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Guide to Postpartum Thyroiditis: Why you may not be feeling like yourself!

April 11, 2017
thyroid, irregular periods, postpartum thyroiditis, naturopathic doctor toronto, female friday, naturopathic doctor danforth

Becoming a mom for the first time (or again!) can be incredibly exhausting. Not only are you raising a human being, but you’re also in the postpartum recovery phase! Moreover, you’re likely exhausted from a lack of sleep, worried about producing enough breast milk, losing hair, having difficulty losing weight and may be experiencing symptoms of postpartum depression. Many of the symptoms that new moms experience are also seen in thyroid conditions – like postpartum thyroiditis.

Postpartum thyroiditis is a thyroid condition that occurs in women who previously had a thyroid disease or just delivered a baby. This is a disease of the thyroid gland, a butterfly-shaped gland located at the front of the neck which produces hormones that regulate metabolism and helps control the body’s organs. 

Phases of Postpartum Thyroiditis

During postpartum thyroiditis, a mom might switch between hyperthyroidism and hypothyroidism. Hyperthyroidism may occur 1-4 months after delivery, while hypothyroidism may occur 4-8 months after delivery. 

Hyperthyroidism

Hyperthyroidism occurs when the thyroid is overactive and overproducing T3 and T4 (thyroid hormones), with a low thyroid stimulating hormone (TSH). 

Symptoms of Hyperthyroidism

  • Anxiety
  • Fatigue
  • Heart palpitations
  • Insomnia
  • Irritability
  • Nervousness
  • Sensitivity to heat
  • Tremor
  • Weight loss

Signs of Hyperthyroidism

  • Shortness of breath
  • Increased appetite
  • Increased sweating
  • Fast heart rate
  • Frequent bowel movements
  • Fine, brittle hair
  • Thinning skin
  • Increased menstrual cycle length
  • Scanty menstrual flow

Hypothyroidism

Hypothyroidism occurs when the thyroid function is under active and isn’t producing enough T3 or T4. Moreover, TSH level is elevated because it’s trying to ‘turn’ the thyroid on and produce more hormones. 

Symptoms of Hypothyroidism

  • Fatigue or low energy
  • Unexplained weight gain or 
  • Difficulty losing weight
  • Constipation
  • Intolerance to cold temperature
  • Tender, stiff or weak muscles
  • Pain, stiffness or swelling in joints
  • Depression
  • Difficulty concentrating and impaired memory
  • Irritability
  • Decreased libido
  • Infertility

Signs of Hypothyroidism

  • Reduced resting body temperature
  • Goitre
  • Slow heart rate
  • Hair loss
  • Brittle nails
  • Dry skin
  • Heavy menstrual periods
  • Irregular menstrual periods

Lab Tests for the Thyroid

Diagnosis of a thyroid condition involves both symptoms and blood work. Ideally women should be getting a thyroid function test prior to pregnancy (as the thyroid can have important implications in neonatal neurodevelopment), and should be tested at least 3-6 months postpartum. 

Moms should be tested if they have a history of autoimmune conditions (like Type 1 Diabetes), a history of thyroid disease before or during (any) pregnancy, or experiencing postpartum depression. 

  • TSH: Thyroid stimulating hormone is the best test for both hyperthyroidism and hypothyroidism. In hyperthyroidism, TSH will be decreased while in hypothyroidism TSH will be increased.
    • Optimal range for TSH is 1-2 mIU/L (non-pregnant patients)
  • Free T4: This is the storage form of the thyroid hormone.
    • Optimal range is 14-18 pmol/L (non-pregnant patients)
  • Free T3: This is the active form of thyroid hormone. The thyroid should be making T3 and the peripheral tissues (like the liver and kidneys) should be converting T4 to T3.
    • Optimal range is 5-6 pmol/L (non-pregnant patients)
  • Anti-TPO: This is the antithyroid peroxidase antibody, which will be elevated in autoimmune thyroid disorders. It signifies autoimmune thyroid disease, and the higher the level, the greater oxidative stress within the thyroid gland. It is an indicator of future thyroid disease. 

Treating Thyroid Disorders

Treating the thyroid can be incredibly tricky and should be accompanied by support through a MD or ND. Nevertheless, there are things you can start to do at home to support and optimize thyroid health!

Decreasing Inflammation

Because it’s thought that women who develop postpartum thyroiditis likely have an underlying autoimmune thyroid condition, it’s best to adopt as much of an anti-inflammatory diet as possible.

THE FIX: Eliminating gluten and dairy (which can be highly inflammatory), may be positive step towards improving thyroid health. 

Chronic stress is incredibly inflammatory and affects our thyroid by actually ‘slowing’ the body down to conserve energy. The stress hormone, cortisol, causes an increase in thyroid binding globulin (TBG) which binds the active thyroid hormone and prevents it from doing its job. 

THE FIX: We all know that being a new mom can be incredibly stressful, so communicating with your partner, asking for help, and taking a bit of time for yourself whenever you can may help in reducing stress levels.

