Overactive, Underactive, and Postpartum
Every pregnant woman receives a TSH test at the beginning of her pregnancy. A person with normal TSH levels has a properly functioning thyroid — therefore her body is in balance and her metabolic systems function properly. A person with low TSH levels often has hyperthyroidism (overactive thyroid). In this instance, the gland is producing too much of the hormone.
Symptoms of hyperthyroidism include racing thoughts, impatience, a “jittery” feeling, weight loss, and lack of appetite. Conversely, in hypothyroidism (underactive gland), the body does not produce enough of the hormone, and the TSH level is elevated as it struggles to encourage the gland to produce more. All of the symptoms I experienced can be linked to my underactive thyroid. Weight gain, anxiety and/or depression, fatigue, dry skin, digestive disorders and low sex-drive are common, and some women experience menstrual and fertility problems, as well as fibrocystic breasts.
My TSH was at the high end of the normal range when I was tested in my first trimester. Perhaps my pregnancy tipped the scales. Researchers are discovering that many cases of alleged postpartum depression might be misdiagnosed thyroid problems. In my case, the underactive gland is a permanent condition, but many women develop postpartum thyroiditis, a temporary condition. An estimated eight to ten percent of all women develop this condition after giving birth. Typically, the new mother experiences an overactive condition for six weeks to three months postpartum, and then an underactive gland between three and nine months after delivery. In most instances the thyroid regulates itself by the end of the first year after giving birth, but in other instances the postpartum thyroiditis results in a permanently underactive gland.
Treatment and Pregnancy
Hypothyroidism and postpartum thyroiditis are fairly easy to treat. In my case, I immediately began taking synthetic hormones, and will be on this drug for life. In the two years since I began the treatment, I have dropped fifty pounds, all of my physical symptoms have disappeared, I am much more emotionally balanced and no longer take anti-depressants. However, I do intend to become pregnant again, and managing these conditions during pregnancy can be tricky. A pregnant woman’s hormones shift dramatically, and hormone levels must be monitored carefully to prevent fetal thyroid conditions. Synthetic hormones are completely safe during pregnancy because they take the place of the body’s normal hormones, and replacement therapy can continue.
An overactive condition is much more difficult to treat. In some instances, radioactive iodine must be used to control hormone production. For obvious reasons, women experiencing an overactive thyroid should not become pregnant while undergoing treatment. If radioactive iodine is administered during pregnancy, the fetus’ thyroid can often be destroyed. Women with an untreated overactive glands also have a higher risk of miscarriage. There are drugs that can be safely administered during pregnancy, but hyperthyroidism remains the most difficult thyroid problem to treat.
Underdiagnosed?
Few pregnancy books discuss these problems, and it’s the rare woman who would even think to suggest a test as part of her postpartum exam. If nearly ten percent of new mothers are experiencing some form of thyroid trouble, and between one and two percent of all women develop a related condition during their lifetime, why isn’t this a hot topic?
In part, postpartum depression has stolen the spotlight from other conditions. Like PMS, postpartum depression was historically dismissed as a problem of self-control and emotional excess. Medical research has legitimized postpartum depression, proving that it is a genuine illness and often the result of a biochemical imbalance. At the same time, other conditions that share the same symptoms may be pushed into the background simply because they are not in the mainstream news.
Just as thyroid tests are administered at the beginning of pregnancy, they should also be a normal part of postpartum examinations. The blood test is a simple, inexpensive procedure that should be performed upon request. Women experiencing symptoms described here should request the test. Many of the emotional problems associated with postpartum depression are often organic, rather than psychological. If a thyroid problem is the cause of physical and emotional symptoms, medical treatment is necessary and a huge relief for the frazzled new mother.
