Up to 7.5% of all pregnant women may experience the thyroid condition known as postpartum thyroiditis.
Even more staggering is the fact that up to 25% of these women, who go through postpartum thyroiditis, will develop PERMANENT hypothyroidism as a result (1).
This makes diagnosing and identifying this condition incredibly important.
This guide will teach you how postpartum thyroiditis presents, how long it takes to recover, how to test for it and includes natural treatment options.
Let's jump in:
What is Postpartum Thyroiditis?
Postpartum thyroiditis is a thyroid condition that MANY women will experience after they have a baby.
Fortunately, this condition tends to be self-limiting (meaning it resolves on its own without treatment) but it's still very important to understand.
This immune confusion comes from pregnancy in which your body naturally alters your immune function to prevent damage to your developing baby.
These change in immune function carry over into the postpartum period which can occasionally "confuse" your own immune system into attacking your thyroid gland.
This confusion occurs in up to 7-8% of women or, in other words, 1 out of 12-13 women who have a baby.
Postpartum thyroiditis can be confusing because it can cause both high and low thyroid problems (hyperthyroidism or hypothyroidism) which mean that no two women will present exactly alike.
Despite this, most women will go back to normal over a 12 month period.
But that doesn't mean they will be "fine" during this time period.
While your thyroid is going haywire it's normal to experience symptoms such as palpitations, anxiety, hair loss, depression and so on.
These symptoms can easily be confused with normal postpartum symptoms, but they can be differentiated with special tests.
In addition, up to 25% of women who have postpartum thyroiditis are at risk for developing PERMANENT hypothyroidism later in their life.
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Symptoms of Postpartum Thyroiditis
How do you know if you have postpartum thyroiditis?
It can sometimes be difficult to determine what kind of symptoms you are experiencing, especially in the postpartum phase.
Are you experiencing postpartum depression or is it really your thyroid?
Is your hair falling out a symptom or a normal part of hormonal changes which occur after delivery?
Are you not returning to your typical pre-baby weight as quickly as you want?
All of these slight changes can be an early indicator that your thyroid is off and that something may be a problem.
But as you can see, some of these problems would be considered "normal" in the postpartum period as well.
So how do you differentiate between the two?
Your symptoms may not be clear by themselves, but when accompanied by abnormal lab tests you can easily identify the issue.
We will discuss lab tests below (you can skip to that section if you want), but it's also important to talk about how postpartum thyroiditis tends to progress.
Women with this condition can present with either HYPERthyroid symptoms or with HYPOthyroid symptoms.
This means that two women can have the exact same condition (postpartum thyroiditis) and yet present with the exact OPPOSITE symptoms.
Because of this, you need to understand the symptoms associated with both conditions.
Women with this condition tend to feel overwhelmed, jittery, anxious and so on.
Around 50% of women with postpartum thyroiditis will go through the hyperthyroid phase.
Symptoms of the hyperthyroid phase include:
- Heart palpitations
- Heat intolerance
- Up to 33% of women may be hyperthyroid but asymptomatic
These symptoms tend to be mild but may be enough to bring you into your doctor's office to try and figure out what is going on.
These symptoms tend to peak about 3 months after delivery as well but can start earlier and proceed later than that.
Another 50% of women will experience the symptoms of hypothyroidism (either, to begin with, or following the symptoms of hyperthyroidism).
Hypothyroidism is the exact opposite condition as hyperthyroidism and is the result of decreased thyroid hormone in the body.
Symptoms of the hypothyroid phase include:
The symptoms of hypothyroidism tend to peak around the 6 month mark and usually tend to completely subside by month 12 (after delivery).
These symptoms may vary in intensity from one person to the other.
This variance is the reason that some women may need thyroid medication while others can go without it.
Testing for Postpartum Thyroiditis
Testing for thyroid conditions in the postpartum period can be done quite easily and should be routine if you are experiencing any of the symptoms we listed above.
If you suspect you have postpartum thyroiditis then your next step is to get the following lab tests:
- TSH (thyroid stimulating hormone) (3) - In the hyperthyroid phase your TSH will be LOW (usually suppressed) and in the HYPOthyroid phase your TSH will most likely be high (somewhere between 5.0 and 10.0 uIU/mL. The higher your TSH the more likely you are to develop permanent hypothyroidism.
- Thyroid antibodies (TPOab & TGab) (4) - Up to 80% of women with hyperthyroid postpartum thyroiditis will be positive for thyroid peroxidase antibody.
- Thyroid stimulating immunoglobulin (TSI) (5) - TSI can help differentiate between Graves' disease (another disease which causes hyperthyroidism) and postpartum thyroiditis during the hyperthyroid phase. A small percentage of women with postpartum thyroiditis may show receptor positivity for TSI even though this is generally a marker for Graves' disease.
