What is Postpartum Thyroiditis: Causes, Symptoms, Treatment, Pathophysiology, Risk Factors, Prognosis, Diagnosis
Thyroiditis means inflammation of the thyroid gland, which results in abnormal levels of thyroid hormones in the bloodstream. Postpartum thyroiditis is caused due to the problem with the thyroid gland of the women after delivery of the baby. It is characterized by symptoms of hyperthyroidism followed by hypothyroidism.
What is Postpartum Thyroiditis?
Thyroid is a small butterfly shaped endocrine gland located in front of the neck. It is a very important gland, which produces thyroid hormones and secretes them into the bloodstream. These hormones control body's growth and metabolism. They affect the processes of body such as temperature, functions of the brain and heart.
During thyroiditis, there is an increase in the production of thyroid hormones and later on there is a decrease in their levels. Postpartum thyroiditis is a destructive thyroiditis. It is a rare autoimmune disorder seen in 5-10% of the women after delivery (postpartum). Postpartum thyroiditis also occurs in some cases of miscarriage and abortions. It is characterized by initial increase and later on decrease in the levels of thyroid hormones in the blood. Patients with postpartum thyroiditis experience symptoms of hyperthyroidism followed by hypothyroidism. If it not treated in time, postpartum thyroiditis can lead to weakness and emotional stress.
Symptoms of Postpartum Thyroiditis
The initial symptoms of Postpartum Thyroiditis are those of overactive thyroid gland (hyperthyroidism) which includes:
- Feeling warm
- Rapid heart beat
- Unexplained weight loss
- Fatigue or Muscle weakness
- Loss of focus.
These signs and symptoms for this first stage occur within one to four months after delivery and last till one to three months. Since these symptoms of Postpartum Thyroiditis occur just after childbirth, hence these are missed by the patient and the doctor as well sometimes.
As the thyroid cells get damaged, they cannot produce these hormones leading to the underactive thyroid gland or hypothyroidism. The symptoms of this condition include:
- Lack of energy
- Memory loss
- Weight gain
- Too sensitive to cold
- Muscle cramps
- Dry skin
Most women recognize these symptoms which begin at 4 to 8 months after delivery and last for 12-18 months.
Not all women show both the symptoms. Approximately, only 1/3 of women suffer from both symptoms, while another 1/3 of the women suffer from either hyperthyroidism or hypothyroidism.
Prevalence Rate of Postpartum Thyroiditis
Postpartum Thyroiditis occurs only in 5-10% of the pregnant women.
Prognosis of Postpartum Thyroiditis
As seen in most of the cases, the initial symptoms are missed which leads to delay in the treatment and causes problems to women with postpartum thyroiditis. If the doctor recognizes the postpartum thyroiditis symptoms immediately and starts the treatment, it leads to complete recovery in some cases.
Postpartum thyroiditis often returns in subsequent pregnancies. Therefore, it is important to perform thyroid tests to check the functioning of thyroid gland after every two to three months. There is always a risk of permanent thyroid disease in future; hence regular blood tests are required to check the onset of any thyroid gland disease.
Causes of Postpartum Thyroiditis
The exact cause of postpartum thyroiditis is not known. It is believed to be an autoimmune disease very similar to Hashimoto's syndrome. The women who suffer from postpartum thyroiditis generally are observed to have high levels of anti-thyroid antibodies during pregnancy and after childbirth. Thus, the symptoms of auto-immunity flare up after childbirth due to fluctuations in immune functions.
Pathophysiology of Postpartum Thyroiditis
Postpartum thyroiditis is considered to be an autoimmune disease. In this case, the immune system generates antibodies (auto-antibodies) against thyroid gland during the first six months of delivery. This attack leads to inflammation (swelling) of the thyroid gland. During this phase, the thyroid gland excessively secretes its hormones into the blood and shows symptoms of hyperthyroidism. After few months, the thyroid gland gets depleted of its hormones and starts showing symptoms of hypothyroidism. Postpartum thyroiditis is presented as:
- Transient hyperthyroidism alone
- Transient hypothyroidism alone
- Both, hyperthyroidism, which is followed by hypothyroidism and then recovery.
Risk Factors of Postpartum Thyroiditis
The risk factors for postpartum thyroiditis include any woman with:
- Auto-immune diseases such as Type1 diabetes
- Presence of anti-thyroid antibodies
- History of previous thyroid dysfunction
- History of previous Postpartum thyroiditis
- Family history of thyroid problem.
Complications of Postpartum Thyroiditis
One of the most serious complications associated with postpartum thyroiditis is maternal depression. Permanent hypothyroidism occurs in 20-30% of the women. These patients are also at the risk of recurrent postpartum thyroiditis in subsequent pregnancies.
Diagnosis of Postpartum Thyroiditis
The doctor advises for performing thyroid hormone related tests such as checking levels of TSH, T3 and T4.
Treatment of Postpartum Thyroiditis
- In case of mild symptoms of Postpartum Thyroiditis, there is no need of any treatment or therapy.
- In case of postpartum thyroiditis women with hyperthyroidism, beta-blockers are used for treatment. These drugs reduce heart palpitations, decrease tremors and ease symptoms.
- In case of postpartum thyroiditis women with hypothyroidism, thyroid replacement therapy is given for 6-12 months.
- In both the cases as the symptoms become less, then medication is stopped.
Coping of Postpartum Thyroiditis
Postpartum thyroiditis leads to physical discomfort and brings emotional ups and downs which affect the woman. Hence, it is necessary to take help of a health care provider who will provide emotional support and help the woman to take ahead the role of a new mother.
Immediate diagnosis of the symptoms and proper understanding of postpartum thyroiditis is necessary to provide immediate relief to the women suffering from it so that they can live a better life in future.