Postpartum Thyroiditis

Dr. Jolene BrightenPublished: Last Reviewed: Postpartum Leave a Comment

Fatigue, weight loss or gain, anxiety and irritability are all just part of being a mother, right? Not necessarily. In fact, when these symptoms persist, postpartum thyroiditis is a likely suspect. 

While we expect there to be some level of fatigue, many mothers find themselves in my practice after being told their severe exhaustion, debilitating anxiety and fluctuations in weight are just part of being a mom.

The truth is, all of these symptoms may be a sign of a postpartum thyroiditis, a condition that affects an estimated 1 in 12 women worldwide and is almost 6 times more likely to occur in women who have positive anti-TPO antibodies.

With anywhere between 10-17% of new mothers (that’s hundreds of thousands of women every year) developing a postpartum thyroid condition, it is a wonder this isn’t screened regularly in new mothers—especially in those women who have risk factors.

Risk for Developing Postpartum Thyroiditis:

  1. Previous postpartum thyroid condition
  2. History of hypothyroidism prior to or during pregnancy
  3. Elevated TPO antibodies preconception or during pregnancy
  4. Other autoimmune conditions, especially Type I Diabetes
  5. Depression, especially postpartum

What does postpartum thyroiditis look like?

Hyperthyroidism, the state of having too much thyroid hormone, often develops 1-4 months after birth and is the main presenting condition in an estimated 20-40% of women. In some cases, this will be the only presenting symptoms, but in the majority of cases, hypothyroid symptoms follow.

In other women (approximately 50% of cases), hypothyroid symptoms will develop in the absence of hyperthyroidism. The most common time to see hypothyroid symptoms is between 2 weeks to 6 months postpartum.

Hyperthyroidism often goes undiagnosed due to the early presentation and the fact that sleep disruption, anxiety (especially about baby’s health), and feeling more stressed can be common for a new mother.

Similarly, hypothyroidism can present with fatigue and depression around the same time we classically see postpartum depression develop. Does that mean your symptoms aren’t real? Not at all!

Hyperthyroid Symptoms:

  • Weight loss
  • Anxiety
  • Sleep disturbance
  • Loose stools
  • Tremor
  • Heat intolerance or feeling flushed
  • Irritability
  • Racing heart or heart palpitations
  • Fatigue

Hypothyroid Symptoms:

  • Decreased milk supply
  • Fatigue
  • Constipation
  • Depression
  • Muscle aches/ Joint pain
  • Dry skin
  • Cold intolerance
  • Changes in voice
  • Weight gain
  • Carpal Tunnel
  • Loss of the lateral 3rd of your eyebrows

Regardless of how postpartum thyroiditis first presents, many women also experience a swollen, non-tender thyroid and may even have difficulty swallowing. I can remember the discomfort I experienced with just swallowing liquids and the sense of always needing to clear my throat.

What To Do If You Suspect Postpartum Thyroiditis:  

Have Appropriate Lab Testing:

I recommend having TSH, free T3, free T4, Reverse T3, Anti-Thyroglobulin and Anti-TPO antibodies tested at 3-6 months postpartum, sooner if symptoms arise.

In my practice, I test women beginning at 4-8 weeks postpartum if there was an elevation of Anti-TPO antibodies prior or during conception, family history of a thyroid condition, previous history of postpartum thyroiditis or if the patient has a history of other autoimmune conditions (like Celiac or Type I Diabetes).

In some patients, I recommend testing as early as 2 weeks postpartum, but find that many mothers will not have significant enough changes in their thyroid markers at that point to rule in or out postpartum thyroiditis.

If you'd like to learn more about my specific treatment approach and the testing I recommend, you can schedule a free 10 minute phone call here.

In addition to the thyroid lab panel, I also recommend the following labs:

  • CRP: A marker of inflammation
  • Adrenal testing via saliva and/or urine
  • CBC: Screens for anemias
  • Ferritin: The storage form of iron. Iron is necessary for thyroid hormone production.
  • B12, Folate, Homocysteine: Gives information about B vitamin utilization.
  • Vitamin D3: Important vitamin in immune system and thyroid health. Knowing your vitamin D status will help you determine how much vitamin D is necessary for supplementation.

Depending on your symptoms, additional lab testing may be appropriate.

Get a Copy of Your Thyroid Guide:

Download a free copy of my eBook, Your Thyroid Guide, to learn more about testing, treatment options and what to talk to your doctor about.

I created this guide to give you the best approaches to thyroid care that will get your results and help you discover what might be causing your thyroid symptoms.

This is my gift to you, to help you heal and help you take back your life.

Download your copy of the Hypothyroid Guide.

A Natural Approach to Postpartum Thyroiditis 

Selenium 200 mcg

Daily intakes of 200 mcg of Selenium has been shown to lower thyroid antibodies and is an important nutrient for thyroid hormone production.

