Thyroid Challenges After Pregnancy

In this article

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Congratulations on the arrival of your new bundle of joy, and welcome to the bliss – and challenges – of new motherhood! While recovering from childbirth and bonding with your new baby are at the top of your list of current priorities, don’t forget to add your thyroid health to your to-do list! Why? Because pregnancy and childbirth can have a major impact on your thyroid, and trigger transient or permanent changes in thyroid function. And, the signs and symptoms of postpartum thyroid problems are easily mistaken for other symptoms experienced by new mothers. Ahead, a look at what you can expect from your thyroid in the weeks and months after your baby is born, and how to ensure that you and your thyroid stay healthy after bringing your new baby into the world. 

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Your thyroid gland is an endocrine organ located in the neck that releases hormones into the bloodstream to control metabolism. The thyroid gland produces two main hormones, thyroxine (T4) and triiodothyronine (T3), which are essential for regulating your body's metabolic rate, growth, and development and providing energy to organs, glands, tissues, and cells. 

During pregnancy, the thyroid has an expanded role, because not only does it need to provide thyroid hormone for the mother, but it is also providing this essential hormone for the developing fetus. As a result, the need for thyroid hormone increases significantly during pregnancy. 

The fetal thyroid gland begins to develop during the first trimester of pregnancy, but it does not become functional until around the 11th to 16th week of gestation when it begins to produce its own thyroid hormones. Until that time, the fetus depends on the maternal thyroid hormone for brain development.

Because a developing fetus depends entirely on the mother’s thyroid hormone supply past the first trimester of pregnancy, a healthy thyroid gland has a response to pregnancy. A fully functional thyroid will, soon after conception, enlarge on its own so that it can increase thyroid hormone production to meet the expanded need. The thyroid enlargement may be felt as sensitivity in your neck or throat, difficulty swallowing foods, or swelling in your neck – known as a goiter. 

If you’re being treated for hypothyroidism during your pregnancy, it’s common for your thyroid to be unable to mount a sufficient response to pregnancy or increase in size enough to produce enough thyroid hormone. This is a problem that needs to be taken seriously, because inadequate thyroid hormone replacement during pregnancy can lead to a variety of adverse outcomes such as miscarriage, preterm delivery, preeclampsia, poor fetal growth, low birth weight, birth defects, and impaired neurocognitive development in your child. 

Given this situation, most women will need to increase their pre-pregnancy dose of thyroid hormone replacement medication by 20 to 50%. Research shows that the increased need for extra thyroid hormone is greatest during the first trimester of a pregnancy before the fetus develops a functioning thyroid. This increase in dosage mimics the healthy thyroid’s enlargement to produce enough thyroid hormone for both you and your developing baby. 

During pregnancy, your immune system also undergoes changes. Pregnancy is a unique immunological state that involves changes in the immune system to support the growth and development of the fetus. The immune system changes during pregnancy prevent the mother's immune system from attacking the fetus, which has a different set of antigens and can be perceived as a “foreign body.” 

During pregnancy, many women with autoimmune diseases also experience a remission in their condition. The reason why is not entirely clear, but it is thought to be due to the suppression of the immune system to prevent the rejection of the fetus. 

An increase in the hormone progesterone during pregnancy also helps prevent inflammation and autoimmune flare-ups.

At the same time, it’s relatively common for women to develop elevated thyroid antibodies during pregnancy. This is typically caused by underlying but asymptomatic thyroid immunity. 

One thing you can do to stay fully on top of your thyroid function is to ask for a Thyroid Peroxidase Antibody (TPOAb) test early in the first trimester of pregnancy. If you test positive for elevated thyroid antibodies – but haven’t been diagnosed with or treated for hypothyroidism – be aware that research shows that you are at higher risk of developing hypothyroidism or postpartum thyroiditis after childbirth. Specifically, your chance of developing postpartum thyroiditis ranges from 30% to 52%.

An important note: Research has found that supplementing with 200 mcg of selenium daily during pregnancy may help reduce the risk of developing postpartum thyroid problems after childbirth. 

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After childbirth, your body undergoes significant hormonal and immune system shifts, starting with a marked reduction in the amount of thyroid hormone needed. Progesterone levels also drop sharply and rapidly, and estrogen levels increase, reactivating the immune system. This can trigger inflammation and autoimmune flare-ups.

If you were already diagnosed with and treated for hypothyroidism during your pregnancy, you should be on the lookout for two potential issues after childbirth. 

You will likely need a dosage change after childbirth. If you’re hypothyroid, you’ll probably need to reduce your dosage of thyroid hormone replacement medication after giving birth. Specifically, according to experts, most women can return to their pre-pregnancy dose. You should plan to have your thyroid function tested in the early weeks after childbirth to ensure that you are not overmedicated. If your levels are out of balance, your healthcare provider can adjust your dosage as needed.

