Thursday, 8 January 2015

Postpartum Hypothyroidism, Pregnancy and Being a Bit of a Divvy

This will make it two personal(ish) and non ranty blogposts in a row!

I made a classic error over the Christmas holidays and ran out of my thyroid medication. Given that it was my own fault for being a divvy and not checking sooner I didn't feel I could justify a GP appointment to get more the same day. So I ordered a repeat online, and assumed I'd be ok to go without for a few days. From this I learned two things:

1- Always check you have enough meds for the holidays and order repeats in plenty of time.

2- I'd forgotten how miserable having untreated hypothyroidism actually is.

I did write about my thyroid condition way back in 2010 but I've learned some new stuff since then, especially through having another pregnancy. So now I have my pills and I'm out of the "thyroid fog" I thought it was time for another blog post on the subject.

***NOTE: I'm going to refer to postpartum thyroditis in this post, but technically that's not what I have, I'll explain that a bit more as we go along!***

Part One: The Basics 
or: Stuff your GP will probably know

What Is Postpartum Thyroiditis?

The thyroid is a little organ in your neck responsible for a variety of hormones which need to be produced in the correct amounts. But sometimes it goes wrong and starts producing too much (hyperthyroidism) or too little (hypothyroidism) of these hormones. This can happen because of all sorts of things but postpartum thyroiditis happens after pregnancy and can involve either hyperthyroidism, hypothyroidism or, often, both, one after the other. Fortunately in the majority of cases it sorts itself out and may never need any treatment.

What Causes it?

During pregnancy, the immune system gets turned down a bit, to prevent it from attacking the baby. Once the baby is out the immune system is allowed to bounce back again but sometimes it gets a bit carried away and starts attacking the mother's own thyroid. There then ensues a bit of a hormonal slanging match as the hormones produced by the thyroid and those that control it all scream at each other about what they think the thyroid should be doing. Ok clearly that isn't an entirely accurate, technical description, but the upshot is the poor thyroid ends up getting it's hormone making all wrong. In the case of postpartum thyroiditis this usually means it starts off making too much and ends up making too little.

What Are The Symptoms?

This is one of the really tricky things about this condition. The major symptoms are tiredness, aching, depression, mental slowness and weight gain (there are quite a few others too, see here for more info).

Basically it makes you feel like cr*p. Ordinarily you would probably notice that, but what if you've just had a baby? Aren't you supposed to feel like cr*p anyway?

*****
When I was pregnant for the first time there seemed to be no end of people who gleefully told me I would never have a good nights sleep again, my body would be ruined, my social life destroyed etc. etc. Throw in the epic labour and the c section (which I'd been taught should be avoided at all costs because of the hideous recovery) and it simply didn't occur to me that there was anything wrong with me. I felt utterly awful, but perhaps this was just what it was like to be a Mum? I'd surely be laughed out of the room if I went to the GP and complained that ever since I had a baby I felt tired and fat? I looked on in wonder as other mums lost the baby weight, got out and about and actually did stuff. It didn't look that hard for them so why was it for me? Were they all just putting on a show like I was, pretending they were coping or were they genuinely better at it all and I was I just being a bit pathetic. I failed to do the birth thing properly after all, perhaps I was just wasn't very good at being a Mum? 
*****

How Is It Diagnosed?

Thankfully this bit is more straightforward. Usually postpartum thyroiditis gets better on it's own and the mother may never realise she had it. But if it goes on and she actually plucks up the nerve to speak to a doctor then there is a simple blood test which can figure out what's going on. It looks at the levels of the hormones produced by the thyroid and at something called TSH (Thyroid Stimulating Hormone).  When the thyroid isn't producing enough hormones it's TSH's job to tell it to work harder so a high level of TSH in the blood test means the thyroid is under active (hypothyroid).

The other thing that can be tested for when a thyroid problem is suspected is antibodies against the thyroid. Again, this is a simple blood test but if the antibodies are present then it is a good indication that there is a problem even if the other tests are a bit borderline. Unfortunately testing positive for the antibodies also means the condition is more likely to stick around permanently.

How Is It Treated?

If the thyroid is over active (hyperthyroidism) then it will probably resolve itself quite quickly and won't need treatment. So from here on in I'm going to concentrate on hypothyroidism (but if the hyper version lingers I believe a short course of beta blockers should sort it out). Hypothyroidism (under active thyroid) is also quite easy to treat with Thyroxine pills. These basically replace the missing hormones and hopefully, once you find the right dose (which may require more blood tests) should alleviate the symptoms and side effects are very unlikely.  Most cases of this will sort themselves out in about a year but in some cases (like mine unfortunately) this doesn't happen and those little white pills become life long companions at which point it isn't technically a postpartum problem anymore!

