Many women experience milk supply problems when breastfeeding and postpartum thyroiditis may be to blame. This condition is often overlooked by healthcare providers because it typically resolves itself within a year of onset. I struggled with postpartum thyroiditis after all three of my pregnancies.
What is postpartum thyroiditis and how can it affect breastfeeding?
Postpartum Thyroiditis Basics
Postpartum thyroiditis is inflammation of the thyroid within the first year after giving birth. It is characterized by the production of thyroid antibodies plus swings between hyperactive and underactive thyroid. It is very similar to Hashimoto’s disease, except with thyroiditis, the hyperactive thyroid phase is a bit different. The thyroid is not actually overactive but the patient suffers from many of the symptoms of hyperactive thyroid.
Postpartum thyroiditis most often starts with a hyperthyroid (or thyrotoxic) phase. Symptoms include:
- weight loss
Many women confuse these symptoms with what is considered to be normal postpartum and the diagnosis can be missed until the mother enters the hypothyroid phase. The thyrotoxic phase generally occurs within the first six months after delivery.
After the thyrotoxic phase comes the hypothyroid phase. This phase lasts for approximately 6 – 9 months and generally resolves itself by 12-18 months postpartum. Symptoms include:
- dry skin
- weight gain
- sensitivity to cold
- aches and pains
Between 5% – 10% of moms will experience postpartum thyroiditis. Those with pre-existing autoimmune diseases such as type 1 diabetes, graves disease, hashimoto’s disease, rheumatoid arthritis, or a latent unknown autoimmune disease are more likely to suffer from thyroiditis.
Breastfeeding and Postpartum Thyroiditis
Milk supply is affected by hormone levels. When the thyroid goes crazy, milk supply can be affected. Moms are more likely to have low supply as a result of the hyper or thyrotoxic phase. During my first struggle with thyroiditis, I needed to supplement my son with 20 oz of formula daily no matter how much I pumped, how often I nursed, or what supplements I took. It is important to keep a close eye on your thyroid postpartum to nip any problems in the bud.
Milk supply issues aren’t linked just to thyroid function. Thyroiditis can trigger depression and anxiety both of which can affect milk supply. It is important to stay on top of your emotional health as well as your physical health in order to maintain optimal supply.
Because the thyroid is not actually overactive, thyroid suppressing therapies are not used. Those patients who are on thyroid replacement hormones already will likely have their dose adjusted. Those who are not may be able to control symptoms with breastfeeding safe medications.
Once the hypothyroid phase occurs, thyroid hormone replacement can be used to obtain optimal levels. Your doctor will likely taper your dose as you approach the end of the typical course of thyroiditis to see if your thyroid regains normal function. 20% of moms who have thyroiditis go on to have long-term thyroid problems.
What does this mean for me?
All women should ask to have their thyroid levels checked postpartum—the 6 week postpartum visit is a perfect time for this test! It is just a simple blood test. Keep track of any symptoms you may have and keep in touch with your doctor. Since not all women experience thyroiditis by 6 weeks postpartum, don’t hesitate to ask for another test even just a few weeks later should you begin to suspect you are having thyroiditis issues.
Once you have had thyroiditis, you have a much greater chance of having it with subsequent pregnancies. Be aware and work to catch it early. If your doctor will not test for or treat thyroiditis, seek a second opinion. There are some doctors who will not treat it because it often resolves on its own.
Because of the nature of postpartum thyroiditis, it is a good idea to work closely with a certified lactation consultant for the duration of the disease. A lactation consultant can guide you through any milk supply issues that arise and help protect your supply long-term.
You know your body best. Take charge of your health and medical care. Work with your medical provider and lactation consultant to be the healthiest you that you can be for your baby. Thyroiditis can, and does, affect milk supply. It doesn’t have to be the end of breastfeeding.