What Is Postpartum Thyroiditis 

The thyroid is an endocrine gland in the neck that secretes hormones triiodothyronine (T3), thyroxine (T4), and calcitonin. These hormones are responsible for the proper functioning of cells in the body. 

Thyroiditis is the inflammation of the thyroid gland caused by abnormal levels of thyroid hormones in the body. 

Postpartum thyroiditis is the inflammation of the thyroid glands in women who have recently given birth. Within 6 months of giving birth, there is an abnormal increase in the levels of thyroid hormones and the patient notices symptoms of an overactive thyroid gland. It occurs as the immune system attacks the thyroid gland. In a few weeks, there will be a decrease in hormones. However, this is a temporary phase and might happen in the next childbirth.

Overview 

According to Thyroid UK, around 5-10% of women experience this disorder after childbirth. It is an autoimmune disorder due to the presence of Thyroid Peroxidase (TPO) antibodies. There are two phases of postpartum thyroiditis - hyperthyroidism and hypothyroidism. Some women experience both phases, while some experience one phase only.

In the first 6 months post-childbirth, there is inflammation of the thyroid gland. This causes leakage of stored thyroid hormones from the gland. Due to leakage, the thyroid hormone levels increase (thyrotoxicosis) causing hyperthyroidism. This hyperthyroidism might last for a few months. This damages the thyroid gland and the overactive thyroid now turns into underactive thyroid. This hypothyroidism can last up to a few months. Some women recover and their hormone levels return to normal. But some women suffer from permanent hypothyroidism.¹

There are different types of thyroiditis and some might be confusing due to the same symptoms.

Hashimoto's thyroiditis: This is also an autoimmune disorder, which means it is caused due to immune cells attacking the thyroid gland. This damage decreases thyroid hormone levels. This causes hypothyroidism or underactive thyroid symptoms. It mostly affects people between the age group 30-50 years.

Subacute thyroiditis: Viral infection such as mumps or flu causes painful swelling of the thyroid gland. Excessive thyroid hormones are released leading to thyrotoxicosis or hyperthyroidism. It affects women in the age group 20-50 years.

Silent thyroiditis: Also called painless thyroiditis. This can affect men as well as women. In this also, high levels of thyroid hormones cause thyrotoxicosis. After this overactive thyroid comes the underactive thyroid phase. For some people, there might be permanent hypothyroidism.

Drug-induced thyroiditis: Sometimes medication used to treat cancer and bipolar disorder can cause swelling of the thyroid gland. This can cause symptoms of overactive thyroid or underactive thyroid. It causes pain around the thyroid gland. Painkillers or anti-inflammatory medications might be needed to manage the symptoms.

Radiation-induced thyroiditis: Radiotherapy or radioactive iodine treatment can sometimes cause thyroiditis. It can also cause overactive thyroid or underactive thyroid symptoms. Mostly, permanent hypothyroidism is observed which can be managed by medications.

Acute thyroiditis: Also called infectious thyroiditis. This disorder is caused due to bacterial infection. Patients might have pain and swelling of the thyroid gland. Antibiotics might be required for the management of symptoms. 

Causes of postpartum thyroiditis 

There is not much research about the exact reasons for developing this condition. Experts believe postpartum thyroiditis is an autoimmune disorder like Hashimoto's thyroiditis. Both disorders show the presence of anti-thyroid antibodies such as anti-thyroid peroxidase and anti-thyroglobulin. These antithyroid antibodies especially attack thyroid tissues leading to inflammation of the thyroid gland. So, the women who have these antibodies are prone to postpartum thyroiditis.²,⁵

Women who have type 1 diabetes, personal or family history of thyroid disorders are also found to be susceptible to this disorder.

Women who had suffered postpartum thyroiditis in previous pregnancies have a chance of suffering from this disorder in consecutive pregnancies.

