post-natal thyroid disorders

Post-natal thyroid disorders can easily be misdiagnosed as post-natal depression or puerperal psychosis.

It is essential that women already diagnosed with post-natal depression or puerperal psychosis, are tested for a thyroid disorder. Ideally, a full thyroid function test should be routine for every woman following childbirth!

Post-partum Hypothyroidism - underactive thyroid disease occurring after childbirth.
It is all too easy to dismiss hypothyroid symptoms as normal parental tiredness.
A woman may have hypothyroid problems beginning shortly after her baby’s birth. In 75% of women with post-partum hypothyroidism, replacement hormone will be needed for only a short time. For the other 25%, blood tests will show that medication is needed for life, often an indication that the woman had a thyroid disorder for some time before the pregnancy or birth.

The discovery that the unpleasant symptoms of depression, exhaustion, weakness, forgetfulness, aching and coldness may be relieved with medication, is very positive and life enhancing.

Consultation with a doctor and a blood test are advisable.
At the correct dosage, thyroid hormone replacement has no side-effects or ill effects on the baby and does not affect breastfeeding – for peace of mind, double check this with your doctor. It simply helps the body to restore itself to a healthy balanced state, making childcare and life in general much more manageable.

It is important to consult a doctor regularly for blood tests, to check thyroid hormone levels in the blood and to make sure your medication is at the correct dose.

Post-partum Thyroiditis - inflammation of the thyroid occurring after childbirth, which may cause overactive thyroid symptoms followed by underactive thyroid symptoms.
The inflammation may make the neck tender and swollen. Post-partum thyroiditis may be dismissed by doctors and partners as “first time mother worry or inability to cope.” The symptoms of post-partum thyroiditis are the characteristic signs of an overactive thyroid gland, tremour, palpitations, sharp loss of weight and general restless anxiety.
The woman feels hot and tired but can’t sleep when she needs it most! This anxious phase may last two to four months and may then go into an underactive phase characterised by fatigue, constipation, depression and sluggishness.
Please get a thyroid test if you have these symptoms.

The anti-thyroid drug Carbimazole is not recommended while breast feeding as it passes into breastmilk, so bottle feeding is advised. There is another option which may be appropriate while breastfeeding so consulting a doctor is vital.
It is important to consult a doctor regularly for blood tests to check thyroid hormone levels. Both post-partum hypothyroidism and post-partum thyroiditis are often short-lived but may reccur when the woman has another child. Thyroid tests are advisable.

If you feel unwell for any reason consult your doctor or psychiatrist and health visitor or community psychiatric nurse for help and support.

Babies and Children
In New Zealand, mothers are offered a blood test for their new born baby, known as the Guthrie, PKU or “heel prick test”. It tests for 7 metabolic disorders, namely:

  • Phenylketonuria (incidence approximately 1:15,000, lack of enzyme to breakdown phenylalanine)
  • Biotinidase deficiency (incidence approximately 1:50,000, lack of enzymerequired to recycle biotin)
  • Congenital adrenal hyperplasia (incidence approximately 1:20,000, lack of enzyme required to produce various hormones in the adrenal cortex)
  • Cystic fibrosis (incidence approximately 1:3,000, lack of a gene vital for making a protein which is needed for the body’s transportation of salt)
  • Galactosaemia (incidence approximately 1;50,000, lack of enzyme required tobreak down sugar in milk)
  • Maple syrup urine disease (incidence approximately 1:250,000, lack of enzyme required to break down certain amino acids)
  • Hypothyroidism (incidence approximately 1:4,500, abnormal development of the thyroid gland potentially leading to multiple developmental problems).

    It is important to have the test done, as it should show up any thyroid problem in the baby. Appropriate treatment for the baby will greatly help with growth and physical and mental development.
    If your baby has not had this test, consult your doctor. A child or adult of any age may develop a thyroid problem.
    If you are worried about this, consult a GP or paediatrician with an interest in endocrinology.
    In some cases, a child's growth rate may be a useful indicator of thyroid disorder. Regular Plunket visits will help with growth checks and records. Keep a record of your child’s growth and take it along to the consultation. Give details of this along with any other symptoms to the doctor. A blood test should help with any thyroid diagnosis.

    Thyroid Hormone Replacement comes in 2 varieties – Thyroxine (synthetic T4-only) or Whole Thyroid Extract (made from Dessicated Porcine Thyroid tissue & containing T4, T3, T2, T1 & Calcitonin). In the correct dosage, it is fine for breastfeeding. It is important to consult a doctor regularly for regular blood tests to check thyroid hormone levels and to take the correct dose of medication daily. You may need to take medication only for a short time or for life, ask your doctor.

    The tests to ask for are: TSH, Free T3, Free T4, TPO - Thyroperoxidase and Tgab - Thyroglobulin antibodies

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