It’s no surprise that thyroid disease is frequently missed in new moms. After all, being a new mom is naturally exhausting! There are sleepless nights. Overwhelm. Anxieties about caring for a baby. Irritability from being tired. Sometimes there are challenges producing enough breast milk. Hormonal swings. In fact, feeling a little blue is even considered a normal part of the process.
And that’s when everything is going normally.
Add to that the possibility that you’re recovering from a cesarean, having significant breastfeeding challenges, or you’re experiencing unexpected health challenges with your new baby. You may be living far from family support, juggling school or work with being a new mom, and in the USA maternity leave, frankly, sucks, compounding the lack of attention that is sorely needed in that first year of having a new baby. Instead, we’re given 8 weeks to adjust and make plans for how we’re going to continue to produce milk, pump it, and feed it to our babies when we return to work, or our partner does. And you might have older kids and other responsibilities that don’t stop just because you’ve had a baby.
Who wouldn’t be tired?
It’s true, having a baby is incredibly demanding physically, and at the same time, we’re going through a tremendous amount of personal, psychological, emotional, and social adjustment. But exhaustion, feeling down, difficulty losing weight, intense struggle to produce enough breast milk, and hair loss aren’t always just a normal part of having had a baby. They can also be telltale signs of hypothyroidism – and struggling with hypothyroidism in the setting of being a new mom is like you’re already pushing a boulder uphill, and now someone has put iron balls around your feet, too! It’s an almost impossible weight to bear. And on the flip side, feeling anxious, having an insatiable appetite, feeling manic and unable to sleep, and losing a lot of weight are common signs of hyperthyroidism.
Tens of thousands of new moms in their first 12 months after birth are struggling with undiagnosed thyroid problems after pregnancy, their symptoms being mistakenly chalked up to the normal challenges of new motherhood. Without a diagnosis, they might be feeling alone, miserable, or crazy. They might be trying valiantly to produce enough breast milk but just aren’t, leading to anxiety, stress, guilt, and a lot of unnecessary hard work.
I know, because I’ve taken care of dozens of such new mommas – each who is relieved to discover that she is not stuck with her symptoms, and that her symptoms are happening for a reason: she has a thyroid problem!
Why Are New Moms Susceptible to Thyroid Problems?
New moms are especially susceptible to developing thyroid problems, particularly Hashimoto’s disease (hypothyroidism, or low functioning thyroid) and Grave’s disease (hyperthyroidism, or hyper-functioning thyroid), both autoimmune conditions that commonly occur in the first 12 months after giving birth. In fact, the chance of developing a postpartum thyroid problem is pretty high, with the reported rate of new cases as high as 17%, and much higher in women who already have an autoimmune disease, particularly Type 1 Diabetes. Thyroid problems after birth occur in as many as 42% of women who previously had postpartum thyroid problems, who already had hypothyroidism going into pregnancy, or who have elevated anti-TPO antibodies without a diagnosed thyroid disorder.
Why is autoimmune thyroid disease so common after birth? When the normal immunologic changes that kept you from rejecting your baby as an alien being while she or he was in your uterus start to revert back to normal after birth, they can play some nasty little tricks on your own body tissue leading to autoimmune disease that targets the thyroid, especially in women who are already genetically susceptible.
What are the Symptoms of Postpartum Thyroid Disease?
Autoimmune thyroid disease tends to roll out in one of three ways in the weeks or months after birth:
- 20-40% of women become hyperthyroid around 1-4 months after birth
- 20-30% become hyperthyroid for two to eight weeks, then become hypothyroid for anywhere from two weeks to six months
- And 40-50% become hypothyroid only, usually between 2 and 6 months after birth.
The symptoms of hyperthyroidism often go unnoticed by the new mom, until she reverts to hypothyroidism, at which time thinking back on it, the hyperthyroid symptoms seem more obvious.
Symptoms of hyperthyroidism include:
- Fatigue
- Weight loss
- Heart palpitations (a feeling that makes you hyper-aware of your heart beat)
- Weight loss
- Heat intolerance
- Anxiety
- Irritability
- Tachycardia, and
- Tremor
The symptoms of Hashimoto’s disease (hypothyroidism) include:
- Fatigue, sometimes exhaustion
- Cold intolerance
- Constipation
- Sluggishness
- Dry skin
- Joint pain (note that carpal tunnel syndrome may be related to hypothyroidism)
- Decreased breast milk volume
Additionally, most women with postpartum thyroiditis have a mildly enlarged, non-tender thyroid gland. This might be something you feel – the thyroid gland is in the front of your neck (see image). 
You may also notice some difficulty swallowing or fullness in your throat telling you that your thyroid is swollen. Thyroid size usually returns to normal with recovery. In some women, a swollen thyroid gland may be the only symptom.
What Tests Should I Get & What Should the Results Be?
