Postpartum Thyroiditis

Postpartum thyroiditis is an autoimmune condition similar to Hashimoto’s disease and is strongly associated with positive thyroid peroxidase (TPO) antibodies .​1–3​ 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​

For more support check out our online community:

http://www.healthunlocked.com/thyroiduk

Date updated: 04/05/21 (V1.2) Review date: 19/03/2022

References

  1. 1.
    Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. Published online March 2017:315-389. doi:10.1089/thy.2016.0457
  2. 2.
    Lazarus JH, Premawardhana LDKE. Postpartum Thyroiditis. In: Contemporary Endocrinology . Humana Press; :177-192. doi:10.1007/978-1-59745-517-6_8
  3. 3.
    Keely EJ. Postpartum thyroiditis: an autoimmune thyroid disorder which predicts future thyroid health. Obstet Med. Published online March 2011:7-11. doi:10.1258/om.2010.100041
  4. 4.
    National Institute of Diabetes and Digestive and Kidney Diseases. Thyroid Disease and Pregnancy. NIDDK. https://www.niddk.nih.gov/health-information/endocrine-diseases/pregnancy-thyroid-disease#postpartum
  5. 5.
    Marqusee E, Hill JA, Mandel SJ. Thyroiditis After Pregnancy Loss1. The Journal of Clinical Endocrinology & Metabolism . Published online August 1997:2455-2457. doi:10.1210/jcem.82.8.4168
  6. 6.
    Stagnaro-Green A. Postpartum Thyroiditis. The Journal of Clinical Endocrinology & Metabolism. Published online September 1, 2002:4042-4047. doi:10.1210/jc.2002-020524
  7. 7.
    Newson L. Thyroid Function Tests. Patient. https://patient.info/doctor/thyroid-function-tests-pro

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