Keep in mind, however, that due to changes in thyroid function during pregnancy – or a significant change from your pre-pregnancy body weight after pregnancy – you may need to continue taking your higher pregnancy dose in order to maintain normal thyroid levels and relieve hypothyroidism symptoms. 

You may have a flare-up of your thyroid symptoms: The suppression of the immune system during pregnancy may be followed by a flare-up of your autoimmune thyroid symptoms after delivery when the immune system returns to its normal state.

You may have problems breastfeeding: Adequate thyroid hormone serum levels are required for normal lactation. Be aware that hypothyroidism can negatively affect your ability to breastfeed. After childbirth, you may experience a low milk supply, which can make it difficult to produce enough milk to satisfy your newborn’s needs. Adjusting your dosage so that your thyroid levels are optimal should improve milk production. 

The symptoms of hypothyroidism such as fatigue and mood changes can also make it challenging to establish and maintain a breastfeeding routine. If you’re hypothyroid and breastfeeding, you should work closely with your healthcare provider to ensure that your thyroid hormone levels are well managed.

Even if you don’t have any detectable or diagnosed thyroid condition during pregnancy, you may develop a thyroid problem after childbirth. In the majority of cases, this is because you actually have a latent autoimmune thyroid disease. The disease was likely never severe or symptomatic enough that it needed attention. 

The most common thyroid issues diagnosed after childbirth include:

• Postpartum hypothyroidism: Postpartum hypothyroidism can occur up to 12 months after pregnancy or delivery. 
• Thyroid autoimmunity and elevated antibodies: Thyroid autoimmunity occurs when the body's immune system mistakenly attacks the thyroid gland. This condition can lead to hypothyroidism and is more common in women who have had a prior pregnancy or delivery. 
• Postpartum thyroiditis: Postpartum thyroiditis is the most common thyroid problem occurring after pregnancy. We’ll explore more about this condition in the next section.

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By medical definition, postpartum thyroiditis is a thyroid problem that develops in the first year after pregnancy in women who had normal thyroid function before pregnancy. Published research suggests that the overall incidence of postpartum thyroiditis is 5-10%. Postpartum thyroiditis is believed to be an autoimmune disease similar to Hashimoto's thyroiditis, and antithyroid antibodies are present in both conditions.

The diagnosis of postpartum thyroiditis is based on a combination of clinical symptoms and laboratory tests. 

In addition to testing positive for thyroid antibodies before or during your pregnancy, there are other risk factors for developing postpartum thyroiditis. These include repeated pregnancies, a personal or family history of thyroid problems, or a diagnosis of type 1 diabetes. 

The first phase of postpartum thyroiditis is called the “thyrotoxic” phase. This phase typically occurs between 1 to 6 months after giving birth. Symptoms during this overactive thyrotoxic thyroid phase are usually mild and may include:

• Anxiety and nervousness
• Weight loss
• Fatigue
• A rapid heartbeat
• Heart palpitations
• Muscle weakness
• Sweating, feeling overheated, sensitivity to heat 
• Difficulty concentrating
• Loose stools or diarrhea
• Increased appetite and hunger

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In most cases, postpartum thyroiditis shifts into a second phase of hypothyroidism. The hypothyroidism signs and symptoms during this phase frequently include:

• Tiredness and fatigue
• Brain fog, difficulty concentrating, and impaired memory
• Depression and anxiety
• Increased sensitivity to cold
• Weight gain, or difficulty losing weight
• Dry skin
• Hair loss
• Constipation
• A slowed heart rate, unusually low blood pressure
• Elevated cholesterol levels
• Muscle cramps and weakness

In about half of women diagnosed with postpartum thyroiditis, the hypothyroid phase is followed by a recovery phase, when the thyroid returns to normal function. Even then, approximately 25% of those women will eventually develop permanent hypothyroidism, usually in the ten years after childbirth. 

For the other half of women with postpartum thyroiditis, the condition does not resolve spontaneously. In this situation, the women have sustained enough thyroid damage that permanent hypothyroidism develops. 

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Treatment for postpartum thyroiditis varies, depending on whether you are in the hyperthyroid or hypothyroid phase, and the severity of your symptoms. 

If a woman experiences significant symptoms during the thyrotoxic hyperthyroid phase, beta-blockers are sometimes prescribed to alleviate symptoms such as tremors, heart palpitations, and a rapid heart rate. In some cases, prednisone may be prescribed to calm thyroid inflammation and help relieve thyroid pain in women with postpartum thyroiditis. However, the use of corticosteroids for postpartum thyroiditis is not common. Antithyroid medications like Tapazole (methimazole) are not used during the hyperthyroid/thyrotoxic phase. 

