Postpartum Thyroiditis

 

Postpartum Thyroiditis

 

Postpartum thyroiditis is an autoimmune condition similar to Hashimoto’s disease and is strongly associated with positive thyroid peroxidase (TPO) antibodies.1,2,3 It affects around 5-10% of women and causes inflammation of the thyroid.3  It usually happens between 1 and 6 months after giving birth and is more common in women with type I diabetes.3,4  Sometimes it happens after a miscarriage.5

Postpartum thyroiditis causes thyroid hormone to leak out of the thyroid gland which firstly raises hormone levels (hyperthyroidism) and then causes hypothyroidism. The hypothyroidism may last around a year but in some women it is permanent.4

In some cases, there will only be the hyperthyroid phase and in others, they will only have the hypothyroid phase.4

 

What are the symptoms of postpartum thyroiditis?

The symptoms are generally mild and in some cases there will be no symptoms in the hyperthyroid stage but may include irritability, insensitivity to heat, tiredness, insomnia and fast heartbeat.4

Symptoms of the hypothyroid phase could be tiredness, anxiety, depression, moodiness, feeling cold, dry skin; trouble concentrating; and tingling in your hands, arms, feet, or legs.  Sometimes the symptoms can be mistaken for the “baby blues”.4

 

What causes postpartum thyroiditis?

Pregnancy partially suppresses the immune system.  In people already at risk of autoimmune thyroid disease i.e. those who have had Hashimoto’s or Graves’ disease, once the baby is born there is a rebound effect of the immune system which can cause postpartum thyroiditis.3

 

How is it diagnosed?

If you have symptoms after your baby is born your doctor will do thyroid function tests, especially thyroid autoimmune testing (thyroid peroxidase antibody – TPO) to check whether it is postpartum thyroiditis or Graves’ disease.6

TPOAb results are usually positive, and if there were TPOAb (antibodies) in early pregnancy there is a 33 – 50% chance of postpartum thyroiditis developing.3

 

How is it treated?

If symptoms are mild during the hyperthyroid stage, treatment may not be needed.  However, if the symptoms are worrying you, you may be prescribed some beta blockers to slow your heart rate down.4

Antithyroid medicines are not found to be useful in postpartum thyroiditis, although if you have Graves’ disease, this could get worse after the baby is born and you may need antithyroid medicines.4

During the hypothyroid stage, your doctor may prescribe levothyroxine and if your symptoms do not improve you will be on levothyroxine for the rest of your life.4

Thyroid UK believes that all women should be screened for hypothyroidism before even thinking about becoming pregnant but the current recommendations are that only women with the following should ideally be screened for thyroid disease pre-conceptually:7

  • type 1 diabetes
  • previous thyroid disease
  • current thyroid disease
  • family history of thyroid disease
  • goitre
  • symptoms of hypothyroidism

Both TSH and FT4 should be tested and TPOAb should be considered, due to the possibility of postpartum thyroiditis.7

 

Can I breastfeed while I’m taking beta-blockers

Some beta-blockers are safe to use while you are breastfeeding (only a small amount is found in breast milk). Your doctor will give you the lowest dose needed to deal with your symptoms.4

 

Check out what people are saying on our online community regarding postpartum thyroiditis:

http://www.healthunlocked.com/thyroiduk

 

Thyroid UK relies on donations so that we can continue to support and campaign for people with thyroid disease and related disorders.  If you have found our information helpful, please do think about donating or becoming a member.

 

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Glossary

Antibodies – protein produced in the blood that fight diseases by attacking and killing harmful bacteria

Autoimmune – patients with autoimmune diseases frequently have antibodies circulating in their blood that target their own body tissues

Beta blockers – a medication that works mainly by decreasing the activity of the heart by blocking the action of hormones like adrenaline. Beta-blockers also help blood vessels open up to improve blood flow

Goitre – a swelling of the neck resulting from enlargement of the thyroid gland

Graves’ disease – an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism)

Hashimoto’s disease – an autoimmune disease causing chronic inflammation and consequential failure of the thyroid gland

Hyperthyroidism – a term used to describe an over-active thyroid gland

Hypothyroidism – a term used to describe an under-active thyroid gland

Immune system – the organs and processes in the body that work together to resist infections

Inflammation – redness, swelling, pain, tenderness, heat and disturbed function of an area of the body

Insomnia – inability to sleep

Levothyroxine – a synthetic thyroid hormone commonly given to treat an underactive thyroid. It is also known as L-thyroxine

Thyroid peroxidase (TPO) antibodies – a marker for the presence of autoimmune thyroid disease

 

References

  1. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum
    https://www.liebertpub.com/doi/full/10.1089/thy.2016.0457?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
  1. Postpartum Thyroiditis
    https://link.springer.com/chapter/10.1007/978-1-59745-517-6_8
  1. Postpartum thyroiditis: an autoimmune thyroid disorder which predicts further thyroid health
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989649/
  1. Thyroid Disease and Pregnancy
    https://www.niddk.nih.gov/health-information/endocrine-diseases/pregnancy-thyroid-disease#postpartum
  1. Thyroidtitis after Pregnancy Loss
    https://academic.oup.com/jcem/article/82/8/2455/2877630
  1. Postpartum thyroiditis
    https://academic.oup.com/jcem/article/87/9/4042/2846380
  1. Thyroid function tests
    https://patient.info/doctor/thyroid-function-tests-pro

 

Date updated: 19/03/2020 (V1.1)
Review date: 19/03/2022