A diagnosis of postpartum thyroiditis is based on your symptoms and thyroid function tests. While routine testing is not necessary for all women after baby is born, thyroid antibodies could be tested for in early pregnancy, and I do recommend testing all women at high risk at 3 and 6 months after birth. You are high risk if you have: a history of Type 1 Diabetes or another autoimmune condition; a history of thyroid problems including before this pregnancy, during this pregnancy, or after a previous baby’s birth; a history of high serum anti-thyroid peroxidase antibody before or during pregnancy; or postpartum depression (now or after a previous baby’s birth).
The tests I recommend are:
- TSH (thyroid-stimulating hormone) – it will be very low in hyperthyroidism and high in hypothyroidism. Note that many practitioners will only treat for hypothyroidism when TSH exceeds 10 mU/L; in my practice I treat if there are symptoms and TSH is over 2.5 mU/L.
- Free T4 – will be high in hyperthyroidism
- Free T3 – might be low or normal in hypothyroidism
- Anti-TPO (antithyroid peroxidase antibody) – will be elevated in autoimmune thyroid disorders.
Women likely to develop postpartum thyroiditis usually have high anti-TPO antibodies early in pregnancy, which decline as pregnancy progresses, and then rise again after birth, so this could be tested in early pregnancy and again after birth. A normal test doesn’t eliminate the risk of postpartum thyroiditis developing, but a positive test (high levels) increases the likelihood, so you’ll be prepared and know what to look out for. Read here to learn more about test results.
Conventional Approaches to Treating Postpartum Thyroiditis
Treatment of postpartum thyroiditis depends on whether there is hyperthyroidism or hypothyroidism, and how troublesome the symptoms are. It also depends on how your provider interprets lab results, particularly the TSH, so read on…
If you have no symptoms, but abnormal thyroid labs, for example, elevated anti-TPO antibodies, then medication therapy is conventionally not recommended; thyroid labs are simply repeated every 4-8 weeks until they return to normal, or if thyroid symptoms develop at any point, treatment is directed appropriately.
If you have symptoms of hyperthyroidism, these can be treated with a blood pressure medication (40 to 120 mg propranolol is the preferred medication if you are breastfeeding) which also quiets hyperthyroidism symptoms, until labs are normal. However, I prefer trying the herbs I discuss in the next section first. Your primary doctor can prescribe this medication for you; note that atenolol may be recommended instead of propranolol, but is not the best choice for breastfeeding moms. Radioiodine treatment and antithyroid drugs are not useful in postpartum thyroiditis, so are not advised.
If you have symptomatic hypothyroidism, thyroid hormone medication is the optimal treatment to get you feeling back to normal quickly, is safe while breastfeeding, and can make a huge difference in breast milk production if low supply is one of your thyroid symptoms. Levothyroxine (T4) at a dose of 50 to 100 mcg/day is usually recommended regardless of the level of TSH, though individual dosing adjustments may need to be made. Other medications, including Armour Thyroid, can be considered; it may take several attempts to find the right dose and medication that fully improves your symptoms and brings your TSH to a normal level (I recommend between 2 and 4 mU/L for optimization).
Functional Medicine and Natural Approaches to Treating Postpartum Thyroiditis
As a functional medicine doctor, I have access to a full range of options for treating my patients struggling with postpartum thyroiditis. Prevention is always the best medicine, and when problems do arise, I find a combination of medications and natural approaches optimal for treating hypothyroidism, whereas with postpartum hyperthyroidism, because it is usually transient (though often turning into hypothyroidism), I use herbs whenever possible for relieving symptoms, while addressing underlying causes, as I do with all autoimmune diseases, and which I discuss below.
When there are elevated anti-TPO antibodies, I begin by reducing inflammation in the system and removing any triggers that increase the risk of developing thyroid disease, particularly gluten, because celiac disease can also develop at any time and is a known trigger of autoimmune thyroid disease. So at this point I recommend a strictly gluten free diet and the addition of Curcumin, the active ingredient in the anti-inflammatory herb turmeric, 1000 mg, twice daily. This is safe while breastfeeding.
Selenium supplementation, 200 mcg daily, may decrease inflammatory activity in pregnant women with autoimmune hypothyroidism and may reduce the risk of postpartum thyroiditis in women who are positive for anti-TPO antibodies, and can be started during pregnancy and continued into the postpartum to reduce risk. Iodine supplementation has not been found to be helpful in preventing postpartum thyroid disease, and in women with Hashimoto’s giving iodine might actually aggravate symptoms; however, all pregnant women should ideally receive 200-300 mcg of iodine in pregnancy for the development and health of the baby. This amount is routinely found in prenatal vitamins.
Circulating levels of vitamin D3 have been found to be very low in those with Hashimoto’s disease and other autoimmune conditions. Supplementing with vitamin D3 at 2000 units per day in pregnancy and up to 4000 units per day while breastfeeding, to achieve a serum level of 50-70nM, may help prevent or reverse autoimmune thyroid disease. Levels can be rechecked every 6 weeks to measure improvement in vitamin D levels and indicate when to stay at a steady dose or decrease the dose. (I don’t recommend exceeding serum levels of 70 nM.) Up to 6000 units of vitamin D3 per day can be continued during the postpartum period if you are breastfeeding instead of giving baby vitamin D3 directly.
