Soon after the birth of my first son in 2006, I was overwhelmed with a debilitating fatigue that never seemed to end. I wished every night to sleep like a baby and hoped to wake up refreshed in the morning like my pre-pregnancy self. Instead I woke every morning struggling to get up for my newborn baby and make it through the day. There are no words to describe the exhaustion I felt that year except to say it was an awful sick tired that no amount of sleep could alleviate. Looking back I don’t know how I made it through that year of my life.
Whenever my son would wake in the night for his feeding in the initial months, I would find myself drenched in sweat with my heart pounding and then be unable to fall back asleep. The pregnancy weight initially came off very easily and quickly. However several months later I noticed that the weight started packing on faster and faster and I couldn’t stop the weight gain no matter what I tried.
My doctor said that it was normal for new mothers to be tired and to struggle with pregnancy weight. She said good-bye and passed me prescriptions for sleeping pills and anti-depressants. However this didn’t seem normal to me. This didn’t feel like a new mother struggling with sleep deprivation. This felt like every part of my body was shutting down and I had an inner sick feeling. My instincts told me she was wrong. I did not know then that I should have insisted my doctor check my thyroid levels. I just didn’t know.
By my son’s first birthday, he was sleeping through the night but still I felt an overpowering fatigue weighing me down. My weight continued to climb. My hair was falling out. The heels of my feet were cracked and my scalp itched. My legs were numb to the touch. Unusually heavy menstrual bleeding, chronic constipation, and constant infections plagued me. From being a healthy woman prior to pregnancy, now my cholesterol and blood sugar levels were sky high and my blood pressure was abnormally low.
Then when my son was 15 months old, painful kidney stones landed me in the emergency room. The doctor unsure of the cause of my stones decided to do a full blood work up. I was diagnosed with hypothyroidism that day in the ER.
What had happened to me?
Postpartum thyroiditis is a condition in which the thyroid, a butterfly-shaped gland at the base of the neck, becomes inflamed and dysfuncional in the first year after childbirth. Pregnancy is a time of complex hormonal changes and therefore a time when women are particularly vulnerable to developing thyroid dysfunction.
In a large quantitative review that included 21 published articles encompassing a total of over 8000 women, the pooled prevalence of postpartum thyroid dysfunction was 8.1%. According to this study reported in Thyroid, postpartum thyroid dysfunction occurs in 1 of 12 women in the general population worldwide, and 1 of 17 women in the United States.
According to the 2011 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum, the “classical form” of postpartum thyroiditis consists of an initial period of transient hyperthyroidism (overactive thyroid) followed by transient hypothyroidism (underactive thyroid) with a return to normal by the end of the initial postpartum year. The hyperthyroid phase typically occurs between 2 and 6 months postpartum, followed by the hypothyroid phase around 3 to 12 months postpartum. 25% of women present with this classical form, 32% with isolated hyperthyroidism, and 43% with isolated hypothyroidism.
I experienced the classical form of postpartum thyroiditis through my first postpartum year with a distinct hyperthyroidism phase during the first initial months of my son’s life followed by hypothyroidism that started some time around the 6th month postpartum.
Each woman may experience symptoms differently, however here is a list of common symptoms:
Hyperthyroidism (overactive thyroid)
• Sudden weight loss
• Rapid heartbeat and palpitations
• Nervousness, anxiety and irritability
• More frequent bowel movements
• Muscle weakness
• Difficulty sleeping
Hypothyroidism (underactive thyroid)
• Unexplained weight gain
• Pale, dry skin
• Elevated blood cholesterol level
• Puffy face
• Increased sensitivity to cold
• Muscle aches and weakness
• Heavier than normal menstrual periods
• Brittle fingernails and hair
While some women spontaneously recover by the end of the first postpartum year, a recently published article based on a large-scale study in Italy reported that 54% of women with postpartum thyroiditis have persistent hypothyroidism at the end of the first postpartum year. I am one of the many women who never recovered postpartum.
Six years later I am still hypothyroid. However by taking charge of my thyroid health and by finding a top thyroid doctor, I am in excellent health despite my hypothyroidism.
I often wonder what would have happened to me if the emergency room physician on duty the day I developed painful kidney stones had not checked my thyroid levels. I would be a very sick, tired woman today with no idea that my thyroid was to blame.
I co-authored this book with Mary Shomon, Your Healthy Pregnancy with Thyroid Disease: A Guide to Fertility, Pregnancy, and Postpartum Wellness, so that every woman will know the lab tests, optimal ranges, medications, supplements, dietary recommendations and more so that she will know more than even her doctors about having miracle babies with thyroid disease and being well postpartum (including managing weight gain, fatigue, breastfeeding challenges, hair loss and more).
1. Nicholson, W.K., Robinson, K.A., Smallridge, R.C., Ladenson, P.W., Powe, N.R. Prevalence of postpartum thyroid dysfunction: a quantitative review. Thyroid 2006;16(6):573–82.
2. Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E.N., Soldin, O.P., Sullivan, S., and Wiersinga, W. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Retrieved from http://thyroidguidelines.net/pregnancy.
3. Stagnaro-Green A, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Negro R 2011 High rate of persistent hypothyroidism in a large-scale prospective study of postpartum thyroiditis in southern Italy. J Clin Endocrinol Metab 96:652–657.