribe you a beta-blocker to reduce nervousness and to slow your heart rate.
In the second phase you will normally be given a thyroid replacement medication called levothyroxine. This drug is a synthetic version of the T4 hormone and is used to bring your T4 levels up to a normal state. You will normally have to take this medication for around six to twelve months, after which you will be assessed to see if your thyroid has started functioning normally again. Generally, the thyroid returns to normal but unfortunately around 23 percent of women will develop long-term hypothyroidism and will need to take levothyroxine for the rest of their lives.