An herb called Guggul (Commiphora mukul) has been shown to have positive effects in improving thyroid function in Hashimoto’s disease, increasing conversion of T4, the inactive form of thyroid hormone, to T3, the active form. This herb should not be taken in pregnancy, but 750 mg can be taken daily while breastfeeding; discontinue if baby has an tummy upset when you take the herb, and discontinue when thyroid levels normalize.
Fluoride and bromide, the latter found in tap water and products made with tap water, and bromide, an additive to some breads and other foodstuffs, interfere with normal thyroid function, so I recommend avoiding these by using filtered water, non-fluoridated toothpaste, and reading labels to avoid bromides, before, during, and after pregnancy.
For hyperthyroidism symptoms, my go-to is to use herbs first for controlling symptoms whenever possible, rather than having mom take propranolol initially. The two most helpful herbs are Motherwort (Leonorus cardiaca) and Lemon balm (Melissa officinalis), 30-60 drops of the liquid extract of each, 2-6 times/day, safe while breastfeeding, to control irritability, agitation, anxiety, and heart racing. These herbs can be purchased from Herb Pharm or Gaia Herbs. If you are unable to use an alcohol extract, look for capsules of these herbs and take 1-2 capsules of each, 2-6 times/day as needed for symptom control.
Heavy metal toxicity has been linked to autoimmune thyroid disease. While I do not recommend any chelation (removal from the body using herbs, supplements, or medications) of metals in pregnancy or while breastfeeding – unless also elevated on conventional testing for lead or mercury, in which case this would be guided by your obstetrician or family doctor – if you have a history of postpartum thyroid problems, or thyroid problems in general, then testing for metals and eliminating exposures and chelating naturally if necessary is something you might consider doing 6-12 months before trying to conceive your next baby, or doing if you don’t plan to have any more children, to protect your thyroid from further damage.
BPA and other related chemicals can also have a deleterious impact on the thyroid; avoid plastic packaging when you purchase, store, and reheat your foods, and drink beverages out of glass, paper, and stainless steel only (not plastic). High levels of, or persistent stress, can also impact the adrenal system, with resultant effects on the thyroid, and gut inflammation, leaky gut, and food sensitivities in addition to gluten can trigger thyroid autoantibodies leading to autoimmune thyroid conditions.
Will I Always Be Hypothyroid & Have to Take Medication Forever?
Most women will recover from postpartum thyroid problems within 6-12 months, at which time medication can be weaned by half for a couple of weeks, and then discontinued. If symptoms persist beyond 18 months after onset, it is more likely that you’ve developed permanent hypothyroidism, and long-term medication might be needed. About 30% of women who develop postpartum thyroiditis develop permanent thyroid problems. For women who have fully recovered from postpartum thyroiditis, repeat thyroid testing within 5 to 10 years after the initial diagnosis, or should you develop symptoms of thyroid problems as described above.
What Can I Do About Low Milk Supply, Exhaustion, Anxiety, & Postpartum Depression?
If these symptoms are being caused by your hypothyroidism, which is quite likely, then optimizing your medication dose to bring your thyroid function into the normal range is going to be the easiest, quickest, and most effective thing you can do to resolve all of these symptoms. Your breast milk supply should increase, your fatigue improve, and your depression lift. If anxiety is being caused by hyperthyroidism, then the medication or herbs I mentioned earlier (motherwort and lemon balm) are a good option, along with breathing exercises, meditation, and yoga.
Adaptogens are a class of herbs that can help your body to not only regulate the stress response and improve your energy by supporting adrenal gland function, but can also help to reduce autoimmunity by shifting your immune system’s reactivity and reducing inflammation. To learn more about the adaptogens you can use, head on over to this article. Adaptogens are safe while you are breastfeeding and can be taken with thyroid medications. I generally don’t recommend Chinese ginseng while breastfeeding as it can be over-stimulating for the baby. I usually recommend continuing the adpatogens for a few months after all thyroid symptoms resolve.
If postpartum depression really has you down, in addition to supporting your thyroid by removing potential triggers of autoimmunity and starting on medication and supplements, consider the approaches in this article. While this article addresses depression in pregnancy, the therapies are applicable after baby is born. Also please be good to you and get a copy of my book Natural Health After Birth, where I take you on a journey of natural new momma care – it will give you a sense of support along with information and recipes to make being a new momma a bit easier.
Postpartum can be a challenging time for all new mommas, and especially so for women with hypothyroidism. The importance of postpartum care is almost completely overlooked in our culture. Having dedicated family or friend support not just in the first 8 weeks after baby is born, but also in the months to come, can make a huge difference in your energy and outlook. As women we’re notoriously bad at asking for help when we need it – now’s the time to get over that and let the people who love help you! If you are far from loved ones and don’t have strong community support, hire the help you need with housekeeping, errands like shopping, and consider a postpartum mother’s companion (doula) to help you with baby and household needs so you can get the rest you need.
Wishing you ease and health,
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