Postpartum thyroiditis & fatigue - is it more than just a lack of sleep?

As January is Thyroid Awareness Month, it’s the perfect time to talk about a postpartum condition called postpartum thyroiditis (PPT) that I commonly see in new mums.

PPT affects a whopping  8% of  pregnant women - making it the most common endocrine disorder associated with pregnancy. I feel so much for these mums as the odds are already stacked against them, and this condition is often dismissed.

The thyroid is a tiny butterfly-shaped gland in the front of your neck and is responsible for producing hormones that regulate the body's metabolic rate controlling heart, muscle and digestive function, brain development and bone maintenance. Thyroid function affects every organ and system in the body.

Postpartum Thyroiditis is an autoimmune condition

PPT is an autoimmune condition that occurs in the first year following pregnancy. On blood tests, it is characterised by raised thyroid antibody levels. These antibodies cause destruction of the thyroid gland and affect thyroid hormone levels. This means the thyroid gland cannot function properly.

This occurs due to the natural postpartum immunological rebound (pregnancy induces a slightly immunosuppressed state so that her body tolerates the foetus, but after birth, the immune system ‘bounces back’). PPT usually presents in individuals already at risk of autoimmune thyroid disease. For example there could have been an asymptomatic subclinical thyroid issue before pregnancy that was not picked up

“I thought as a new mum it was normal to feel so tired!”

The symptoms of PPT are often missed for two reasons:

—> The symptoms of PPT are very similar to changes in a woman’s body post pregnancy - ‘being a new mum:’ Fatigue, anxiety, depression, low mood, weight gain or weight loss - and therefore commonly dismissed. I can’t tell you how many times I’ve heard “I thought it was normal to feel so tired!.”

—> Secondly, the manifestations of postpartum thyroiditis often only begin after the six-week postpartum check up, and thus it is missed at first screening. Most often the thyroid is not checked again. Surely we can do better than that! Education is key - be your own health advocate!

Symptoms to look out for:

Postpartum thyroiditis may result in Hyperthyroidism (overactive thyroid) presenting between 1-6 months postpartum, or Hypothyroidism (underactive thyroid ) presenting 3-9 months postpartum. Sometimes symptoms first present as overactive and then can flip to underactive symptoms.

Overactive symptoms: Fatigue, weight loss, hunger, anxiety, insomnia, irritability and heart palpitations.
Under-active symptoms: Fatigue, weight gain, depression/low mood, anxiety, constipation, cold extremities, hair loss, dry skin.

Risk factors:

Family history of thyroid conditions
Type 1 Diabetes
Smoking
Subclinical thyroid condition before pregnancy
In my clinical experience I'll add here stress, gut issues and toxicity.

Testing and prevention strategies

As a naturopath I believe in preventative medicine - that means identifying any thyroid pathology risks before pregnancy. This means carrying out a thorough investigation of thyroid health prior to conception, or at the very least when pregnancy confirmed (it’s never too late to work on reducing the thyroid antibodies).

Screening for PPT should (but currently is not) continue throughout pregnancy and repeated at the three and six month postpartum period - or if you are worried about symptoms.

Testing thyroid health must be comprehensive:

Often physicians will only test TSH (thyroid stimulating hormone). However TSH may be normal with raised antibodies. This mean not just testing TSH but additionally:

T4 (inactive thyroid hormone)
T3 (active thyroid hormone)
Thyroid antibodies

For those women who’s TPO-Ab antibodies are positive in the first trimester, 33– 50% will go on to develop postpartum thyroiditis compared with 0–5% in those who are TPO-Ab negative. For those who remain TPO-Ab positive in the third trimester, 80% will develop postpartum thyroiditis. As you can see - thyroid antibodies are a pretty strong indicator and so should be monitored closely.

Conventional & naturopathic treatment:

Conventional treatment involves antithyroid medicines like carbimazole for overactive thyroid or Levothyroxine for hypothyroid. Indeed in some cases these can be very effective and necessary. However they do not address the antibody levels. If PPT is already in full swing and my client is struggling, I will often work in an integrative way alongside your GP or endocrinologist, depending on symptoms.

Naturopathic management of postpartum thyroiditis

Selenium: Supplementation of 200mcg a day for women at risk has been shown in a number of studies to reduce inflammation, oxidative stress, and reduce postpartum antibody rebound levels(1). Due to depletion of selenium in modern soils, supplementation is recommended.

Myo-Inositol (600-2gm daily): Inositol not only improves egg quality, ovulation, and has a beneficial effect of blood sugar, it is essential for the synthesis of thyroid hormones. Numerous clinical studies have shown that after treatment with myo-Inositol plus selenium, TSH levels significantly decreased in patients with subclinical hypothyroidism with or without autoimmune thyroiditis (2)

Vitamin D: I will always test and ensure vitamin D levels are around 100nmol/L - as vitamin D is the essential nutrient to modulate immune response and fertility.

Address any digestive issues like intestinal permeability (gut inflammation). Leaky gut allows bacterial toxins like LPS to negatively affect thyroid health
Avoid gluten - known to exacerbate autoimmune thyroid conditions
Support detox organs liver, gut, kidneys
Reduction of exposure to the following chemicals that are toxic to the thyroid gland:

Fluoride, chlorine - get a water filter PCB’s, flame retardants,
BPA and phthalates - use glass instead of plastic
Fragrances - use natural makeup, hair dye, body care products and household cleaners
Pesticides and herbicides - eat according to the clean 15 dirty dozen

Stress reduction and management
Address any underlying infectious conditions

Concluding thoughts

If you are considering becoming pregnant, currently pregnant or in the postpartum period - and especially if you are experiencing some of these symptoms - please seek help. Postpartum thyroiditis is a strong predictor of future thyroid health, studies show that women who develop PPT have a 25-30% risk of developing permanent hypothyroidism within 5-10years (1). Your postpartum fatigue could be far more than just a lack of sleep!

It’s not always easy to obtain the correct testing - please do reach out or book an appointment if you are needing help

Karen xx

References

Postpartum thyroiditis: an autoimmune thyroid disorder which predicts future thyroid health https://doi.org/10.1258/om.2010.100041
The Role of Inositol in Thyroid Physiology and in Subclinical Hypothyroidism Management https://doi.org/10.3389/fendo.2021.662582