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Friday, January 27, 2012

How thyroid disorders can affect postpartum health and the breastfeeding relationship

When you have a baby, you're tired. Your hormones are out of whack, your periods are wonky, you might feel like crap and your hair falls out. Is it from "just being a tired mom" (said by your OB rather condescendingly) or is it because of something else?

When I was three or four months postpartum, I noticed weird stuff going on in my neck. As a side sleeper, I could no longer sleep that way without discomfort and even some pain. It was mildly uncomfortable to swallow, even though it wasn't the same as a typical sore throat pain. My neck swelled up and I thought I had some kind of virus, so I went to the doctor.

The physician's assistant thought maybe I had mono, so she ordered a blood test. It came back negative, but in the meantime she put me on antibiotics. After I took one pill, I thought, Wait a minute, mono is a virus, not bacterial. What the heck am I taking these for? I threw them out.

Another thing she told me: Stop breastfeeding for a while in case your baby gets what you have.

No way was I doing that. I knew my baby would be protected because I was nursing exclusively, and who's to say he wouldn't get it anyway?

I went at least another year before finding out why I felt half-dead most of the time, and probably another year on top of that before starting medication. I couldn't help but wonder, how many other "tired moms" go that long and then some with doctors throwing antidepressants at them, and everyone else patronizingly telling them, "Oh, you're just tired! Get more rest!"

In retrospect, I know now that I had postpartum thyroiditis, where the thyroid gland is affected by a surge of hormones and gets inflamed. In some cases it can last weeks or even months, and then go back to normal. In others, it makes you hypothyroid, and is under the umbrella of autoimmune thyroid disorders, or Hashimoto's disease.

Thyroid disorders can also make you feel depressed, on top of what you might already be feeling as a new mom who is struggling to adjust to changes or new additions in the family. In addition, another possibly huge impact on the new mother is how it can interfere with the breastfeeding relationship. I am bolding this simply because I feel that perhaps this is one component to lower breastfeeding rates, and perhaps the root of some women's difficulties with breastfeeding, that has perhaps been overlooked.

One of the signs is decreased milk volume in breastfeeding women. Considering how prevalent thyroid disorders are, it almost makes you wonder if this is one of the causes behind why some women are unsuccessful at breastfeeding and never really know why. And, according to the La Leche League, little if any research has been done on it - not only do many doctors not have a sound understanding of the mechanics of breast milk production, supply and demand, but seemingly few of those doctors truly understand thyroid disorders, either, sadly. This unknown factor in a mom's health could mean the difference between treating her condition properly or going years without knowing the true underlying cause of why she "couldn't nurse" her babies.

I posed this question of many thyroid patients recently and came up with interesting responses: I asked them if they ever had trouble breastfeeding, and if so, did they find out why? Some never had problems, others were, at one time, able to nurse very well and then suddenly production declined as they had more children. I noticed this myself: with my first, I could pump like crazy, but almost nothing with my second or third children. One said she was successfully able to nurse twins and then, in a later child, had supply issues. And some women said they tried everything - and nothing worked.

Breastmilk production is stimulated by prolactin, which is produced in the pituitary gland. Not coincidentally, the pituitary gland is also responsible for producing TSH, or thyroid stimulating hormone.

In reality, "any woman who has been pregnant can have postpartum thyroiditis," according to thyroid advocate Mary Shomon's website. There is the chance that the thyroid will return to normal in some women, but in others it can lead to a more persistent form of thyroid disorder, whether Hashimoto's or eventually full-blown hypothyroidism.

More reading:
Hashimoto's and Postpartum Thyroiditis
Thyroid problems after pregnancy: A look at postpartum thyroiditis
The impact of thyroid dysfunction on lactation - La Leche League

6 comments:

K said...

