Postpartum Thyroiditis (PPT)Shannon McKelden
The Onset of Postpartum Thyroiditis
Lisa McShane of Annapolis, Maryland, knew something was not right about four months after delivery. “I went to the doctor with some depression, anxiety, heart palpitations, and just generally feeling uncomfortable all the time,” she says. “I figured a lot of this was due to just having a baby and would pass with time.”
Instead of passing, though, McShane’s symptoms continued. “The heart palpitations were the scariest part for me because … I would suddenly feel a fluttering in my chest and then a little gasp as I tried to catch my breath,” she says.
In addition, McShane experienced sadness and anxiety, and, after gaining nearly 75 pounds during pregnancy and developing high blood pressure, her body experienced a rapid drop in weight. “I felt that maybe it was just too many extreme changes for my body to handle in such a short amount of time.”
What McShane was really experiencing was postpartum thyroiditis (PPT).
What is Postpartum Thyroiditis?
PPT is defined as an inflammation of the thyroid gland following pregnancy and delivery (but can also occur after a miscarriage or abortion). “In postpartum thyroiditis, the thyroid gland gets inflamed and swollen and enters a phase of hyperthyroidism as the inflamed thyroid dumps its stores of thyroid hormone into the patient’s blood stream,” says Dr. Raymond Powrie, associate professor of Medicine and Obstetrics and Gynecology at the Brown Medical School. “Once these stores are used up, the inflammation in the gland prevents proper production of thyroid hormone and the patient undergoes a period of hypothyroidism. Over time the thyroid gland generally improves and resumes normal function.”
Statistically, Dr. Powrie suggests between 1 to 21 percent of postpartum women will have postpartum thyroiditis. “Most of these women will have little or no symptoms,” he says. “Women with type 1 diabetes and women with a prior history of postpartum thyroiditis are more likely to get the condition.”
McShane’s symptom complex was pretty typical of postpartum thyroiditis. “[With] early postpartum thyroiditis, you may initially experience signs and symptoms of overactive thyroid (hyperthyroidism), which may include rapid heartbeat, sudden and unexplained weight loss, nervousness, fatigue, and increased sensitivity to heat,” says Dr. Annette Perez-Delboy, assistant clinical professor of Obstetrics and Gynecology at the Columbia University Medical Center Eastside. “Later, you may develop signs and symptoms of underactive thyroid (hypothyroidism), which may include unexplained weight gain, hoarse voice, constipation, puffy face, fatigue, and increased sensitivity to cold.”
There can be some difficulty in correctly diagnosing PPT in that so many of the symptoms can be explained by having recently given birth. “I was tired all the time but … didn’t think much of it as I was keeping up with a newborn that was up numerous times a night,” says Megan Venner, a resident of Nova Scotia. Two months after the birth of her son, Venner visited her family. “I was still complaining about being tired, and it was my sister who first noticed my goiter (a swelling around the base of my neck),” she says. “She has some medical knowledge and suspected my thyroid might be the problem.” Venner’s physician sent her to a specialist, who confirmed her diagnosis with a blood test, which revealed hypothyroidism.
Dr. Powrie states that, like Venner, most women with postpartum thyroiditis have a small, non-tender enlargement of the thyroid gland, followed by the symptoms noted above. A formal diagnosis is made on the basis of blood tests, including the level of thyroid hormone (T4 and T3) and thyroid stimulating hormone (TSH). “The results that are seen will vary depending on whether the patient is in the hyper- or hypo-thyroid phase of the condition,” Dr. Powrie says. “Sometimes a thyroid scan or other additional blood tests may be needed to help distinguish this condition from other causes of thyroid disease.”
PPT generally follows the pattern of hyperthyroidism followed by hypothyroidism, which seems to be the way McShane’s thyroiditis played out. However, there can be a few variables, according to Dr. Susan S. Shi, an OB-GYN at The Methodist Hospital in Houston, Texas. “Postpartum thyroiditis usually presents in one of three ways: transient [temporary] hyperthyroidism alone, transient hypothyroidism alone or transient hyperthyroidism followed by hypothyroidism, and then recovery,” she says.
While the symptoms of PPT may be annoying, they aren’t fatal and often require no treatment at all. “Most patients with postpartum thyroiditis won’t require any treatment except for medical evaluation and reassurance,” Dr. Powrie says. “The condition tends to get better on its own over time.” He does add that more severe cases may require a beta blocker to alleviate symptoms during the hyperthyroid phase and some thyroid replacement therapy during the hypothyroid phase. “This is the exception rather than the rule,” he says.
Both Venner and McShane were given Synthroid as treatment for the hypothyroid phase of the postpartum thyroiditis. For McShane, the symptoms eventually disappeared. “I took the medication for a short while, and after about a year my body started to naturally balance itself out,” she says. “I was able to go off the medication and no longer have the symptoms of thyroiditis.”
Dr. Shi estimates, however, that approximately 25 percent of women who experience postpartum thyroiditis are at high risk of developing permanent hypothyroidism. Venner may be one of those women. She continued to take Synthroid in the two years between the births of her sons.
Even if the postpartum thyroiditis proves temporary, Dr. Powrie warns that women who have experienced PPT should be alert for it in the future. “Women who have had postpartum thryoiditis after one pregnancy are more likely to get it again in a subsequent pregnancy and are more likely to develop chronic hypothyroidism sometime in the future,” he says.
While generally not a serious disease, postpartum thyroiditis on top of the normal demands of a new baby can affect women emotionally. “PPT can affect a woman’s well-being by causing physical and emotional problems that keep the patient from functioning and bonding with the family and baby for a longer period of time,” Dr. Perez-Delboy says. “I recommend women who develop postpartum depression, women with any of the mentioned symptoms, women with other autoimmune disorders, and women with a strong family history of autoimmune thyroid disease should also be screened for PPT.”