How does the disease progress?
The classic course includes three phases, but does not occur in everyone. The first phase begins one to four months after childbirth: the inflamed gland cells are destroyed and release stored hormones into the blood, causing palpitations, sweating, anxiety, and trembling. It lasts several weeks or months. Then the reserves are depleted, and a phase of hormone deficiency begins with the opposite complaints. Some women experience only one of the phases: either short-term excess or immediate hypothyroidism. By the end of the first year, function is usually restored.
- Hormone excess phase one to four months after birth
- Hormone deficiency phase after three to eight months
- Recovery phase at the end of the first year
- Isolated flow options possible
- The inflammation is painless, unlike subacute thyroiditis
Who's at risk
The main factor is the presence of antibodies to thyroid peroxidase, which are detected already during pregnancy. Women with type 1 diabetes and other autoimmune diseases are also more likely to get sick, as well as those who have already had thyroiditis after a previous birth: the likelihood of recurrence is significant. Smoking and a family history of thyroid disease also increase your risk. At the same time, breastfeeding itself, the method of delivery and the course of pregnancy do not affect the development of thyroiditis.
- Antibodies to thyroid peroxidase
- Diabetes mellitus type 1
- Other autoimmune diseases
- Previous episode of postpartum thyroiditis
- Family history of thyroid disease
- Smoking
Symptoms that are easy to miss
The complaints are nonspecific and overlap with the usual state after childbirth: lack of sleep, fatigue, mood swings. In the phase of excess hormones, a woman notes palpitations, internal trembling, sweating, irritability, poor sleep, weight loss with preserved appetite. In the lack phase - severe weakness, chilliness, dry skin, constipation, swelling of the face, hair loss, depression and memory loss. It is the second phase that is often mistakenly regarded as postpartum depression, so with such complaints it is reasonable to check TSH.
- Palpitations and trembling in the first phase
- Sweating and irritability
- Weakness and chilliness in the second phase
- Dry skin, hair loss
- Swelling of the face, constipation
- Depressed mood and decreased concentration
Survey
The basis of diagnosis is a blood test for TSH and free T4, as well as antibodies to thyroid peroxidase, which are usually elevated. Ultrasound shows signs of autoimmune inflammation and helps exclude nodes. An important task is to distinguish postpartum thyroiditis from Graves' disease, in which excess hormones are associated not with cell destruction, but with their excessive work: treatment approaches are different. If the picture is unclear, the endocrinologist prescribes additional studies. Tests are often repeated after several weeks to see the transition from one phase to another.
- TSH and free T4
- Antibodies to thyroid peroxidase
- Ultrasound of the thyroid gland
- Repeated analyzes over time
- Differential diagnosis with Graves' disease
- TSH monitoring one year after the episode
Treatment and observation
In the phase of excess hormones, specific treatment is usually not necessary: drugs that suppress the production of hormones do not work here, because the gland does not produce them in excess, but only releases reserves. If the heartbeat is severe, the doctor may prescribe drugs that slow down the pulse. In the phase of hormone deficiency with a significant decrease in function and complaints, replacement therapy with levothyroxine is prescribed - the drug is compatible with breastfeeding. After some time, the dose is revised: in many women the function is restored, and the treatment is canceled. TSH monitoring after a year is mandatory even if you feel well.
- Observation in the phase of hormone excess
- Means for slowing the pulse as prescribed by a doctor
- Replacement therapy for severe hypothyroidism
- Compatibility of treatment with breastfeeding
- Review the dose and try to stop after a few months
- TSH monitoring after a year and when planning a new pregnancy
