Postpartum Thyroiditis: Symptoms, Causes And Treatment

Postpartum thyroiditis is a temporary thyroid abnormality that affects some women after pregnancy (1). The thyroid is a butterfly-shaped endocrine gland present in the neck region. It produces and secretes the hormones thyroxine (T4) and triiodothyronine (T3) into the blood.

Postpartum thyroiditis occurs due to the hyperactive immune system affecting the thyroid gland. The gland can become hyper- or hypo-activated, causing hormonal fluctuations in the blood. Therefore, it can result in metabolic changes in the body, influencing body weight, energy levels, body temperature, skin and hair growth. The condition can last up to six months after giving birth.

Read this post to learn about postpartum thyroiditis and how to manage this autoimmune disease.

Prevalence, And Types Of Postpartum Thyroiditis

Around 1.1 to 16.7% of new mothers develop postpartum thyroiditis (1). Women having type-I diabetes or a prior history of thyroid disease are at greater risk of developing the condition.

The disease clinically manifests in three major types (2).

1. Transient hyperthyroidism: The first phase of postpartum thyroiditis where high levels of thyroid hormones are seen in the blood. It occurs in 32% of cases.

2. Transient hypothyroidism: A hypothyroid phase is commonly seen after a hyperthyroidism phase. It occurs in 43% of cases.

3. Classic form: It is prevalent in 25 % of cases. The transient hyperthyroidism is followed by hypothyroidism and then recovery.

Symptoms Of Postpartum Thyroiditis

Postpartum thyroiditis develops gradually, and it takes around six months to develop noticeable symptoms. Some of the common signs and symptoms associated with the disease are (3):

• Thyroid enlargement
• Sudden weight loss without putting any extra effort
• Anxiety
• Feeling warm and anxious
• Sweating
• Irritability
• Rapid heart rate
• Excessive hair loss

Once the disease attains its peak in months after delivery, the symptoms may subside naturally. Some mothers may continue with hypothyroidism for their lifetime, and the symptoms are:

• Unexplained weight gain
• Fatigue
• Dry skin
• Constipation
• Muscle pain
• Hair loss
• Sensitivity to cold

Causes And Risk Factors Of Postpartum Thyroiditis

Postpartum thyroiditis is a form of destructive thyroiditis mediated by antibodies fighting against the thyroid (2). These antibodies are produced against the thyroid peroxidase enzyme, called TPO antibodies. Pregnant women having TPO antibodies early in their pregnancy are 30 – 52% more prone to postpartum thyroiditis. If the levels of antithyroid antibodies persist towards the third trimester, the chances of the disease go up to 80%.

Some factors that may increase the risk for postpartum thyroiditis are:

• Hyperthyroidism, a case of overactive thyroid
• Hypothyroidism, a case of underactive thyroid
• Type 1 diabetes, an inheritable diabetes condition
• Antibodies, a high level of antithyroid antibodies in the blood
• Family history of thyroid problems
• Previous history may increase the risk in subsequent pregnancies

Diagnosis Of Postpartum Thyroiditis

The doctor will go through the family history and conduct laboratory tests to confirm the postpartum thyroiditis (4). They perform the blood tests to measure the-

• Blood TSH levels
• Levels of T3 and T4 hormones
• TPO and anti-TSH receptor antibodies

The blood flow in the thyroid gland can be known using ultrasonography. This test is used to ascertain and distinguish between different thyroid diseases.

Complications Of Postpartum Thyroiditis

New mothers with postpartum thyroiditis may take a year and a half to recover completely. Medications are given to improve the condition (5). However, some women with persistent thyroid antibody levels may not recover from hypothyroidism. They may need life-long thyroid hormone replacement therapy.

Prognosis And Treatment Of Postpartum Thyroiditis

If the symptoms do not subside naturally, one should seek medical advice. The exact treatment plan may depend on the severity of the disease.

It is also essential to monitor the patient periodically for the levels of thyroid biomarkers in the blood. The treatment will therefore change accordingly since the disease transitions from a surplus to a low hormone condition. Long-term treatment might be essential for 20% of the cases (2).

• For mild symptoms, lifestyle changes, such as a healthy diet and exercise routine, can help.

• Hyperthyroidism is treated with beta-blockers, such as Propranolol.

• Hypothyroidism is treated with hormone replacement therapy using synthetic hormones, such as levothyroxine.

Preventive Measures Of Postpartum Thyroiditis

Some measures that help prevent worsening of the disease condition are (6):

• Consumption of fish rich in omega-3 fatty acids during pregnancy has been shown to prevent/cure postpartum thyroiditis. Studies reported that oily fish helps maintain a steady profile of serum thyroid antibodies.

• Avoid consumption of swordfish during pregnancy.

• After the delivery, the mother should work on her physical and emotional wellbeing.

• Prior thyroid problems may increase the risk of developing postpartum thyroiditis. A discussion with the doctor and lab tests may help manage the condition in pregnancy.

References

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