Hypothyroidism, which primarily affects women, is a notoriously under-diagnosed condition. The fact that the symptoms are so similar to what a woman might feel in the postpartum period – fatigue, overwhelm, hair loss, trouble losing baby weight, anxiety, and trouble sleeping, makes it even more likely that the diagnoses will be overlooked, with symptoms chalked up to “it’s normal to feel that way when you have a baby.”
Know the Symptoms
If you test positive for this in the first trimester or early second trimester, you are at a 40% to 60% higher risk that you could develop postpartum thyroiditis, which is why, in my opinion, it’s so worthwhile for all women to get checked for this antibody in their early pregnancy labs. If you know that you have this elevated antibody, you can start to do things to improve your antibodies.
Postpartum thyroiditis is going to show up in one of 3 ways:
- Or hyperthyroidism that lasts for a few weeks and then turns into hypothyroidism
Therefore, knowing the symptoms of both ends of the thyroid function spectrum can keep you alert to the possibility that you might be having a thyroid problem. It helps to think of your thyroid as the gas pedal on your car. Indeed, it is your thyroid that controls the rate of your energy use and metabolism, body temperature, heart rate, sex hormones, cognitive function, and it impacts mood and even cholesterol storage.
Hyperthyroidism is like having your foot pedal to the metal. You’re in overdrive. You’re amped up. And that explains the symptoms:
- Nervousness, anxiety and irritability
- Rapid heartbeat and palpitations
- Intense appetite – famished, hungry all the time
- Weight loss
- Difficulty sleeping
- Frequent or loose stools
Hypothyroidism is exactly the opposite. It’s like you can’t even make your foot press down on the gas pedal – your foot just won’t do it because you’re just too tired, you’re so run down, you’re so fatigued or exhausted. That explains the symptoms, too:
- Fatigue or downright exhaustion
- Decreased milk volume
- Unexplained weight gain, inability to lose the “baby weight”
- Carpal tunnel syndrome, tendonitis, joint or muscles aches
- Puffy face
- Increased sensitivity to cold
- Muscle weakness
- Heavier than normal menstrual periods
- Dry or brittle hair and nails, hair loss (can be confused with telogen effluvium by doctors)
- High cholesterol
Moms tell me that postpartum hypothyroidism is like taking care of a baby with one hand, and pushing an 18-wheeler up Mount Kilimanjaro with the other. Impossibly exhausting.
Thyroid Lab Testing You’ll Want to Get
While I’m firmly opposed to medical over-testing, in the case of autoimmune thyroid disorders my motto is “test don’t guess.” When you get your standard first trimester prenatal blood work done, ask to have your TPO checked. If you test positive, you can both take preventative steps during pregnancy, which I’ll share in a minute, and you can be more prepared so that if you do have symptoms, you can get appropriate treatment ASAP.
If you’ve already had your baby, and experience any symptom of hyperthyroidism or hypothyroidism, go to your primary care provider and ask her to check your TSH, Free T4, Free T3, and your thyroid antibodies (this time get TPO and Anti-thyroglobulin antibody). See my article here on what your lab values should be.
I always recommend that when you’re getting checked for thyroid issues, also get checked for other things that can make you feel really exhausted. For example, iron deficiency anemia, especially if you lost a lot of blood at the birth or if you had heavy postpartum bleeding. That can make you feel really tired. It can make you feel depressed. It can make it harder to lose weight. You can also get checked for vitamin B-12 and vitamin D at the same time. Vitamin B-12 deficiency can make you very tired, and typically if you’re deficient in iron, you may also be deficient in B-12 and also vitamin D. Treating all of those at the same time is a good idea and bumping up your nutrition and using the appropriate supplements.
Steps You Can Take During Pregnancy to Prevent Postpartum Thyroiditis
The one therapy that has shown consistently good results for preventing postpartum thyroiditis in women with high antibodies during pregnant, whether or not they have been diagnosed with Hashimoto’s disease, is giving selenium during pregnancy, which seems to act as an anti-inflammatory in pregnant women with autoimmune hypothyroidism. It can actually reduce the chances of developing postpartum thyroiditis after baby is born. The typical dose is 200 micrograms daily, and you can start it in the first trimester.
You can also start an anti-inflammatory diet, removing common triggers of thyroid autoimmunity including gluten and gluten cross-reactives, and dairy. You can actually do an elimination diet while you’re pregnant as long as you’re making sure to get plenty of protein, vegetables, and good quality fats at each meal.
There are also other inflammatory triggers. Stress in itself is a big inflammatory trigger, but so are things like environmental toxins, particularly plastics from drinking out of plastic water bottles or storing or heating our foods in plastic containers, so be as thoughtful as you can. You don’t want to go drive yourself crazy, but really, truly being as thoughtful as you can with your cosmetics and your body products is important. Have them be BPA-free, phthalate-free, and paraben-free, particularly if you’re at risk.
If you are pregnant and you know you’ve had Hashimoto’s or postpartum hypothyroidism in the past, it’s really important to get tested and possibly be on medication from the get-go with the next pregnancy. If you do find that you stay hypothyroid indefinitely after baby, then you want to work with your primary provider to find the right medication for you so that you can live your life optimally without struggling with miserable exhausting symptoms that also keep you from being the mom you want to be.