Postpartum Thyroiditis

What is postpartum thyroiditis?

Postpartum thyroiditis is a rare condition where your thyroid gland becomes inflamed within the first year after pregnancy. It’s a type of thyroiditis, or inflammation in your thyroid gland. Your thyroid is a butterfly-shaped gland in the lower front of your neck. It releases hormones that control essential body processes, including how you use energy (metabolism).

Postpartum thyroiditis usually unfolds in phases.

• Phase one: The inflammation causes your thyroid to produce and release too many hormones (hyperthyroidism). This phase usually happens between one to six months after a pregnancy. It may last from one week up to three months.
• Phase two: Your thyroid doesn’t produce or release enough hormones (hypothyroidism). This phase usually takes place four to eight months after pregnancy. It can last as long as a year.
• Phase three: Your thyroid usually returns to producing normal hormone levels.

Not everyone experiences all the phases in order, though. Some people skip over the hypothyroid phase. They have hyperthyroidism, and then their thyroid function returns to normal.

In rare cases, people remain in the hypothyroid phase. You’ll need hormone replacement therapy to make up for low thyroid hormone levels.

How common is postpartum thyroiditis?

An estimated 5% to 10% of people experience postpartum thyroiditis in the year after a birth, abortion or miscarriage. Rates are higher among people with more risk factors, like a thyroid condition.

What are the symptoms of postpartum thyroiditis?

Most people don’t notice symptoms in the first phase, hyperthyroidism. If you do experience symptoms, they usually involve body functions (like metabolism) being “hyper” or sped up. They may include:

• Anxiety.
• Hair loss.
• Unexplained weight loss.
• Rapid heart rate (tachycardia).
• Hypersensitivity to heat.

It isn’t until the second phase, hypothyroidism, that most people notice symptoms. Symptoms of hypothyroidism usually involve body functions (like metabolism) slowing down. They may include:

• Fatigue.
• Weight gain.
• Depression.
• Dry skin.
• Constipation.
• Muscle pain.
• Not having enough breast (chest) milk come in.
• Hypersensitivity to cold.

What causes postpartum thyroiditis?

Postpartum thyroiditis involves anti-thyroid antibodies attacking your thyroid gland. Antibodies are your body’s protectors. They fight germs that make you sick. With postpartum thyroiditis, antibodies go haywire and attack your thyroid gland instead. The attack causes inflammation in your thyroid.

The process is like what happens in Hashimoto’s disease, which is the most common type of thyroiditis.

Scientists are still researching what causes the antibodies to attack after a pregnancy. A popular theory is that you’re more likely to get diagnosed if you had an underlying autoimmune condition (that you didn’t know about) before pregnancy. An autoimmune condition happens when antibodies attack healthy cells and tissue.

What are the risk factors?

You’re more likely to develop postpartum thyroiditis if you:

• Have had postpartum thyroiditis before.
• Have Type 1 diabetes (a type of autoimmune condition).
• Have a personal or family history of thyroid disease.
• Had anti-thyroid antibodies before you were pregnant (you may not have known because you didn’t notice symptoms).

How is postpartum thyroiditis diagnosed?

Your healthcare provider will perform a physical exam and ask about your symptoms. They’ll do a blood test to check the levels of thyroid hormones (T3, T4 or TSH) in your blood. A blood test is usually enough to diagnose postpartum thyroiditis. It can also help exclude similar diagnoses, like Graves’ disease.

Graves’ disease is a lifelong condition that causes symptoms similar to postpartum thyroiditis.

How is postpartum thyroiditis treated?

Most people have mild symptoms and don’t need treatment unless symptoms worsen. If your symptoms are severe, you’ll need prescription medications. Let your provider know if you’re breastfeeding (chestfeeding). They can recommend medications that are safe for you and your baby.

Treatment depends on whether you’re experiencing hyperthyroidism or hypothyroidism.

• Hyperthyroidism: Medications include corticosteroids, like prednisone, and beta-blockers. Corticosteroids ease inflammation. Beta-blockers block the effects of the thyroid hormones. Both ease symptoms.
• Hypothyroidism: You’ll likely need thyroid hormone replacement therapy. This treatment usually lasts half a year to a year. You’ll probably be able to taper off the medication as your thyroid returns to normal.

Your healthcare provider will monitor your thyroid levels during treatment.

Is this a permanent condition?

Postpartum hypothyroidism is usually temporary. Seventy to 80% of people eventually no longer need medication because their thyroid starts making hormones at normal levels again. The other 20% to 30% stay in the hypothyroid phase. They’ll need thyroid long-term hormone replacement therapy.

Postpartum hypothyroidism also makes you more likely to develop future thyroid issues, including hypothyroidism or an enlarged thyroid gland (goiter). Even if your thyroid returns to normal, your provider will likely need to monitor your thyroid.

How long does it take to recover from postpartum thyroiditis?

Postpartum thyroiditis usually lasts between a year and a year and a half. Usually, within 12 to 18 months from when you first notice symptoms, your thyroid will return to normal. At this point, you’ll no longer need medicine.

Can I get pregnant again after postpartum thyroiditis?

Absolutely. Many people go on to have healthy pregnancies after postpartum thyroiditis. It’s important, though, that you tell your provider that you’ve had this condition if you’re planning a pregnancy. Approximately 20% of people with a history of postpartum thyroiditis develop it during later pregnancies.

Your provider can monitor your thyroid hormone levels to help guide you through a healthy pregnancy.

What questions should I ask my healthcare provider?

Questions include:

• Do I have an underlying thyroid or autoimmune condition?
• What treatments would you recommend?
• What medications are safest to use while I’m breastfeeding (chestfeeding)?
• When is it safe to reduce my thyroid medications?
• What follow-up schedule will I need to monitor my condition?
• What symptoms should I look for to alert me of a new thyroid issue?

A note from Cleveland Clinic

Many people with postpartum thyroiditis symptoms delay seeing their provider because they assume the changes are a normal part of pregnancy recovery. Caring for an infant can cause changes that may feel like hypothyroidism symptoms, like fatigue and muscle pain. But don’t assume you have to power through symptoms that aren’t improving. The problem may be your thyroid. A simple blood test is usually all it takes, so you know for sure. There are medications that can help you feel better and more capable of managing life with a new baby.