My story:

I had my third child in Dec 1996. Come May of 1997 I was ill, very ill. I was exhausted-couldn'y get off the couch, my legs ached horribly, my hands and fingers were painful and my joints were red and swollen, I could barely hold my baby to nurse him let alone do things like push a shopping cart. I went to my GP. She looked at me and ran some labs. Sed rate, rheumatoid factor, CBC etc...all were fine. She turfed me to a rheumatologist. He examined me thoroughly and ran a HUGE amount of bloodwork. Among the gazillion dollar tests that all came back normal was one little test with a big red H next to it. My TSH. It was 37. After being told I may have lupus it turned out to be my thyroid. It wasn't until years later that an endo ran my antibodies and I found out it was Hashimoto's. Since then our family has begun a long term 'relationship' with the disease as my daugther was diagnosed with Hashi's also at the age of 8. Her TSH was in the 70's and her antibodies were off the chart. Blessedly she was asymptomatic except for a large goiter. It's been over 10 years and she is still fairly asypmtomatic except for getting a little tired and extremely irregular periods. We have some issues with compliance and understanding the importance of taking her replacement mainly because a)she is young and therefore invincible and b) she has never felt bad so it is easy to blow off her meds. We are currently watching another dd as she may be developing a little goiter. My grandmother had Hashi's, I do, my mother is crazy symptomatic-she is textbook hypo-but since her labs are 'normal' no one will treat her. Blackmarket synthroid anyone? and my daughter has Hashi's...genetic link much?

One of my favorite 'doctor stories' happened when we were sent to "large important medical school pediatric endocrinology clinic" (read in radio announcers voice) and some little weanie of a resident sat us down, looked at me and said in the most patronizing tone..."Do you know why you are here?" I swear he almost patted my hand when he said it. I smiled, turned to my 8 year old and said "Explain to the doctor why we are here." and she went through a basic description of her autoimmune destruction of the thyroid and the feedback loop between her thyroid and pituitary. He responded with "I guess you do." and left the room and didn't come until God...err...the attending endo did. BWAHAHAHAHA

Teaching-Mommy said...

I was wondering, I have hypothyroidism, and I'm on a very low dosage of synthroid. It's working well...however, I'm worried about AFTER the baby is born (I was diagnosed my first month preggers). My OB said she would retest me @ 6 weeks, but should I get tested sooner?

The Deranged Housewife said...

A little "weanie." LOL! How awesome that your daughter was so well-versed on her condition. That's wonderful!

As far as your mom, have they tested her antibodies? Also, her TSH could be within normal range but high for HER. Has she switched doctors at all? I see a DO and so far, I think he's a lot more open minded than what I've heard about endos. I think the highest my TSH has ever been is around 2.5 and I felt like crap. Now it's .5 something and I feel better, but still have neck symptoms and discomfort and wonder if it could be even a little lower still. Also, someone mentioned selenium supplements for lowering antibodies; I haven't really looked into but it might be beneficial with the meds as well.

Your daughter is lucky that she doesn't have many symptoms but there is definitely a genetic link, as you're finding out. Her irregular periods are definitely a sign that something is going on.

Teaching Mommy, have you had labs done since you've been pregnant? If you're feeling good, then that sounds great - I would probably watch for symptoms once your baby is born and then definitely do the labs after that. You might need a slight raise at that point - and don't let them tell you you're just "tired!" when you present with tons of symptoms. Good luck!

K said...

She has tried multiple internists and an endo. They were all all about the numbers. I am pretty sure her antibodies were negative bit her tsh is usually between 4-5 which we know is high enough to be symptomatic regardless of what 'lab normal' is. My gp usually keeps me under two, and is fine if I am under 1 as long as I have no hyper symptoms. I take a pretty big dose, 200mcg so I am watched fairly close for hyper symptoms/labs but how I feel is definitely taken into account.

As for Dd, at almost 19 I have to let her take some reponsibilty now. If I get on her she feels nagged and digs her heels in more. I did message her roommate and ask her to 'remind' Dd here and there. I know, I'm awful.

The Deranged Housewife said...

As she gets older, she'll learn soon enough how not taking her meds can make her feel. I guess that has to be her decision, though, you know?

My family has been pressuring me to see an endo, and honestly, I'm not looking forward to it. My own doctor is not perfect, but he's way more open-minded than many endocrinologists, and I don't want to deal with BS on top of everything else - like hearing, "Your TSH is really low, so let's put you on an antidepressant instead!" No thanks.

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