Decreasing Toxic Load

Toxins may interfere with thyroid function. This includes heavy metals (cadmium, mercury, lead) which may lower T3 levels, halogens (fluorine, chlorine, bromine) which may interfere with iodine uptake, and BPA which interferes with endocrine function. 

THE FIXCostume jewellery has been shown to contain cadmium, and can be absorbed via our skin through chronic exposure. Fluorine can be found in tap water, as well as toothpaste. Whereas bromine may be found as an additive in food products such as dough. Check out this post for some simple substitutions!

Keep in mind that if your interested in completing a heavy metal detox, it’s is not advised during breastfeeding, as breastmilk is a route of elimination for metals.

Tracking Body Temperature

Normal body temperature is 37.0C (98.6F). As previously mentioned, it will be low in hypothyroidism (everything is slowing down) and high in hyperthyroidism (everything is speeding up).

THE FIX: We want to restore the body’s normal temperature. This is not a treatment per se, however tracking your body temperature throughout the day (at waking, in the afternoon, and in the evening) will help give us a baseline average of what your temperature is. As you progress with treatment, we can continue to track the temperature to see how your body is responding! 

Next Steps

As I previously mentioned, in order to determine if you have postpartum thyroiditis it’s best to look at your symptoms and blood work. Moms should also remember that many factors can affect the health of the thyroid – for instance an iron deficiency can decrease levels of thyroid hormone and prevent conversion from the inactive to active form. Plus, iron deficiency can also be a cause for fatigue and hair loss!

Because the thyroid plays such a critical role in our health, it’s important to work together with a health professional (like a ND!) to go about healing and restoring normal thyroid function. With my patients, I take a look at their entire health history to see what exactly is being affected by suboptimal thyroid levels and how to go about healing – rather than tackling everything at once and potentially causing the body more stress. 

So if you’re a mom experiencing exhaustion, hair loss, depression or even a low body temperature – it could be because of your thyroid! Book an appointment with a ND because this doesn’t need to be your new ‘normal!’

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Postpartum Depression and Naturopathic Medicine

May 5, 2016
postpartum depression naturopathic medicine, toronto naturopath, naturopathic doctor pregnancy

Postpartum depression can only be treated with medication, right?

Wrong!

It can be approached holistically, if you have some time and patience. 

If PPD is not treated properly, it can affect your overall functioning. While untreated PPD may cause health and developmental problems in your baby, and to be honest, it can affect your whole family. 

May moms are reluctant to seek help when it comes to PPD because they’re unable to recognize their own mental health symptoms, and accessing care can be difficult. An easy screening tool that will help you determine is PPD is affecting you is the Edinburgh Postnatal Depression Scale.  

Many treatments for PPD are emerging. Antidepressants (ex. SSRIs) are commonly used as the first-line treatment, but do have a range of side effects that many moms hope to avoid. Furthermore, some moms discontinue taking their antidepressants because they worry about transmission into breastmilk. 

Naturopathic treatments often focus on how PPD symptoms are affecting your quality of life, but also aim to discover the underlying cause of postpartum depression.

When I work with women who have PPD, my treatments can range between dietary and lifestyle changes, counselling, acupuncture, botanical medicine, and more! I give you all the info, but it’s up to you to determine what you have time for. 

Holistic Treatment of Postpartum Depression

Lavender and Postpartum Depression

A study was conducted on the effects of lavender during the postpartum period. Mothers in the intervention group applied lavender essential oil on their palms and rubbed them together throughout the day and inhaled the lavender scent. They did this for 4 weeks post-birth, and were followed up at the 2 week, 1 month, and 3 month mark (post-birth) using the EPDS. Results demonstrated that although stress and depression rates naturally decrease after birth, the decrease was higher in the lavender group.

Iron and Postpartum Depression

Many women go into pregnancy with low iron levels. It’s not a surprise considering that an iron deficiency is the most common nutritional deficiency in women – thanks to our period! Plus ferritin (the storage form of iron) has an optimal level. Which means that even if you fall within the ‘normal’ range, your stores may not be optimal. 

When you’re pregnant, your body needs more hemoglobin (as your blood volume is increasing), so it shouldn’t be a surprise that you need more iron! Blood loss after birth (ex. postpartum hemorrhage and c-section) may also cause iron stores to decrease. 

It seems like the odds are stacked against you, right?

A recent review examined the effect of iron deficiency and postpartum depression. Eight out of ten studies found higher risk for PPD in anemic women. Women who had low ferritin in the postpartum period (not pregnancy) was associated with an increase risk in PPD. Giving iron in the postpartum decreased PPD risk. 

For example, one study showed that supplementing iron in moms with PPD improved depressive symptoms. Mothers experiencing PPD (based on the EPDS) 7 days after delivery were supplemented with iron. After 6 weeks, the mothers took the EPDS again to determine if anything changed with supplementation. Results demonstrated that mothers who supplemented with iron had a significantly lower EPDS score compared to placebo.

So what does this mean for you? Well, you should get your ferritin levels checked before pregnancy, but definitely after pregnancy. Working with a ND, will help determine how much iron you should be taking, when, and the best form (because I’m sure you don’t have time for constipation). 

