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Ask the Midwife Postpartum Thyroid Problems

by Gail Chapin, CNM

I had my first baby about three months ago. Everything went fine and I was feeling pretty good at first, but now I am tired all the time. My memory is shot and I canít concentrate on even a magazine article. Life just seems like one big chore day after day. Is this postpartum depression?

It certainly could be postpartum depression, but I would lean more towards investigating a thyroid problem. Your thyroid is a gland located at the base of your neck, just below your ďAdamís Apple.Ē The thyroid gland makes, stores, and releases thyroid hormone into the blood. Too little thyroid hormone in the blood slows your body down causing symptoms of fatigue, signs of depression, weight gain, dry skin and hair, feeling cold all the time, hair loss and difficulty with concentration and memory. Too much thyroid hormone causes the opposite symptoms: irritability, insomnia, heat intolerance and sweating, weight loss, rapid heart rate and nervousness. Both conditions can cause the thyroid gland to enlarge. This is called a goiter.

Women have a 5% to 10% chance of developing a thyroid disorder after giving birth. It is also typical to develop problems around three months postpartum. During pregnancy, your immune system is geared down to allow for proper growth of the baby. After you give birth, your immune system gears up again. Sometimes the immune system becomes overactive and begins attacking the thyroid gland resulting in postpartum thyroiditis. Usually, postpartum thyroiditis is characterized by a period of hyperthyroidism (overactive thyroid) followed by a period of hypothyroidism (underactive thyroid). Medications are generally given for about one year and then withdrawn to see how the thyroid gland functions on its own. In many instances, the condition eventually reverses itself and thyroid function returns to normal. About twenty five percent of women with postpartum thyroiditis do not return to normal and have to continue their medication for life.

Diagnosis of postpartum thyroiditis is made based on symptoms and a blood test called a TSH (thyroid stimulating hormone, which is secreted by the pituitary gland in response to high or low levels of thyroid hormone). Your care provider will also palpate the thyroid gland to see if it enlarged. If you need to take thyroid replacement medication, you should still be able to breastfeed since only a very small amount of the medication gets into the breast milk.

Most importantly, trust your own intuition. If you are not feeling right, find out why. Treatments for postpartum thyroiditis and for postpartum depression are available.

If you have any questions about pregnancy, childbirth or womenís health, please call them to The Birth Place 1-717-593-9173, e-mail to, or mail to: The Birth Place, 14478 Molly Pitcher Highway, Greencastle, PA 17225.

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