About 5% of pregnant women experience Postpartum Thyroiditis in the first few months following childbirth. This rare condition is said to be a temporary inflammatory response of the thyroid gland, with resolves by 18 months postpartum. A key feature is that- you may not feel ill at the onset of thyroid imbalance, but over time the process creates signs and symptoms that reveals something is not quite right.

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What is Postpartum Thyroiditis?

Postpartum Thyroiditis (PPT) is an imbalance in thyroid function after pregnancy. During pregnancy, your body goes through many hormonal and physiological changes. Hormones like hCG and estrogen can influence changes in thyroid hormones and alter the size of your thyroid gland. The classical form of PPT causes transient hyperthyroid (too much thyroid hormone is released), then fluctuates to a hypothyroid status (too little thyroid hormone) is created before it returns to baseline function. On average, a woman's body returns to normal within 12-18 months postpartum.

What Causes Postpartum Thyroiditis?

The literature states that Postpartum Thyroiditis is a form of subclinical autoimmune thyroiditis, which is aggravated after pregnancy. Often this occurs in women without a history of thyroid disease before pregnancy.

This condition has an inflammatory component, which in some cases can lead to immune dysfunction due to the initiation of thyroid antibodies (TPOAb and TgAb). These antibodies then activate a slew of events that destroy thyroid follicles, which will release excessive thyroid hormones- thyroxine (T4) and triiodothyronine (T3). In classical PPT, the excess release of these hormones will cause the thyroid gland to become depleted and plummet to an underactive hypothyroid state. Most women will start to experience symptoms during this phase.

Nutrient deficiency has an impact on thyroid function. Having adequate levels of selenium is necessary for enzymatic and antioxidant functions, along with inflammation modulation and thyroid hormone metabolism. A study of 2134 pregnant women examined the effects of selenomethionine supplementation during and after pregnancy. The results showed that those who were antibody positive and received selenium supplementation had a reduced rate of thyroid inflammation and development of hypothyroidism. Due to selenium's critical role in thyroid health, it is best to ensure you get adequate amounts of this in your diet and/or through supplementation.

An important but highly debated component of thyroid dysfunction is Iodine imbalances. Studies have shown that iodine deficiency can play a role in hypothyroidism, while other studies have shown that high iodine intake can be a risk factor for developing PPT. The general consensus is that iodine and thyroid dysfunction are individualized and may or may not be part of the underlying cause of PPT.

Postpartum Thyroiditis Signs & Symptoms

During the onset of PPT, many women do not report symptoms. Typically this is during the hyperthyroid (thyrotoxicosis) state, where you may not have symptoms or they are short-lived. If you start to feel differently, here are some of the hyperthyroid side effects you can experience.

Hyperthyroid State

• Anxiety
• Nervousness
• Difficulty focusing
• Rapid Heart Rate
• Warm body temperature
• Unexplained weight loss
• Excessive hair loss

In classical PPT, your thyroid gland becomes exhausted from prolonged overactivity. This then causes a hypothyroid state and typically appears four to eight months after pregnancy. Most women begin to notice something isn't right at this point because they are out of the fourth trimester, but postpartum symptoms are persisting or worsening. This feeling can be a result of an underactive thyroid, leading to these signs and symptoms:

Hypothyroid State

• Depression
• Memory loss
• Constipation
• Feeling cold
• Dry skin
• Weight gain
• Fatigue
• Muscle pain

Who Is At Risk For Developing Postpartum Thyroiditis?

Some women are more at risk for developing PPT due to medical and family history. Knowing if you are at risk can help you be proactive in your pregnancy and after. You're more likely to experience PPT if you have the following:

• History of postpartum thyroiditis
• Previous thyroid dysfunction
• Presence of thyroid antibodies before pregnancy
• Medical history of other autoimmune disorders
• Type 1 Diabetes
• Family history of thyroid disease

Is Postpartum Thyroiditis a Permanent Condition?

While this condition can be challenging and throw your body off track, it is mostly temporary. One study in southern Italy looked at the incidence of PPT amongst 4,394 pregnant women. Of the cohort, 169 developed PPT, and only 54% of those women had persistent hypothyroidism at the end of their first year postpartum. Multiple studies have shown that around 20% of women have persistent hypothyroidism after 12-18 months. These women will need continued thyroid support after the one-year postpartum mark. Women who had thyroid dysfunction before pregnancy may have worsening symptoms, which will need monitoring and support from their healthcare provider.

How To Test For Postpartum Thyroiditis?

Postpartum follow-up visits with your doctor are essential for monitoring your health and well-being. Often, these check-ins can help detect any post-birth complications like postpartum depression and PPT. Your doctor should do a thorough intake of your signs and symptoms, a physical exam, and, if warranted, order labs to evaluate thyroid function.

