Published March 20 2017
While there are many different factors that can trigger Hashimoto’s Thyroiditis, many women seem to develop this condition during the postpartum period. But thyroid autoimmunity isn’t directly triggered by giving birth. The process actually starts months or years before, and during postpartum there is an “immunologic flare” that usually leads to overt symptoms. And while many women with postpartum thyroiditis become euthyroid after one year, this isn’t the case with everyone, and approximately 25% of women will develop permanent hypothyroidism within 10 years (1) [1].
Although some consider the postpartum period to be an autoimmune trigger, many women already have elevated thyroid antibodies well before developing postpartum thyroiditis. If this is the case then why do many women not experience symptoms until after giving birth? Well, there is something called a silent autoimmune stage, and this is when someone has elevated thyroid antibodies, but no symptoms. Someone with Hashimoto’s Thyroiditis might be in this stage for many years before developing overt symptoms.
In addition, pregnancy usually will suppress the autoimmune response in those with Hashimoto’s Thyroiditis. And the reason for this is because pregnancy is characterized by a shift towards a Th2 dominant state, which will suppress most cases of Hashimoto’s, which is usually a Th1 dominant condition. This is why many people with Hashimoto’s Thyroiditis will seem to go into remission during pregnancy. If you’re not familiar with the Th1 and Th2 pathways and want to learn more about this you can read my blog post entitled “The Role of Cytokines In Autoimmune Thyroid Conditions [2]”.
What Are The Symptoms Of Postpartum Thyroiditis?
Although one might expect to experience hypothyroid symptoms when dealing with postpartum thyroiditis, this isn’t always the case. In fact, transient hyperthyroidism is very common with postpartum thyroiditis, which can lead to symptoms such as an increased resting heart rate, heart palpitations, tremors, anxiety, hair loss, increased appetite, and/or weight loss. But while transient hyperthyroidism is common, the majority of people with this condition will experience a period of hypothyroidism.
Is postpartum depression more common in those who have postpartum thyroiditis? Postpartum depression affects up to 15% of mothers (2) [3]. A few studies have looked to see if there is a greater incidence of postpartum depression in those women with postpartum thyroiditis, but so far the research doesn’t seem to show a link between postpartum depression and postpartum thyroiditis (3) [4].
Managing The Hyperthyroid Symptoms Associated With Postpartum Thyroiditis
How should transient hyperthyroid symptoms that are associated with postpartum thyroiditis be managed? Because the hyperthyroid symptoms are usually temporary you wouldn’t want to take antithyroid medication such as Methimazole, and you probably would also want to avoid antithyroid herbs such as bugleweed. Sometimes beta blockers are prescribed by medical doctors to help manage the cardiac symptoms, including the increased heart rate and palpitations. But there are also natural alternatives to consider, such as motherwort. And for those with postpartum thyroiditis who are nursing, motherwort does seem to be safe to take according to master herbalist Kerry Bone.
Should Thyroid Hormone Medication Be Taken?
As for whether thyroid hormone medication should be taken if someone with postpartum thyroiditis has hypothyroidism, in many cases the answer will be “yes”. If the person is fluctuating back and forth between hyperthyroidism and hypothyroidism then they probably wouldn’t want to take thyroid hormone. But most of the time the transient hyperthyroidism period will appear first, followed by a longer period of hypothyroidism. And if the thyroid hormone levels are low or depressed for a prolonged period of time then of course this isn’t a good thing.
Can Postpartum Thyroiditis Be Prevented For Those Who Have Elevated Thyroid Autoantibodies?
It’s very common for women who test positive for thyroid antibodies during pregnancy to develop postpartum thyroiditis. As a result, if it is discovered that someone has elevated thyroid peroxidase or thyroglobulin antibodies during pregnancy, can anything be done to prevent postpartum thyroiditis from occurring? Well, although I’m not a big fan of giving people with autoimmune conditions nutrients and herbs to make someone more Th1 or Th2 dominant, this is something to consider for a woman who is pregnant and tests positive for thyroid antibodies.
However, rather than using nutrients and herbs to shift someone with Hashimoto’s towards a Th2 dominant state, what I would focus on is the following:
1. Find and remove the autoimmune trigger. This admittedly can be a challenge depending on what the trigger is. For example, if stress or gluten are factors then one can address these triggers. However, if a pregnant woman’s autoimmunity is caused by a gut infection, or an environmental toxin such as mercury, then this can be more challenging to treat during pregnancy. This is especially true in the case of an environmental toxin such as mercury, as for obvious reasons it’s not advised to be aggressive with detoxification during pregnancy. And in the case of mercury amalgams, removal isn’t advised for pregnant or nursing women.
2. Heal the gut. Since a leaky gut is a factor in autoimmunity, it is important to do what is necessary to heal the gut. Of course removing the factor that is causing the leaky gut is the first step of the 5-R protocol. And then you want to do things to reinoculate, replace, repair, and rebalance. To learn more about the 5-R protocol I would read the blog post I wrote entitled “What Is The 5-R Protocol? [5]”.
3. Do things to decrease proinflammatory cytokines and increase regulatory T cells. Decreasing proinflammatory cytokines and increasing regulatory T cells during pregnancy will reduce the likelihood of postpartum thyroiditis developing, along with removing the autoimmune trigger and healing the gut. In the past I’ve written blog posts on how to increase regulatory T cells [6] and decrease proinflammatory cytokines [6], and so I’d check these out.
Earlier I mentioned that many women already have elevated thyroid antibodies well before developing postpartum thyroiditis. But how about those women who test negative for thyroid antibodies, but then develop postpartum thyroiditis? In this situation can we conclude that the birth process is what triggered the autoimmune response? Perhaps, but we also need to keep in mind that not everyone who has Hashimoto’s will have elevated thyroid antibodies. It’s possible for people with autoimmune conditions to have negative antibodies. As a result, even if someone with postpartum thyroiditis had negative thyroid antibodies during pregnancy, we can’t assume that the birth process itself was a trigger.
Postpartum Thyroiditis and Natural Treatment Methods
Just as is the case with anyone who has Hashimoto’s Thyroiditis, with postpartum thyroiditis, the goal is to do what is necessary to improve the health of the immune system. While taking medication or herbs to manage the thyroid symptoms is important, postpartum thyroiditis is an immune system condition, not a thyroid condition. I’m not going to get into great detail about what to do in order to improve immune system health, as there are many factors that play a role in this, and I have written numerous blog posts and articles on this topic, which you can find on this website.
But I will say here that three of the biggest things you need to do in order to reverse the autoimmune component are 1) find the autoimmune trigger, 2) remove the autoimmune trigger, and 3) heal the gut. As I mentioned earlier, finding the trigger can be challenging, and healing the gut does take some time. But the good news is that doing these is very possible, and is essential to restoring the health of the immune system.
In summary, many women develop postpartum thyroiditis during birth, although the process of autoimmunity starts months or years before. Frequently what happens is that there will be the presence of thyroid antibodies prior to giving birth, and an “immunologic flare” during postpartum will cause overt symptoms. The person with postpartum thyroiditis many times will experience transient hyperthyroidism, followed by hypothyroidism. If a pregnant woman tests positive for elevated thyroid antibodies, in order to try to prevent postpartum thyroiditis from developing she would want to 1) find and remove the autoimmune trigger, 2) heal the gut, and 3) decrease proinflammatory cytokines and increase regulatory T cells.