Postpartum thyroiditis is a multiphasic inflammation of the thyroid gland that can occur immediately after pregnancy and is now considered a special form of autoimmune Hashimoto’s thyroiditis. In the first phase of the disease, affected individuals suffer from hyperthyroidism followed by hypothyroidism. Normalization usually occurs without treatment.
What is postpartum thyroiditis?
The thyroid gland is one of the most relevant hormonal glands in the human body. The gland produces the thyroid hormones triiodothyronine T3 and thyroxine T4, which act on nearly all cells of the body and stimulate vital energy metabolism in the cells. The thyroid gland is regulated in its activity by the hypothalamic hormone TSH-releasing hormone and is additionally functionally regulated by the pituitary hormone TSH. Different diseases can affect the thyroid gland in its function. One of them is thyroiditis or inflammation of the thyroid gland. Different diseases with different causes are characterized by inflammation of the thyroid gland. Postpartum thyroiditis or postpartum thyroiditis is one such condition and usually occurs shortly after pregnancy. About seven percent of all new mothers develop postpartum thyroiditis. The disease is an inflammation of the thyroid gland with a comparatively mild course, associated with a favorable prognosis.
Causes
The causes of postpartum thyroiditis have not been conclusively determined. However, researchers now suspect an autoimmune disease behind the phenomenon. For example, many scientists currently believe the condition to be a special form of chronic lymphocytic thyroiditis along the lines of Hashimoto’s thyroiditis. Some risk factors may favor the occurrence of postpartum thyroiditis after pregnancy. For example, women with type I diabetes mellitus develop thyroiditis in up to 25 percent of all cases. Patients with thyroid antibodies also have an increased risk of developing the disease. For autoimmune thyroid diseases and in particular postpartum thyroiditis, familial clustering has been reported. Therefore, women with corresponding cases in the family are also at increased risk. Is the
Postpartum thyroiditis has occurred after a previous pregnancy, those affected are up to 70 percent likely to develop the disease again in their subsequent pregnancies.
Symptoms, complaints, and signs
Women with postpartum thyroiditis suffer from a variable clinical presentation that may be similar to silent thyroiditis. Classically, the disease progresses in three phases. Up to six months after delivery of a child, new mothers develop hyperthyroidism lasting about two months, followed by four to eight months of hypothyroidism. After the first two phases, thyroid function normalizes for the time being. In other cases, the inflammatory disease has manifested itself exclusively in the form of hypothyroidism or hyperthyroidism. After one year, nearly all patients were symptom-free again. However, the transition to a persistent hypothyroidism cannot be completely excluded. Symptomatic of the disease may be metabolic abnormalities, hyperthyroidism, hypothyroidism, mood swings, disturbed temperature sensation and similar complaints. Pain does not usually occur in postpartum thyroiditis.
Diagnosis and course of the disease
The diagnosis of postpartum thyroiditis is made by the physician on the basis of the patient’s medical history and hormone status. Hormone status can be used to detect hyperthyroidism or hypothyroidism, depending on the particular phase. In order to prove the inflammatory basis, imaging of the thyroid gland as well as histological examinations of the affected thyroid tissue can be performed. In principle, there is a favorable prognosis for affected women. The symptoms usually resolve themselves within the next few months. Only in the rarest cases does a permanent disturbance of thyroid function occur.
Complications
In postpartum thyroiditis, affected individuals suffer from inflammation of the thyroid gland.In most cases, no special treatment is necessary, so that the symptoms disappear completely on their own. Complications also do not usually occur. Patients suffer from hypothyroidism for a short time and then eventually from hyperthyroidism. The duration of this condition generally cannot be predicted. However, thyroid hormone production returns to normal in most cases. However, there may be mild obesity and impaired metabolism during postpartum thyroiditis. Mood swings or a disturbed sense of temperature may also occur and have a negative impact on the quality of life of the affected person. Most patients do not suffer from pain due to postpartum thyroiditis. Direct treatment is not necessary in many cases. However, the disease can be helped by taking hormones and other medications. In case of depression or other psychological complaints, appropriate therapy is necessary. However, postpartum thyroiditis always presents a positive course of the disease. The patient’s life expectancy is usually not affected by the disease.
When should you see a doctor?
