Postpartum Thyroid Health: An often overlooked contribution to fatigue and other “normal” concerns

In the whirlwind of postpartum, changing bodies and new symptoms get overlooked or inappropriately labelled as “just normal”. While the focus is mostly on babe, Mom’s concerns can get ignored or trivialized.  My first real experience of this was when A.G., a new mama to a five month old babe, came to see me. She was exhausted. Her babe was still breastfeeding and her sleep was interrupted, so she was told that it was normal for her to feel tired.

Her family doctor dismissed her without digging any deeper into her symptoms or running any lab work. We ran some blood work and found that she was experiencing significant thyroid disease. She was barely making any active thyroid hormone, and her Thyroid Stimulating Hormone (TSH – more on this later) was 100x the normal level. Yes, she was a new mom. Yes, she was experiencing sleep disturbances. But there was so much more going on. Let’s break it down.

The Thyroid Gland: The Body’s Thermostat

The thyroid gland is a butterfly-shaped organ located near the base of your neck. It not only acts as a thermostat, controlling your body’s temperature, but also its metabolic rate. This translates to thyroid health affecting energy levels, mood, weight loss or weight gain, body temperature, skin and hair health, and reproductive health. 

Postpartum Changes

Thyroid hormone production and cellular receptivity to those hormones can vary through pregnancy and postpartum. With all the other hormonal changes happening, not to mention lifestyle changes (different sleep patterns, dietary habits, and exercise routines, etc.), it’s no wonder that thyroid function can fluctuate. Postpartum thyroid disease is common and usually transient, meaning that it usually returns to normal within 12 months. However, suffering symptoms for that long can be brutal, and it puts you at a higher risk of developing permanent thyroid disease (even years later). Thyroid disease may present as hyperthyroidism (too much thyroid hormone), hypothyroidism (not enough thyroid hormone), autoimmunity (your own body attacking thyroid cells), or a mix of any of the above (often hyperthyroidism is followed by a hypothyroid state). 

“Normal” Symptoms 

Just because these concerns are common does not make them normal. ALL of the following “normal” postpartum symptoms have been associated with thyroid disease:

  • Fatigue
  • Weight gain/difficulty losing weight
  • Palpitations
  • Memory difficulty/brain fog
  • Hair loss
  • Irregular or absent periods
  • Postpartum depression (mild and severe!)

Some of these symptoms, like hair loss, can be expected in a healthy postpartum period, but it’s important to be able to differentiate between healthy changes and a disease state. While having one or many of these concerns may not mean that you have a thyroid issue, it’s worth investigating to at least rule it out. 

Thyroid Lab Tests

Other tests should be run to investigate causes of fatigue at the same time, but the thyroid ones to consider are:

  • Thyroid Stimulating Hormone (TSH): this is generally the first (and usually only test that gets run). It gets released by the brain to tell the thyroid to make thyroid hormone (or not). If levels are off, then more testing may be ordered, but this doesn’t tell the full story. This value can be totally normal in mild thyroid disease (known as subclinical), while the other thyroid hormones show that something is off.
  • Free T4: one of the two thyroid hormones that is actually produced by the thyroid. However, it’s in an inactive state and must be converted to Free T3 to actually be used by the body. Running TSH and Free T4 alone aren’t enough to tell whether your body has enough active thyroid hormone to function.
  • Free T3: this test is often overlooked, but it shouldn’t be. When tested with TSH and Free T4, it helps paint a broader picture of thyroid health and function.
  • Reverse T3: this hormone is produced when Free T4 isn’t converting properly to Free T3. It doesn’t have much function in the body, so knowing its level can help determine thyroid hormone conversion ability.
  • Autoimmune Antibodies: Anti-TPO (Anti-thyroid peroxidase) and Anti-TG (Antithyroglobulin) are two markers that indicate your body’s immune system attacking your thyroid. Treatment for autoimmune thyroid disease is different than non-autoimmune processes, so it’s important to be able to rule this in or out.

Postpartum Thyroid Health

If you’re unsure if you might be experiencing thyroid disease, you should be consulting your medical care provider (e.g. your Naturopathic Doctor, family physician, or Nurse Practitioner). In the meantime, here are some simple tips to help support your thyroid:

  • Ensure adequate protein intake: low protein diets have been associated with worsening of thyroid diseases
  • Have 2-3 Brazil nuts daily: these contain selenium, an important micronutrient for thyroid health
  • Add unsalted pumpkin seeds to your diet (e.g. on top of salads, on their own as a snack, etc.): high in zinc, these seeds support thyroid hormone production and conversion
  • Take it easy with exercise: overexertion or HIIT-type training can push the thyroid into overdrive and exhaustion states if it’s already borderline
  • Continue supplementing with your prenatal multivitamin: although vitamin and mineral levels in your multivitamin won’t likely be high enough to act in the therapeutic range for thyroid disease, getting in baseline amounts can help support you through until you know more. Prenatal multivitamins contain iron, B-vitamins, zinc, selenium, and vitamin D – all of which are super important for thyroid health. Not all prenatal multis are created equally, so make sure to check with your healthcare provider to make sure you’re taking one that’s right for you.

While you’re navigating this world of motherhood, make sure to take the time to check-in with yourself. Reflecting on your own experience, body, moods, and mental state is the important first step in investigating any abnormal health state. You know your body best, so take cues when you feel that something is off. Always be sure to discuss your concerns with your healthcare provider, and don’t be afraid to get a second opinion if you feel that you’re not being heard. Trust your gut, mama! 

Dr Laura Smith ND

Written by Dr. Laura Smith, Naturopathic Doctor. Dr Laura has a clinical focus in women’s health including fertility and pre/postnatal health. She currently lives and works in Ottawa, Ontario, Canada.

Disclaimer – Everything shared is for informative purposes only. It is not intended for assessment, diagnosis or treatment purposes. If you feel there needs to be further investigation, please seek out a qualified health care professional for a proper assessment.