The point of testing your labs is three-fold:
#1. To help identify and diagnose your condition.
#2. The second is to help you determine how to proceed with treatment and what kind of options are available to you.
#3. And the third is to help you monitor and track your disease course over time.
Many women will just be happy to know where their symptoms are coming from and they are happy to understand what is happening in their body.
But beyond this comfort, it's also important to diagnose your condition because it affects your treatment options.
The severity of your lab tests (in terms of how abnormal they are) can help you to determine how aggressive you want to be with your treatment.
Some women, especially if their symptoms are relatively easy to manage and their lab tests are not grossly abnormal, may be fine with the "wait and see" approach.
Other women, may benefit tremendously from additional thyroid hormone replacement therapy to help manage depression, weight gain, hair loss and so on.
This type of consideration can be taken on an individual basis.
Lastly, it's also important to track your lab tests over time (with tests at least every 2-3 months) so you can determine if you are actually improving.
The typical course of postpartum thyroiditis is one that usually resolves by 12 months or so, but what if your symptoms persist beyond that time?
Checking your lab tests and monitoring them over this period can help you to determine if indeed you are getting better (or worse) and help you manage your expectations.
Postpartum Thyroiditis Typical Course & Recovery
So what can you expect as a patient if you have postpartum thyroiditis?
There are really four main outcomes that can come from this disease state.
#1. Some patients (around 32% of all patients) begin with hyperthyroidism which peaks around the 3 months postpartum which then goes back to normal by about 6 months postpartum.
#2. Other patients (around 25% of patients) begin with hyperthyroidism which then bounces to hypothyroidism around the 3 month mark (postpartum) which then rebounds back to normal thyroid function around 12 months postpartum.
#3. Other patients (around 43% of patients) skip the hyperthyroid phase (outlined above) and head straight to hypothyroidism which peaks around the 3 month mark. This hypothyroidism then slowly improves and tends to resolve around the 12 month mark. This represents the most common course for most patients.
#4. Lastly, another subgroup of patients skip the hyperthyroid phase and head straight for hypothyroidism but these patients never recover and end up with permanent hypothyroidism. This is the most serious consequence of postpartum thyroiditis and is the option that you want to avoid if possible. Up to 23-29% of women with postpartum thyroiditis will end up with permanent hypothyroidism several years after pregnancy.
The main takeaway here is that up to 80% of women who present with postpartum thyroiditis will COMPLETELY recover without any long-term consequences.
That does leave, however, up to 20% of women who will end up to permanent hypothyroidism as a result of this condition.
With odds as high as 1 in 5 women developing complete hypothyroidism (meaning you will require thyroid medication for life) it's a good idea to take this condition seriously.
Because these odds are quite high it's a good idea to review the treatment options (listed below) with a goal to improve
Natural Treatment Options + Thyroid Medication
One of the most frustrating aspects about postpartum thyroiditis is that there aren't really any concrete therapies that physicians can use.
Instead, most of the treatment largely depends on how you feel, what your doctor is comfortable with and how aggressive he/she wants to be.
Because of this, most patients (about 70%) will be told to "wait and see" with frequent lab tests over a 6-12 month or so period.
This can be incredibly frustrating for patients who may be suffering from a multitude of symptoms such as weight gain, depression, hot flashes and so on.
But don't let this discourage you, because there are some natural treatments that you can potentially start.
The first two listed below can be started by all women, but the third will require a physician prescription (more on that below).
The first therapy is to adjust your diet.
If you haven't done this already then there is a decent chance that you will notice a significant improvement with this change alone.
The good news about postpartum thyroiditis is that most of the time, it is transient (meaning it will go away on its own without permanent side effects).
You can take advantage of this by using some very specific diets which are high in vegetables/fruits and low in processed foods.
These types of diets also cut out gluten, sugars, dairy and other common allergens which commonly cause issues for thyroid patients such as those with Hashimoto's thyroiditis.
I would strongly encourage you to consider altering your diet instead of hanging out and waiting to see if your condition will pass.
With a 20% chance of developing permanent hypothyroidism later in your life, it's worth it to be aggressive with your diet in the short term.
The exact diet you use can vary (based on your needs, tastes and so on), but you should be good to start with any of the following diets:
- Autoimmune protocol diet (AIP) - Generally I don't recommend this diet, but it seriously packs a punch in the short term (1-2 months) and may be worth a try to really balance immune function during the postpartum period. It's also not a bad idea to be eating healthy for your kiddo!
- Whole 30 Diet - This diet isn't quite as restrictive as the AIP diet and so it may be easier to follow for many women. This diet is high in all natural whole foods, fruits, vegetables, nuts and meats.