Signs and symptoms of postpartum thyroiditis 

As mentioned earlier, there are two phases of postpartum thyroiditis- hyperthyroidism and hypothyroidism. Some women experience both phases, while some experience either one of them.³,⁴

Hyperthyroidism 

In this phase, thyroid hormone levels are increased. Symptoms of overactive thyroid are- 

• Weight loss 
• Anxiety and nervousness
• Weakness in muscles 
• Feeling warm 
• Fast heartbeat 
• Excessive hair loss

Hypothyroidism 

In this phase, thyroid hormone levels are reduced. Symptoms of underactive thyroid are-

• Weight gain 
• Weakness and fatigue 
• Muscle cramps 
• Constipation 
• Memory loss 
• Depression 
• Dry skin 
• Inability to tolerate cold

Management and treatment for postpartum thyroiditis 

If you have doubts about your symptoms, then it is better to consult your GP. Blood tests and general health questions will help diagnose this disorder.

Patients with overactive thyroid will be treated with beta-blockers to reduce palpitations and tremors. As symptoms improve, medications can be adjusted. 

Patients with underactive thyroid glands will be treated with hormone replacement therapy for a few months. After taking the medications for a few months, the dosage can be reduced to see the effects on the body. Then the doctor can determine if medications need to be permanent or not. In the case of mild hypothyroidism, therapy might not be required.³,⁵

Treatment is decided depending on the severity of the symptoms.

FAQs

How is postpartum thyroiditis diagnosed 

Postpartum thyroiditis is diagnosed by blood tests. Healthcare professionals might ask questions about symptoms experienced and decide the outcome. 

How can I prevent postpartum thyroiditis 

As the exact causes are still unknown, there are no certain prevention measures for this disorder. But taking good care by ensuring a nutritious diet and getting rest after childbirth can reduce the chances of getting affected by this postpartum thyroid dysfunction.

Who are at risk of postpartum thyroiditis 

Women who have type-1 diabetes, personal or family history of thyroid disorders, and prior history of postpartum thyroiditis are at risk of developing this disorder.

How common is postpartum thyroiditis 

Postpartum thyroiditis affects 5-10% of women post-childbirth.

When should I see a doctor 

If you have symptoms of hyperthyroidism or hypothyroidism, please contact your GP. Sometimes women think that the symptoms are due to childbirth, so it is better to get an expert opinion.

Summary 

The thyroid is a butterfly-shaped endocrine organ in the neck. It secretes three hormones triiodothyronine (T3), thyroxine (T4), and calcitonin. T3 and T4 help in regulating the metabolic rate of the body, while calcitonin regulates the calcium levels in the blood. 

Thyroid Stimulating Hormone (TSH) is a hormone secreted by the pituitary gland which regulates the secretion of hormones T3 and T4. 

Thyroiditis is the inflammation of the thyroid gland due to abnormal thyroid hormone levels. There are various types of thyroiditis such as silent thyroiditis, acute thyroiditis, postpartum thyroiditis, Hashimoto's thyroiditis, drug-induced thyroiditis, radiation-induced thyroiditis, and subacute thyroiditis. 

Postpartum thyroiditis is the inflammation of the thyroid gland observed in postpartum women. It is an autoimmune thyroid disease. Women with type-1 diabetes, prior history of postpartum thyroiditis, and personal or family history of thyroid disorders are prone to develop this disorder. This happens in the first 6 months post-childbirth. It happens in two phases - hyperthyroidism and hypothyroidism. Some experience any one phase, while some experience both phases. Around 5-10% of women experience this disorder. It is mostly a temporary phase with the symptoms getting better by the first year of childbirth. But some women face a permanent phase of hypothyroidism.

In this, a woman's thyroid gets inflamed due to the presence of TPO antibodies. Due to damage, excessive thyroid hormones leak out causing thyrotoxicosis and symptoms of hyperthyroidism. 

In this first phase, women experience weight loss, anxiety, muscle weakness, rapid heart rate, and excessive hair loss. This phase might last for a few months.

After this, there comes the hypothyroidism phase where women experience symptoms like weight gain, weakness, muscle cramps, dry skin, memory loss, and inability to tolerate cold. This phase also might last a few months, but some women might experience permanent hypothyroidism.

Symptoms are quite confusing for patients as they might feel it as a result of childbirth. So it is essential to contact GP in case of any doubt. It is better to get tested and treated.

It is diagnosed by blood tests and general queries about symptoms might help the experts diagnose the condition. 

Treatment for hyperthyroid phase includes the use of beta-blockers to reduce symptoms. Hormone replacement therapy is used to manage hypothyroidism symptoms. 

The dosage and duration of medications vary according to the condition of the patient.