If you are currently pregnant and at risk, you can begin selenium during your pregnancy. Women with anti-thyroid antibodies present prior to conception or during pregnancy are recommended to begin selenium in order to reduce the risk of postpartum thyroid disease.

Do NOT Begin Iodine!

I can not emphasize this point enough. While iodine is necessary for thyroid hormone synthesis, it can aggravate autoimmunity when taken in excess. This means taking iodine can make your symptoms worse! 

All pregnant women should receive about 300 mcg of iodine daily, which includes food. Iodine is necessary for fetal development as well as your thyroid health, but once baby is born, adding extra iodine is of little help to postpartum thyroiditis and can actually cause harm.

Iodine at 150 mcg daily with a selenium supplement of 200 mcg can improve thyroid function with a lower risk of an autoimmune flare.

Begin Fish Oil.

Omega-3 fatty acids, especially EPA, reduce inflammation in your body. I generally recommend patients begin with 1,000-2,000 mg of total Omega-3s daily. Note, this is not total amount of fish oil, but rather the  total amount actual EPA and DHA, which will be listed as the total Omega-3s on the label.

Some patients require more, but it is important to check in with your doctor before exceeding levels of 2,000 mg. Certain medical conditions can be aggravated with too much omega-3s. 

Consider Thyroid Medication.

While no one likes the idea of beginning a medication, sometimes they are necessary. If your symptoms are robbing you of your life, talking to your doctor about beginning a thyroid medication. 

Beginning thyroid medication may improve symptoms and slow the progression of thyroid destruction. 

Left untreated, symptoms can progress and become debilitating.

Common thyroid medications include Levothyroxine (synthetic T4), Cytomel (synthetic T3), and Natural Dessicated Thyroid (NDT) such as Armour, Nature-Throid and WP Thyroid.

If you do begin medication, remember, this may not be permanent. In fact, 70-80% of women recover normal thyroid function after the first year postpartum.

Work with a Postpartum Thyroid Expert

There are uniques needs that a postpartum woman has that differ from other women experiencing hypothyroidism or Hashimoto's thyroiditis. It is important to find a doctor who understands how thyroid disease affects new mothers and what therapies are safe while breastfeeding.

Working with an experienced practitioner who treats the whole person can help you reverse your autoimmunity and regain full thyroid function. Your doctor should be working with you as a partner in your health.

In my clinical experience, I find there is great value in listening to the patient's full story and to evaluate treatment based on your symptoms and your labs. Remember you are more than just your labs and no one else knows what is “normal” for you. 

If your doctor is dismissing your symptoms or telling you, “of course you feel awful, you're a mom” then we should chat. No mother deserves to have have her symptoms dismissed—in fact, I'd argue that this dismissal is harmful to both mother and child.

Find the Root Cause.

While childbirth may have triggered your postpartum thyroiditis, there are other factors involved in the development of this condition that may be making your feel worse and allowing the disease to progress. 

I encourage you to find a Naturopathic or Functional Medicine practitioner who will help you explore gut health, chronic viruses, heavy metal toxicity, environmental toxins, food sensitivities and lifestyle factors that may be contributing to your autoimmunity.

If you'd like to find out more about what a root cause approach looks like, I invite you to schedule a complimentary 10 minute Thyroid Trouble Shooting Call  with myself or my associate. 

You Can Heal Your Thyroid

Approximately 20-30% of women will develop a lifelong thyroid condition after postpartum thyroiditis. If you’ve ever had postpartum thyroiditis, you have approximately 40-50% risk of developing it again with subsequent pregnancies— at which point, it may become permanent.

My intention is not to scare you with this information, but rather, I want you to be informed and able to advocate for yourself. Many doctors are of the mindset that postpartum thyroiditis is a transient inconvenience, when in fact, it is a very serious condition.

Left untreated, postpartum thyroiditis can become a permanent hypothyroidism and rob you of your energy, your mood and your joy as a mother. Untreated hypothyroidism can also make it impossible to become pregnant again.

But with appropriate treatment, you can reverse your autoimmunity, increase your energy, improve your mood and create amazing health that allows you to be present as a mother everyday.

This is just one of the reasons why I do my work.  I know this can be complicated to understand and that many doctors are outright dismissive of a mom's concerns about her own health, which is why I want to make it simpler for you and hold space for your story to be heard.  

You deserve to thrive. You deserve to be heard.  

Get you free copy of my eBook, Your Thyroid Guide,
and start healing your thyroid today! 


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About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten, NMD, is a women’s hormone expert and prominent leader in women’s medicine. As a licensed naturopathic physician who is board certified in naturopathic endocrinology, she takes an integrative approach in her clinical practice. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is the best selling author of Beyond the Pill and Healing Your Body Naturally After Childbirth. Dr. Brighten is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. She is a member of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian, Sports Illustrated, Elle, and ABC News. Read more about me here.