Vitamin D and Postpartum Depression

Low vitamin D status was shown to be associated with postpartum depression, compared to women not suffering from postpartum depression (as measured by the EPDS). Because vitamin D can be protective, it’s imperative that serum levels are measured during pregnancy and supplementation is done as required.

Omega-3 and Postpartum Depression

A deficiency of omega-3 fatty acids during pregnancy and lactation is considered a risk factor for PPD. It is thought that supplementing with EPA-rich oil during pregnancy can reduce depression and PPD once your child is born. Taking only DHA may help with reducing PPD in women who are not breastfeeding. DHA does help build a healthy brain in children, so if you are supplementing – be sure to choose a formula with both EPA and DHA. 

Acupuncture and Postpartum Depression

New evidence is showing that acupuncture can be helpful when it comes to PPD. I personally love acupuncture for everything, but huge barrier is carving out the time to get a 30 minute treatment. Nevertheless, it’s an option and perhaps something to have done if you have help with childcare.

Acupuncture is more than just inserting needles in different areas in the body. It’s thought to influence your neuroendocrine and immune systems through regulating different neurotransmitters like serotonin, dopamine, endorphins and glucocorticoids. It can regulate gene expression and new research is suggesting that it may actually have antidepressive effects. 

While we don’t know the true cause of PPD, it’s thought that a drop in hormones, specifically estrogen, can lead to depressive symptoms. A 2018 review showed that in 4 studies, estrogen levels increased after acupuncture. 

If acupuncture is something that you might consider trying, book an appointment with a Naturopathic Doctor or Licensed Acupuncturist. The way they use acupuncture, may be a bit different than a Chiropractor or Physiotherapist.  

Sleep and Postpartum Depression

In case you are reading this before you give birth, now is the best time to rest and get all your sleep in. A study showed that prenatal sleep disorders in pregnant women may actually increase the risk of developing postpartum depression. There are many remedies out there that can help with sleep for instance acupuncture, magnesium, and even balancing your blood sugar before bed!

When dealing with lack of sleep post pregnancy, you may want to consider supporting your adrenal glands, evaluating your breastfeeding expectations (especially as your baby gets older), and seeking help when needed (ie. partner, family, doula).  

Breastfeeding and Postpartum Depression

Breastfeeding has been associated with positive maternal outcomes. Despite experiencing many stressors upon giving birth, breastfeeding protects mothers as it induces calm feelings, decreases stress, and increases nurturing behaviour.

Yoga and Postpartum Depression

Yoga has been shown to be a complimentary therapy for mothers experiencing PPD. Depressive symptoms were assessed using the Hamilton Depression Scale. Mothers in the yoga group practiced twice a week for 8 weeks and improved at a significantly faster rate on measures of depression, anxiety, well-being, and health-related quality of life.

Cognitive Behavioural Therapy (CBT) and Postpartum Depression

Cognitive behavioural therapy will identify negative thinking patterns and assess the link between thoughts, feelings, and behaviour. When you experience depression, you might experience negative thoughts that carry significant meaning. This meaning might be relation to the past, future, about yourself or your world.

CBT helps you change thee negative thoughts, so ultimately you can change how you view and feel about yourself, and change your behaviour. 

A review looked at CBT in moms with PPD and found that 7 practices were commonly used in treatment – pyschoeducation, thought restructuring, problem-solving, behaviour management, goal setting and achieving, stress management, and relaxation. The most common were psychoeducation and challenging negative thoughts and beliefs. While CBT was found to be an effective treatment for PPD it can be time consuming and may require adjunctive childcare. 

Next Steps

You don’t need to go through PPD alone! Check out the Canadian Mental Health Association website for more information about PPD, or book an appointment with a Naturopathic Doctor start implementing the best therapies for you, so you can feel great again!

References

Li, S., Zhong, W., Peng, W. and Jiang, G. (2018). Effectiveness of acupuncture in postpartum depression: a systematic review and meta-analysis. Acupuncture in Medicine, 36(5), pp.295-301.

Polmanteer, R., Keefe, R. and Brownstein-Evans, C. (2018). Trauma-informed care with women diagnosed with postpartum depression: a conceptual framework. Social Work in Health Care, pp.1-16

Schiller, C., Meltzer-Brody, S. and Rubinow, D. (2014). The role of reproductive hormones in postpartum depression. CNS Spectrums, 20(01), pp.48-59.

Sheikh, M., Hantoushzadeh, S., Shariat, M., Farahani, Z. and Ebrahiminasab, O. (2015). The efficacy of early iron supplementation on postpartum depression, a randomized double-blind placebo-controlled trial. European Journal of Nutrition, 56(2), pp.901-908.

Stamou, G., García-Palacios, A. and Botella, C. (2018). Cognitive-Behavioural therapy and interpersonal psychotherapy for the treatment of post-natal depression: a narrative review. BMC Psychology, 6(1).

Wassef, A., Nguyen, Q. and St-André, M. (2018). Anaemia and depletion of iron stores as risk factors for postpartum depression: a literature review. Journal of Psychosomatic Obstetrics & Gynecology, pp.1-10.