Postpartum Mood Disorders, Thyroid

Postpartum Thyroid Disorder

female hormone imbalance

Thyroid Dysfunction in Pregnancy & Postpartum
Image: 123rf

World Thyroid Day & Maternal Mental Health Awareness Month

May is an important time of year in my circles:  May 25 is World Thyroid Day – a day to increase awareness of what I believe is a hidden epidemic.  The month of May has been declared by Postpartum Support International (PSI) to be Maternal Mental Health Awareness Month.  It’s a perfect time to take a closer look at the connection between thyroid function and perinatal mood disorders.

Worldwide pooled prevalence for Postpartum Thyroid Dysfunction (PPTD) is estimated to be 8%.  That means it affects 11 million women per year globally.  In my view, because it’s related to pregnancy it’s actually double that:

11 million women + 11 million babies = 22 milion human beings every single year

And yet, unfortunately The Endocrine Society recommends screening only high risk women which in my opinion, would assume that you have a doctor that bothers to find out if you’re high risk!   Ask yourself this, has your doctor ever asked you any thyroid screening questions?  I’ve been pregnant 5 times. I’ve lived in 2 provinces and 1 territory and had 5 different obstetricians and 2 family doctors while I was pregnant and I can’t recall a time any of the 7 physicians asked me about my thyroid risk.

Furthermore even if your doctor did find out if all his/her patients were in the high risk category the doctor would still miss 30% of hypo-thyroid and 69% of hyperthyroid patients!   In my view that is entirely unacceptable given the risk factors.

If we know that PPTD is affecting 22 million humans beings every year, so what are the risk factors? 

Physicians who DO advocate universal screening have these risk factors in mind:

  • avoiding the disease itself – especially hypothyroid PPTD,
  • predicting the need for thyroid treatment at the end of the first postpartum year,
  • identifying women who may develop PPTD in subsequent pregnancies,
  • identifying women for followup to detect long-term hypothyroidism several years from initial diagnosis

Thyroid Dysfunction is not a One-Size-Fits-All Condition

The standard test for thyroid disfunction that most doctors will do is TSH (Thyroid Stimulating Hormone) and doctors are currently fighting amongst themselves over the appropriate ranges.  While they are busy trying to figure out what’s normal, many forward thinking doctors have realized that TSH is only one small piece of the thyroid puzzle.  That’s the type of doctor you want to find – forget about the doctor that focuses on TSH alone – you won’t get the best treatment unless you are a “textbook” case of thyroid disorder.  Here’s the thing you need to know: Thyroid Dysfunction is not a One-Size-Fits-All condition.  There are several tests that your doctor should consider AND needs to consider your symptoms as important as the blood tests.  Now is the time to take charge of your health.

Get your TPOAb Test (among others) & Here’s Why: 

One of the thyroid tests that is rarely done is called TPOAb.  Here’s why it’s particularly important if you’re pregnant or trying to get pregnant:

  • the presence of TPOAb in pregnant women varies between 2.8 – 19.6% globally.
  • if you take the published data alone it’s estimated to be 15.3–16% which represents:
    • Globally ~20 million pregnant women each year
    • USA ~600,000 pregnant women per year
    • Canada ~57,000 pregnant women each year
    • UK ~120,000 pregnant women each year
  • Researches don’t know why but have discovered that the presence of TPOAb identifies which pregnant women have a higher risk of developing PPTD
  • TPOAb also identifies women who have a higher risk of long-term hypothyroidism after PPTD
  • It’s also associated with miscarriage and preterm delivery
  •  an IQ decrement in children of mothers who have normally functioning thyroids but show a presence of TPOAb
  •  higher risk for postpartum mood disorders

If you’ve ever had a miscarriage or suffered a postpartum mood disorder, insisting your doctor do a full thyroid panel before or during pregnancy or postpartum or finding a doctor who will is a small price to pay for the information that may save you from these terrible outcomes.

Some researchers believe that 80% – 90% of postpartum depression is actually postpartum thyroiditis!  Yet how many women with PPTD are suffering in silence and when they do go see their doctor for their PPTD they never get a proper thyroid check up!  

In his book, Thyroid Mind Power, Dr. Richard Shames, explains that during pregnancy the certain immune response is supressed so that the baby’s placenta (which is ‘temporarily grafted’ onto the lining of the uterine wall) is not rejected by the mother’s immune system.  After delivery there is a rapid surge in antibodies which may result in thyroid imbalance.

Knowing what I know about the prevalence of thyroid disorders in women and the connection between infertility, miscarriages, perinatal mood disorders and depression if I had any one of these issues today (and I’ve had 3 of the 4 so far in my life) I would get my thyroid properly tested – emphasis on properly!

To know me is to know that I am a strong believer in participatory health.  I had to learn to participate in my own healthcare and it’s been a road full of ups and downs.  Today, if my doctor wouldn’t agree to the testing I would:

a) find another doctor or,

b) print off all of my research and take it in to my doctors appointment in a BIG file

c)  in countries with a national health care program (like Canada & Britain) I would even tell the doctor I would be willing to pay for the tests – this will let the doctor know you’re serious about getting these tests.

d) I would even let my doctor know that I believe in participatory health

 

References:

Adlan, M. and Premawardhana, L., (2011). Thyroid Peroxidase Antibody and Screening for Postpartum Thyroid Dysfunction. Journal of Thyroid Research Volume 2011 (2011), Article ID 745135, 5 pages. doi:10.4061/2011/745135

 

Stuckey, B.G., Kent, G.N., Ward, L.C., Brown, S.J. and Walsh, J.P. (2010). Postpartum thyroid dysfunction and the long-term risk of hypothyroidism: results from a 12-year follow-up study of women with and without postpartum thyroid dysfunction. Clin Endocrinol (Oxf). 2010 Sep; 73(3):389-95. doi: 10.1111/j.1365-2265.2010.03787.x. Epub 2010 Feb 23. 

 

Shames, R., Shames, K., (2011). Thyroid Mind Power. New York, NY: Rodale

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