- Whole-food Vegan Diet - The whole-food vegan diet is primarily high in whole plant-based foods such as fruits, vegetables, legumes, nuts and seeds. If you opt for this you will need to make it gluten free as well.
- Basic or Strict Paleo Diet - The paleo diet automatically restricts
If these diets are confusing for you, then you can do your best to follow these basic guidelines and eat foods/meals which fit into them:
- Avoid Gluten, Dairy & Soy
- Avoid processed foods (anything in a box)
- Avoid eating out
- Avoid sugary drinks, coffee and other novelty drinks
- Eat whole foods
- Avoid processed fats
- Avoid extra or added sugar
These diets do not necessarily need to (or should be) continued forever, but they may help calm down the inflammation and autoimmunity in your body in the postpartum period.
Supplements play an important role in providing your body with nutrients it may be missing or with nutrients which may act to calm down inflammation and promote normal immune function.
The most commonly used (and safest in the postpartum period) include:
- Selenium - Selenium is required in many enzymes in the body including those which help promote thyroid hormone creation. Selenium deficiency has been implicated in the pathogenesis (7) of Hashimoto's thyroiditis and supplementing with selenium has been shown to reduce antibodies in women with postpartum thyroiditis (8). It has also been shown, in these studies, to reduce thyroid inflammation (both things you want!). Taking selenium may also reduce the risk that you will develop permanent hypothyroidism.
- Zinc - This trace mineral also helps promote thyroid function (9) but, perhaps more importantly, it's required for optimal immune function. Zinc is commonly used in "flu and cold" remedies because of these properties. Taking zinc in combination with selenium is a great place to start if you have postpartum thyroiditis (10). Many women in the US may be at risk for zinc deficiency due to soil depletion and poor diets.
- Fish oil - Fish oil is added to this list because of its special properties in reducing inflammation in autoimmune disease (11). Fish oil can help calm down the body by normalizing the ratio of omega fatty acids. It also has special properties which may help promote normal fat metabolism.
- Curcumin - Curcumin, like fish oil, is helpful in reducing inflammation. Curcumin is the active ingredient in the spice turmeric and is well known for its ability to help balance blood sugar, help reduce inflammation, improve metabolic function and so on (12). Fish oil and curcumin can be used together or one without the other. The goal here is to just use something to help reduce inflammation.
Supplements provide an added boost for your body to get the nutrients it needs, especially those which may be difficult to get from foods alone.
It's certainly possible to get all of your nutrients from food, but it may require massive consumption of certain types of foods which can be difficult to get.
Adding supplements helps cover your bases and provide a continuous supply of nutrients and vitamins that your body needs.
#3. Thyroid Hormone (Not always Necessary)
While not necessarily a "natural" treatment, it's still important to discuss the value of thyroid hormone for women with postpartum thyroiditis.
Thyroid medication is used to treat people who have LOW thyroid hormone (hypothyroidism) and is used to help supplement your body with whatever your thyroid is unable to make on its own.
Most women with postpartum will recover over a 12 month period (or so), but that doesn't mean that they wouldn't benefit from the temporary use of thyroid hormone in the meantime.
Thyroid hormone, for use in postpartum thyroiditis, is predominately used to help alleviate your symptoms, help you feel more like yourself and help you take care of your child.
Taking thyroid medication can help improve your energy levels, reduce (or eliminate) depression, reduce the amount of hair you are losing and so forth.
With benefits like these, the use of thyroid hormone should be considered in women with postpartum thyroiditis, especially if they are suffering considerably from their condition.
Up to 30% of women with this condition will take thyroid hormone (so about 1 in 3 women) which makes it fairly common.
The general stance from your doctor may be to "wait and see" but, depending on your labs and symptoms, you may want to push for thyroid hormone replacement therapy.
This should be left up to you (as the patient) and your doctor.
Postpartum thyroiditis is one of the most common endocrine conditions that women will face after they have a baby.
The good news is that this condition almost always resolves on its own over a period of time.
The bad news is that this condition can cause some serious symptoms which may impair your quality of life and prevent you from spending quality time with your new baby.
By understanding the signs and symptoms of this condition you will be well equipped to help diagnose it or prevent your doctor from missing it.
If you do have postpartum thyroiditis make sure that you look at all of the therapies available to you, especially natural treatments.
Most doctors tend to take the "wait and see" approach, but that doesn't mean you can't change your diet, take supplements and do your best to treat your condition.
Now I want to hear from you:
Are you suffering from symptoms in the postpartum period?
Do you suspect (or know) that you have postpartum thyroiditis?
Have you been able to treat your condition?
What has worked? What hasn't?
Leave your comments below!
References (Click to Expand)