Me, pre diagnosis. Looking back on this the eyes are more honest that the smile and the baby weight was clearly going nowhere.



Part Two: Hypothyroidism In Pregnancy
Or: Important stuff your GP might not know


*****
My thyroid condition was managed entirely by my GP for a couple of years. But when we came to thinking about baby number two I happened to listen to a podcast which mentioned the problems hypothyroidism can cause in pregnancy my GP didn't seem to know much about that so I asked to be refered to a specialist. Perhaps other GPs are more knowledgeable about this but none of the ones at my surgery seemed to be.
*****

The Risks

Untreated hypothyroidism can be a big problem in pregnancy, it seems to increase the risk of all sorts of bad stuff including miscarriages, low birth weight, premature birth and pre-eclampsia. In some cases it may also impair the baby's intellectual ability. Clearly avoiding all these things is pretty important.


 - MASSIVE CAVEAT ALERT - 
I'm not a medical doctor and the treatment advice I was given will not be appropriate for everyone. If you have or think you have hypothyroidism and are planning a pregnancy don't just follow what I say here, go see your GP,  if they are as hopeless as mine, go see a specialist!! 
(here endeth the caveat).



Treating Hypothyroidism in Pregnancy

Normally hypothyroidism is monitored with occasional blood tests to check those TSH levels. So long as they stay below about 5 (there are units, but this is complicated enough already) then the patient is probably on an ok dose of thyroxine. In pregnancy this isn't good enough (something my GPs had no idea about until I told them).

In pregnancy, especially in the first trimester, the TSH level needs to be lower, I was told by the specialist that mine needed to be below 2.5. There is obviously a problem if GPs aren't aware of this as it is quite normal in the UK not to see any other medical professionals during the first trimester if all is going well. Yet this is the most critical window.

Luckily for me the specialist had told me what to do in advance, he had made a small increase to my thyroxine dose and as soon as I got a positive pregnancy test I increased it again then checked the new dose with a blood test a week later.

Monitoring

With the right dose of thyroxine on board, hypothyroidism shouldn't cause any problems for the rest of the pregnancy but I was monitored very closely anyway. I had blood tests every 4 weeks to check my TSH levels were staying low and I also had ultrasound scans every 4 weeks to check the baby's size - although given that my first was a hefty 9lb 10oz (4.4kg) I wasn't too worried about this one being smaller! I was initially also having separate appointments with both the Obstetricians and midwives every 4 weeks but thankfully the docs decided that was a bit OTT and scaled back their appointments!

So there we go! There are a few potential problems for mums that I heard a lot about while I was pregnant, post natal depression and incontinence being the main ones. But I had no idea about postpartum thyroiditis until a medical student friend spotted a very slight lump in my neck (another symptom) and suggested I see my GP (see not all doctors are bad and said med student is now training as a GP herself). I also have friends who've developed other immune system related problems after having a baby yet there seems to be little awareness of these conditions and I wonder how many other mums are just putting up with them, not realising treatment is available? No one wants to turn pregnancy and motherhood into an endless warning list of what can go wrong, except perhaps the "you'll never sleep again parade". But I'd like to see a little more awareness of these things even if just among GPs, midwives and health visitors. I pretty much pay no attention to my condition now, but my little visit back to the cold, tired fog I was in for the first months of MissEs life was a reminder of just how much those little white pills improved my life - and in future I'll try not to run out of them!

SB




2 comments:

  1. Emma Day (Crazy with Twins)9 February 2015 at 13:21

    I really feel for you as I know the hypos and the hypers very well.

    I have experienced both Hypothyroidism and Hyperthyroidism. I had Thyroid Cancer in 2013 and once my thyroid was removed, it took a good six months to get me on the right dosage of medication. First they overdosed me and I ended up in hospital with high blood pressure and all the symptoms of someone having a stroke. Going too far hyper can actually cause a stroke. I luckily got to A&E just in time to stop it happening. Then they underdosed me and I went so far hypo that my doctor called me and said "whatever you do, don't drive anywhere". At the time, I was on the M4 two hours from home! Before my radiotherapy, I was forced to go into a two week hypo and do a low iodine diet at the same time. The second week, was without a doubt, one of the worst weeks of my life. With zero thyroxine in my body for such a long time, I felt like utter shite. I was so weak and depressed that I just gave up eating altogether. Thankfully I am all-clear and on the right dosage now.

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  2. Gosh you poor thing, I haven't had it nearly that bad, I can't imagine how you got through that, except I guess you just had to. Really pleased that you have had the all clear and got the dosage right now.x

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