Immediately after childbirth, there is a change in the hormonal system in the female organism. This leads to changes, health problems and irregularities. In the case of postpartum thyroiditis, a doctor is not normally needed, as the disorders regulate themselves independently as they progress. Timely comprehensive education about the physical changes after childbirth is advisable. This can be done virtually through appropriate contributions on the Internet or through the use of specialist literature on childbirth. In addition, discussions in advance with the gynecologist or midwife are helpful. In many cases, consultation with women who have already given birth can be sufficient. In a mutual exchange, open questions are clarified and doubts are removed. In addition, the prospect of further development can be helpful in deciding whether a visit to the doctor is indicated. Asking a doctor is recommended if there are persistent uncertainties or fears. If the existing questions cannot be clarified by people in the environment, consultation with the doctor is advisable. If worries, distress or irregularities increase in intensity or scope, it is recommended to seek help. If there are irregularities in handling the infant due to the discomfort, a visit to the doctor is also recommended.
Treatment and therapy
In most cases, women with postpartum thyroiditis do not require further therapy. The symptoms often resolve completely after a few days. Normal thyroid function returns. Since the causes of the disease have not yet been conclusively clarified, a causal therapy is not available anyway. In severe cases, however, symptomatic therapy can make sense. In the case of hypothyroidism, this symptomatic therapy usually corresponds to conservative hormone replacement with drugs such as levothyroxine. In the case of hyperthyroidism, symptomatic treatment usually involves thyrostatic drugs. These drugs inhibit the production of thyroid hormones. Sulfur-containing thyrostatic drugs such as propylthiouracil or carbimazole have a one-week action period and must be combined with other drugs for more rapid action. However, thyrostatic drugs have often been found to be ineffective in hyperthyroidism in the setting of thyroiditis in the past. Hormones are stored within the thyroid gland and can be released despite inhibited formation. For this reason, symptomatic treatment of hyperthyroidism due to inflammation turns out to be much more difficult than symptomatic therapy of hypothyroidism due to inflammation. If the thyroid dysfunction causes mood swings or even depressive moods, psychotherapeutic care for the affected women is conceivable. Since many women suffer from mood crises immediately after pregnancy anyway, the step of psychotherapy makes all the more sense.
Prevention
Postpartum thyroiditis can hardly be prevented up to the present time.The causes are still too poorly understood for preventive measures to exist. Although the familial connection makes it possible to estimate the probability of developing the disease, it does not provide any starting points for prevention. Affected women can now have their own risk of postpartum thyroiditis assessed more or less accurately and thus prepare themselves psychologically for the eventuality of the disease, but so far they cannot actively avoid the disease.
Aftercare
The aftercare of postpartum thyroiditis amounts mainly to the regular presentation to the family doctor or endocrinologist. The treating gynecologist may also be an optimal point of contact. In the follow-up, the main thing is to take blood samples at short intervals to determine that the thyroiditis has healed. If permanent secondary disease develops, lifelong treatment with thyroid medication may be required. Another point of follow-up treatment is imaging of the thyroid gland. The first procedure used here is ultrasound, and this can often be done directly at the family doctor’s office. Late changes in the thyroid gland can be detected here, such as enlargement or reduction or the formation of nodules. In some cases, an examination by a radiologist may also be necessary. This is particularly indicated if there is evidence of inadequate healing, unclear findings on ultrasound, or a flare-up of postpartum thyroiditis or the occurrence of secondary disease. The patient should be conscientious in attending the agreed-upon follow-up examinations, as thyroid disease that has not been treated or has not been treated adequately can have significant consequences on the entire body and metabolic processes.
Here’s what you can do yourself
Close relatives should be informed about the course of postpartum thyroiditis. Depressive moods, inner restlessness, weight changes and hair loss thereby meet with understanding in the patient’s environment. Additional stress and feelings of guilt are avoided. Help in caring for the infant also makes everyday life easier for the patient. The necessity of further measures to cope with everyday life depends on the symptoms. If euthyroidism is present, no further measures are necessary. Excessive weight gain in the presence of hypothyroidism can be reduced by adjusting eating habits to the decreased feeling of hunger. Rest and sufficient sleep enable the patient to cope with everyday life despite a slowed metabolism. For muscle tension, massages and warm compresses help. For dry skin, moisturizers and adequate fluid intake are recommended. Constipation symptoms are counteracted by a high fluid intake, a high-fiber diet that promotes stool, exercise, abdominal massages, and avoidance of constipating foods. If hyperthyroidism is present, exercise, yoga, Pilates, and relaxation exercises are suitable for managing inner turmoil. Increasing caloric intake to match the greater appetite prevents excessive weight loss due to accelerated metabolism. Teaching medical professionals about further childbearing ensures thyroid levels are set within the normal range before conception again.