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Postpartum thyroiditis is a thyroid condition specific to women in the postpartum period. The symptoms associated with this condition can often be hard to pick up and often are mistaken for other issues related to post-pregnancy recovery. For this reason, all women and their providers should know about postpartum thyroiditis and keep an eye out for the telltale signs of this condition in the months following childbirth. Here, we detail what you need to know about postpartum thyroiditis, including common symptoms, risk factors, and treatment options.
The postpartum period is sometimes referred to as the fourth trimester or the fourth stage of labor. The timing of when this period occurs is debatable, but most medical sources agree it starts immediately after birth up until 12 weeks. During these first three months, the woman's body is working on returning to its pre-pregnancy state, where hormones and organs go back to their non-pregnant functioning.
However, the parameters of the postpartum period are debatable because many issues related to childbirth can extend well beyond that 12-week timeframe. For this reason, many health care sources consider the postpartum period to last up until 12 months following delivery.
Postpartum thyroiditis is one such condition that can show up in the 12 months following childbirth. In this condition, the thyroid gland becomes inflamed following birth. It affects a small portion of the pregnant population (about 3 in 100) and causes quite a disruption in the body if left untreated. Most women will initially enter a state of hyperthyroidism but will eventually switch to hypothyroidism.
Experts do not know the cause of postpartum thyroiditis. It seems to have roots in autoimmunity or at least a connection to other autoimmune conditions like Hashimoto's. Indeed, both conditions share a lot of the same features and symptoms, but unlike Hashimoto's, postpartum thyroiditis usually goes away.
Certain factors increase a woman's risk of developing this type of thyroiditis. Perhaps the biggest risk factor is having antithyroid antibodies prior to pregnancy. Antithyroid antibodies suggest there is damage to the thyroid gland from autoimmune processes. So, women with either positive antithyroid antibodies or with a condition like Hashimoto's are more likely to develop thyroiditis. Of course, a personal or family history of other thyroid conditions can also increase your risk for this condition.
Aside from thyroid conditions, there appears to be a risk of this condition in women with type 1 diabetes. This form of diabetes is caused by autoimmune processes, where the immune system attacks cells that make insulin.
Postpartum thyroiditis is usually divided into two phases: firstly, a woman will likely have a case of hyperthyroidism followed by hypothyroidism in the second phase. Recall that hyperthyroidism is an overactive state of the thyroid marked by an excess of thyroid hormone in the body, whereas hypothyroidism is when the gland is underactive and does not produce enough hormone.
Common symptoms of postpartum thyroiditis can be split between the hyperthyroid and hypothyroid states. And as you may imagine, the symptoms are much the same as non-postpartum-induced hyper- or hypothyroidism.
Hyperthyroid symptoms:
- Anxiety
- Nervousness
- Heat intolerance
- fast heartbeat
- Muscle weakness
- Weight loss
Hypothyroid symptoms:
- Fatigue
- Cold intolerance
- Muscle cramps
- Generalized weakness
- Constipation
- Trouble with cognitive processes, such as memory formation
- Depression
During the hyperthyroid state, some women may not experience any symptoms at all, and the condition may resolve without developing into hypothyroidism. However, other women may have damage to their thyroid from this first phase, causing the thyroid to become underactive or fail to produce enough thyroid hormone. Surprisingly, many women who develop into the second phase can still recover, but there is potential that hypothyroidism may continue for the rest of their life.
Importantly, women with postpartum thyroiditis may experience anxiety or depression, both of which are also signs of the "baby blues." It is often all too easy to blow off mental symptoms following childbirth, as there appear to be obvious explanations for mental and emotional changes (such as lack of sleep, physical healing, change in role, etc.). But, if a woman feels down, anxious, or just not herself, it warrants further investigation as it could also be a sign of a thyroid problem.
Like other thyroid conditions, postpartum thyroiditis can be diagnosed with a blood test. Typically, a provider will order a TSH, T3, and T4. These tests can help not only detect disease but also point toward which phase you may be in postpartum thyroiditis.
A doctor will likely also palpate the neck to assess for any lumps or swelling on the thyroid, and an ultrasound may even be ordered if further information is needed. However, usually a medical and family history, current symptoms, and blood test can help the provider conclude if a woman has this condition or not.
A variety of factors will influence how postpartum thyroiditis is treated. Firstly, age, symptoms, and overall health will guide a provider on what type of treatment may be required. Similarly, the phase of the condition will also influence treatment.
For women in the hyperthyroid phase, major symptoms may require medications such as beta blockers to slow the heart rate and, less often, prednisone, a corticosteroid that can decrease inflammation. Antithyroid medications are not used in postpartum thyroiditis because the thyroid is not actually overactive but is rather just inflamed. But, because of all the changes a woman goes through following childbirth, this phase is often missed (unless it is severe), so most women do not get treatment during this phase.
Because the hypothyroid phase lasts longer and usually shows up between 4-8 months following birth, women are more likely to seek help for their symptoms. And fortunately, this phase can be treated with thyroid hormone replacement medication. Should symptoms be mild, treatment may not even be necessary, but if they are more intense, medication treatment is warranted. Some women may need to continue with medication for the rest of their lives, whereas many will not require it once the condition resolves (which can last between 12-18 months after birth).
If you suspect problems with your thyroid, the first step is to meet with your provider and get a blood test to identify if the disease is present. Paloma Health offers at-home test kits and online consultations with doctors specializing in hypothyroid care.
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