During the hypothyroid phase, thyroid hormone replacement treatment may be needed to restore normal thyroid hormone levels and resolve symptoms of an underactive thyroid. The most commonly prescribed thyroid hormone replacement medication is levothyroxine, which is biologically equivalent to the body's own thyroid hormone, thyroxine (T4). Levothyroxine is a synthetic T4 hormone that is available in various brand names including Synthroid, Levoxyl, and Tirosint, as well as numerous generic formulations. Other types of thyroid hormone replacement medication include liothyronine (T3), which is a synthetic T3 hormone, and natural desiccated thyroid, which is derived from the thyroid gland of pigs and contains both T3 and T4 hormones. 

Because half of all women return to normal thyroid function within 12 to 18 months, women with postpartum thyroiditis should have their thyroid function evaluated frequently. If the thyroid function moves towards normal levels, treatment can be carefully tapered and eventually stopped. 

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One of the major challenges of thyroid problems after childbirth is confusion about symptoms. Fatigue, anxiety, difficulty losing baby weight, breastfeeding difficulties, hair loss, brain fog, and mood changes are all too common experiences for many new mothers. But they may also be symptoms of an undiagnosed or poorly managed thyroid condition. 

Here are some tips to help ensure a healthy thyroid after childbirth:

Test early and often.
‍Even if you don’t have any history of thyroid problems, ask your healthcare provider to test your thyroid function – including thyroid antibodies – early in your pregnancy. And after delivery, it’s important to get regular thyroid checks to monitor hormone levels. This can help identify any issues early and ensure prompt treatment.

If you have postpartum thyroid problems, get your thyroid checked frequently – ideally every three months – to monitor for changes. 

If you have been diagnosed with and treated for hypothyroidism prior to or during pregnancy, get a complete thyroid panel done soon after childbirth. You may need a dosage adjustment to manage your thyroid function during your postpartum period. 

If you are having trouble breastfeeding, or your baby is not gaining weight at a normal rate, get a complete thyroid evaluation. 

Don’t ignore signs and symptoms.
‍If you have symptoms including fatigue, hair loss, difficulty losing weight, depression, anxiety, and brain fog after childbirth, don’t assume that it’s solely due to being postpartum. Ask your doctor to run comprehensive thyroid tests to rule out the possibility of thyroid issues. 

Eat a balanced diet.
‍It’s also important to eat a balanced diet to ensure that you are getting an adequate intake of nutrients that are important for your thyroid health. Foods that are rich in iodine, such as seaweed, seafood, and dairy products, can also support thyroid function. 

You may want to supplement with thyroid-friendly nutrients as well. (Paloma’s Daily Thyroid Care supplement has a combination of essential nutrients for healthy thyroid function.) 

Manage stress.
‍Stress can have a negative impact on thyroid function, so it’s important to find ways to manage stress after childbirth. This might include practicing relaxation techniques such as meditation or yoga, getting adequate sleep, and seeking support from family and friends. If you’re feeling overwhelmed, talk to your doctor or a mental health professional for guidance and support.

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When you’re looking for a more accurate thyroid diagnosis and optimal thyroid treatment, consider partnering with Paloma Health. As a practice, Paloma Health is committed to providing you with comprehensive and personalized treatment plans, tailored to your unique needs and goals. 

Paloma’s patient-centered approach prioritizes your thyroid care and supports your overall wellness with a multidisciplinary approach that includes medical care, education, testing, and community. Paloma is a comprehensive, one-stop practice to help conveniently and effectively manage your hypothyroidism!

If you are hypothyroid after pregnancy, ensuring optimal thyroid function needs to be a top priority. Frequent testing is recommended, and Paloma Health’s Complete Thyroid Home Test kit makes it simple and convenient to test your thyroid hormone levels easily and affordably at home with painless fingerstick testing. The Paloma panel tests your Thyroid Stimulating Hormone (TSH), Free Thyroxine (Free T4), Free Triiodothyronine (Free T3), and Thyroid Peroxidase Antibodies (TPOAb). You also have the option at checkout to add Reverse T3 (RT3) and Vitamin D tests to your panel. Just order your kit online, follow the easy instructions to take your samples, and send your test kit back to our certified lab in the prepaid mailer. Your results come back quickly to your secure online portal.

When you’re hypothyroid after pregnancy, it’s important to be treated by experienced and knowledgeable professionals who understand that optimal thyroid care may require frequent testing and adjustments to your thyroid hormone replacement dosage. After pregnancy, you can also schedule a virtual visit with one of Paloma’s knowledgeable thyroid practitioners, who are fully committed to providing optimal thyroid treatment. Paloma’s doctors are knowledgeable about all facets of thyroid treatment and will work diligently with you to ensure that your treatment is effective for you.

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Note: Paloma Health’s Director of Research Vedrana Högqvist Tabor, PhD contributed to this article.

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