What Is Postpartum Thyroiditis?

It is autoimmune condition where the immune system attacks the thyroid gland after childbirth. It affects up to 8% to 10% of women. Usually resolves but does not resolve in 20-30% of cases.

Women with chronic autoimmune hypothyroidism (Hashimoto’s) carrying high anti-TPO antibodies face a 1.4 to 1.5 times higher risk of experiencing postpartum depressive symptoms compared to women with normal thyroid function.

Nutritional Support for Thyroid Autoimmunity

  • Selenomethionine: Selenium bound to methionine is better absorbed, and more easily incorporated into protein. Selenium can be toxic; do not use more than 200 mcg elemental selenium/day [1].
  • Myo-Inositol: Combining selenomethionine with myo-inositol is more effective than giving the selenium alone. Consider 600 mg/day [1,2].
  • Vitamin D3: Vitamin D supplementation successfully reduces titers of both TPO-Ab and TG-Ab, while simultaneously improving thyroid function by decreasing TSH and increasing free T3/T4 levels [3-5].

Hypothyroidism

For women managing chronic hypothyroidism during pregnancy, more than 50% experience a significant hypothyroid flare or insufficiency in the first year postpartum, often requiring an immediate adjustment of their medication.

What Should Be Tested?

At minimum, a postpartum thyroid evaluation may include:

  • TSH
  • Free T4
  • TPO antibodies
  • Thyroglobulin antibodies

Free T3 may add useful information in selected patients, although it is not ordinarily the principal test used to diagnose hypothyroidism.

Final Thoughts

Research connecting thyroid function with postpartum depression has focused heavily on thyroid antibodies and postpartum thyroiditis. Studies of TSH and thyroid hormones have produced mixed results, although some associate higher TSH or lower free T4 with postpartum depressive symptoms.

The practical point is simple: depression after childbirth should not automatically be treated as a purely psychiatric problem. Thyroid function deserves evaluation even when thyroid antibodies are negative.

Related Articles:

Rethinking Postpartum Depression

Selected References

  1. Endocr J. 2020 Nov 28;67(11):1093-1098. Role of selenium and myo-inositol supplementation on autoimmune thyroiditis progression
  2. Int J Endocrinol. 2017:2017:2549491. Treatment with Myo-Inositol and Selenium Ensures Euthyroidism in Patients with Autoimmune Thyroiditis
  3. Medicine (Baltimore). 2023 Dec 29;102(52):e36759. Effects of vitamin D supplementation on autoantibodies and thyroid function in patients with Hashimoto’s thyroiditis: A systematic review and meta-analysis
  4. Indian J Endocrinol Metab. 2016 May-Jun;20(3):391-8. Vitamin D supplementation reduces thyroid peroxidase antibody levels in patients with autoimmune thyroid disease: An open-labeled randomized controlled trial
  5. J Clin Pharm Ther. 2022 Jun;47(6):767-775. Effects of vitamin D treatment on thyroid function and autoimmunity markers in patients with Hashimoto’s thyroiditis-A meta-analysis of randomized controlled trials