Postpartum Thyroiditis - Causes, Symptoms, Diagnosis, and Management

Introduction:

The thyroid is a small gland located in the neck. It produces two important hormones, T3 (triiodothyronine) and T4 (thyroxin), which regulate body functions like metabolism, bone growth, brain development, body temperature, and digestion. The thyroid hormone production is controlled by the hypothalamus and pituitary gland located at the skull base. The hypothalamus-pituitary complex releases a hormone called thyroid-stimulating hormone (TSH) into the bloodstream, making the thyroid gland release T3 and T4 when there is an imbalance in hormonal levels in the bloodstream. Low levels of TSH, along with high levels of T3 and T4, suggest hyperthyroidism, whereas abnormally high TSH with low T4 levels indicate hypothyroidism.

What Is Postpartum Thyroiditis?

Thyroiditis is an inflammation of the thyroid, which alters the hormones released by the gland. Postpartum thyroiditis refers to thyroid gland inflammation that occurs in women after the birth of a baby. The condition affects about five percent of women. In the initial months, the thyroid hormones rise, leading to hyperthyroidism or thyrotoxicosis. Later the thyroid hormone stores get depleted, leading to a decrease in hormone release, causing hypothyroidism. Postpartum thyroiditis is a rare and temporary condition that usually goes unrecognized in cases of mild symptoms as it is mistaken for fatigue that commonly occurs post-delivery.

Who Is at an Increased Risk for Postpartum Thyroiditis?

Though a rare condition, the following factors can increase the risk of postpartum thyroiditis in women who have or had:

• A family history of thyroid problems.

• A personal history of thyroid complaints before pregnancy.

• Thyroid antibodies before getting pregnant.

• Postpartum thyroiditis in earlier pregnancies.

• Diseases like type 1 diabetes.

What Can Cause Postpartum Thyroiditis?

Postpartum thyroiditis is an autoimmune condition, which means the body's immune system attacks its cells. The condition's cause is antithyroid antibodies, which inflame the thyroid gland. Though the exact cause for the production of antibodies is unknown, it is believed that women who have a form of autoimmune thyroid condition without any symptoms before pregnancy have a greater tendency to develop postpartum thyroiditis.

What Are the Signs and Symptoms of Postpartum Thyroiditis?

Postpartum thyroiditis begins when the thyroid gland makes antibodies and inflames the gland. However, noticeable symptoms occur when hormonal levels get altered due to thyroiditis.

The initial symptoms occur due to overactivity of the thyroid gland, producing excess hormones causing hyperthyroidism or thyrotoxicosis. The initial phase starts within the first four months of delivery. The signs and symptoms of which include:

• Anxiety.

• Irritability.

• Fatigue.

• Palpitations.

• Tremors.

• Nervousness.

• Increased sweating.

• Unexplained weight loss.

• Difficulty in falling asleep.

• Diarrhea.

As the symptoms occur in a new mother, they can be confused with hormonal changes post-delivery.

The thyroid hormone levels start to fall after an initial overactivity, leading to hypothyroidism. Women start noticing symptoms during this phase, which lasts from four to eight months post-delivery. The condition can last for about a year, after which it starts to resolve itself. However, a small percentage of women continue to have symptoms for the rest of their lives, for which they may require treatment.

The signs and symptoms of hypothyroidism in postpartum thyroiditis include:

• Tiredness.

• Depression.

• Feeling cold.

• Dryness of skin.

• Weight gain.

• Constipation.

• Depression.

• Muscle pain.

Though the symptoms coincide with those of postpartum, patients must take care in identifying them and receiving prompt treatment from the doctor.

What Are the Complications of Postpartum Thyroiditis?

Uncontrolled high thyroid levels, when left untreated, can lead to a fatal, life-threatening condition called thyroid storm. Though rare, symptoms of thyroid storm have to be treated without any delay. The symptoms of thyroid storm include:

• Rapid heartbeat.

• Irritation.

• Confusion.

• Diarrhea.

• Vomiting.

• High fever.

• Yellowish discoloration of the eyes and skin.

• Loss of consciousness.

Women with any of the above symptoms should immediately reach out for medical help.

How to Diagnose Postpartum Thyroiditis?

Doctors conduct a physical examination and further note the patient's medical and family history. They may then order blood tests that determine the thyroid hormones T3, T4, and TSH levels. An imbalance in the hormonal blood levels and a history of recent delivery can help confirm the diagnosis of postpartum thyroiditis.

How Is Postpartum Thyroiditis Managed?

Postpartum thyroiditis is a condition that usually subsides on its own. Therefore, the treatment aims at reducing the symptoms. In people with mild symptoms, the doctor decides to wait and watch. However, treatment is started in cases where the symptoms begin to worsen.

In cases of overactive thyroid, the doctor may suggest using beta-blockers, which decrease symptoms like tremors and palpitations, or Prednisone steroids that help lower the inflammation of the thyroid gland. Medicines are stopped once the symptoms start to reduce, as elevated thyroid hormone levels are only a transient phase that subsides in two to three months. Also, as the thyroid gland is not overactive, traditional antithyroid medicines are not recommended.

Thyroid hormone replacement therapy, in which a medicine named Levothyroxine is prescribed for cases of underactive thyroid gland functioning or hormonal levels. Mild cases with very few symptoms do not require therapy. However, noticeable symptoms require treatment. The treatment has to be continued for a period of 6 to 12 months, based on the response of the patient. The blood hormone levels are checked periodically to assess if the treatment can be discontinued or does the patient require life-long treatment.

Doctors also suggest taking a diet rich in selenium as it helps lower inflammation. Foods rich in selenium include:

1. Brazil nuts.

2. Seafood.

3. Lean meat.

4. Rice.

5. Pasta.

6. Oatmeal.

7. Eggs.

8. Baked beans.

Women with postpartum thyroiditis have to get tested periodically to check if the thyroid hormones are maintained at normal levels. Also, blood tests help assess if the treatment needs to be continued or stopped if they are on medications.

Conclusion:

Postpartum thyroiditis is an uncommon condition that affects women post-delivery. Though temporary, it should be attended to based on the severity of the symptoms. Periodic check-ups with the doctors, followed by getting tested regularly for blood levels, are necessary. Doctors decide whether to continue or taper off the treatment based on the hormonal blood levels. Around eighty percent of women do not require treatment past twelve months. However, few women with persisting symptoms of hypothyroidism may require treatment throughout their lives. The time post-delivery can be overwhelming for new mothers with sudden changes and responsibilities that they have to adjust to in a short span of time. Family support and necessary counseling are paramount in the beautiful journey of motherhood.