Thyroid function tests look at serum TSH, free T4, and free T3. Since this condition is very similar to Hashimoto's Thyroiditis, it's beneficial also to measure thyroid antibodies.

Women who have a pre-existing thyroid condition or are part of the at-risk group should be closely monitored by having a thyroid function test done at their 6-week and 12-week postpartum appointments.

Practitioners ordering thyroid markers can order them as individual tests-TSH, Free T4, Free T3, Anti-TPO, Anti-TG, or as a comprehensive thyroid panel.  

Other Lab Tests to Check

While additional labs are not necessary to diagnose PPT, they could benefit overall health and root cause support.

Liver Function

The liver does play a role in T4 to T3 conversion, so optimal function is essential. Evaluating liver function and monitoring glucose status through a Comprehensive Metabolic Panel (CMP) can help determine if there are other areas compromising hormone function. A CMP can detect if your liver enzymes are in a healthy range.

Gut Health

Some of the symptoms of PPT correlate with symptoms of gut dysbiosis. While it may not seem like a direct cause for PPT, there is a gut-thyroid axis linking thyroid autoimmunity and a dysfunctional gut.

A Comprehensive Stool Analysis is a great way to evaluate gut microbiome and assess for dysbiosis, inflammation, leaky gut, or other unwanted organisms.

Inflammation

The process of autoimmunity can be a culprit of inflammation. Inflammatory markers like CRP and ESR can help quantify how inflamed the body is. Measuring these markers can aid treatment modalities and assess if inflammation is worsening.

Imaging

The use of ultrasound as a diagnostic and prognosis tool could be helpful. This study looked at serial ultrasounds of 135 postpartum women. Results revealed a correlation between those who had PPT with positive antibodies and hypoechogenicity present on the thyroid ultrasound. In women with normal thyroid function but positive antibodies and in the control group (no antibodies), hypoechogenicity was less present.

Using ultrasound as a monitoring tool for PPT antibody-positive patients, especially with thyroid gland enlargement, could be helpful in the progression of their condition and therapeutic interventions.

Iodine Testing

There is a mixture of clinical perspectives when it comes to Iodine testing. Research has shown that iodine can be beneficial and harmful to thyroid function, based on each individual's case.

If you are interested in this avenue of thyroid support or suspect you have iodine deficiency, we recommend you seek a practitioner with extensive training in this area.

Functional Medicine Treatment for Postpartum Thyroiditis

While most cases of postpartum thyroiditis will naturally resolve in a majority of women, there is supportive care that can help. For women with symptoms past the 12-month mark, it is recommended to seek care with a thyroid specialist.

Nutrition

If an autoimmunity component is involved, research suggests that a gluten-free diet can reduce thyroid antibodies while also decreasing inflammation in the body. Following an anti-inflammatory diet like the Mediterranean Diet can help decrease the immune and inflammatory response while providing your body with adequate nutrition.

Functional foods, like Brazil nuts, that are high in selenium are a great way to get your daily consumption of this mineral. Other foods rich in selenium include seafood, lean meat, rice, oatmeal, beans, and eggs.

Consuming iodine in your diet is one way to support healthy levels. Although iodine therapy is something you should work on with an iodine-literate doctor.

Herbs & Supplements

Ashwagandha: is an adaptogenic herb used to treat fatigue, anxiety, stress, and cognitive function. A study on subclinical hypothyroidism revealed that ashwagandha significantly improved serum TSH, TS, and T4 levels compared to the placebo group. Using this herb with guidance may help bring your thyroid back to health.

Ginger: is an excellent botanical for gut discomfort, inflammation, and hypothyroid symptoms. If your symptoms persist and you remain hypothyroid, Ginger may be a consideration for long-term use.

Thyroid Hormone Therapy

It is worth mentioning that women with persistent hypothyroidism or thyrotoxicosis may need an integrative approach between functional medicine and conventional medicine.

Thyroid hormone therapy is often used to help provide essential hormones the body is not appropriately making. Although thyrotoxicosis is not the classical form of PPT, some women could have detrimental effects from a prolonged hyperthyroid state. The most common thyroid replacement medication is Levothyroxine, synthetic T4.

Insulin and Blood Sugar Balancing

Women with pre-existing conditions such as Type 1 Diabetes who develop PPT should also consult with their primary care doctor to ensure their insulin levels and blood sugar remain in optimal ranges.

Summary

Postpartum healing can take time and bring about many symptoms before your body regains balance. Making sure you have a postpartum care plan, checking in with your health care provider, and watching for signs and symptoms of postpartum thyroiditis are all helpful in early detection and support. Testing options help verify areas of deficiency and help achieve optimal function in a shorter time frame.

While postpartum thyroiditis typically resolves with time, being proactive can prevent cases of progression. With this information, you and your doctor can formulate a treatment plan that supports any underlying disturbances and help get your thyroid function back in an optimal range.