You are a new mom, a few months past birth, and things don’t feel quite right. Sure, you are tired from sleepless nights, breastfeeding and balancing responsibilities of being a mom and a person BUT something still doesn’t feel right! You are experiencing anxiety, insomnia, fast heart rate, fatigue, weight loss, and irritability. Or you are experiencing absolute exhaustion, weight gain (not the loss expected after a few months), constipation, dry skin, and depression. You might have wondered if you suffer from postpartum depression or if this is just life as a mom.
Being a new mother can be challenging but it shouldn’t feel impossible. It is very important that you talk to you health care provider about how you are feeling. Don’t be shy - lay it all out on the table and when you do, ask your provider to run some basic blood work along with your thyroid levels. If these levels come back normal and you are still unsure - consider asking for a full thyroid panel with TSH, Free T4, Free T3 and Thyroid Antibodies. Time is of the essence here because the sooner you identify the issue, the easier it will be to treat. Also, thyroid function is very important for women postpartum because it influences mood, energy, sleep, weight, breast milk levels and future fertility.
Women are more susceptible to thyroid issues after giving birth than they are at any other time. This risk increases dramatically if they have a history of diabetes, autoimmune disease or a family history of thyroid dysfunction.
Why? During pregnancy the body suppresses overall immune function to protect the growing baby (who has a different genetic profile than the mother). This protects the baby from being attacked by the immune system. But once the pregnancy is over the immune system kicks back into action and in about 7-8% of women, attacks the thyroid gland. In some women, this ‘attack’ is transient and affects the thyroid gland for a year. This condition is diagnosed as Postpartum Thyroiditis. In other women the thyroid is said to be permanently damaged leading to a diagnosis of Hashimoto’s Disease.
Both Postpartum Thyroiditis and Hashimoto’s Disease typically start with inflammation in the thyroid gland or ‘thyroiditis’. Thyroiditis can cause high thyroid hormone levels, low thyroid hormone levels or a combination of high levels followed by low levels.
1/3 of women will manifest two phases of thyroiditis: high thyroid hormone levels followed by low thyroid hormone levels.
1/3rd of women will have only a thyrotoxic phase typically 1-4 months after delivery; this phase lasts for 1-3 months and is associated with symptoms including anxiety, insomnia, palpitations (fast heart rate), fatigue, weight loss, and irritability.
1/3 of women will have only a hypothyroid phase typically 4-8 months after delivery and lasting up to 9 –12 months; symptoms include fatigue, weight gain, constipation, dry skin, depression and poor exercise tolerance.
Most women will have return to normal thyroid function within 12-18 months of the onset of symptoms while 20% of women that go into a hypothyroid phase will remain hypothyroid.
The exact cause of Postpartum Thyroiditis is unknown but it is believed to be an autoimmune disease associated with the development of anti-thyroid antibodies to thyroglobulin (Tg) and thyroid peroxidase (TPO) triggered by the shift in immune function after delivery. Therefore, from a naturopathic perspective, we need to treat both the thyroid and the immune system.
Thyroid Antibodies
Autoantibodies to Tg and TPO are somewhat common in the normal population (10-15%) and are considered indicative of thyroid inflammation. These ‘normal’ individuals with thyroid antibodies have no active thyroid disease. This is interesting because it means that anti-TPO antibodies in healthy individuals do not interfere with thyroid function the way they do in patients with established autoimmune thyroid disease. Here are some things you should know about treating autoimmune thyroid conditions:
Blood Sugar
Both hyperthyroidism and hypothyroidism have been correlated with Type 1 and Type 2 Diabetes. The link here is very strong and it is highly recommended that patients follow a Low Glycemic Index Diet. An anti-inflammatory, Low Glycemic Index Diet is one of the main things we will work on while treating your thyroid gland.
Infection
Consider the following:
Viruses such as hepatitis C (HCV), hepatitis E, parvovirus, rubella, herpes simplex, Epstein–Barr (think Mono) could be involved in the development of autoimmune thyroid.
Infection with Helicobacter pylori bacteria in the stomach have also been linked to autoimmune thyroid.
Enteroviruses have been identified in thyroid tissues.
The balance of good and bad bacteria in the gut can influence the immune system as well as the thyroid directly.
This list shows that chronic infection is associated with thyroid and immune dysfunction. In fact, infections tends to be involved with many autoimmune conditions when they start. It is important to identify any underlying infections (don’t forget about ‘below the radar’ dental infections!).
Leaky Gut Syndrome
Enteropathy (leaky gut syndrome) involves increased intestinal permeability and may increase the risk for developing thyroid autoimmunity. Numerous autoimmune diseases show increased intestinal permeability. This phenomenon has been seen in the connection between Celiac Disease and thyroid dysfunction or Irritable Bowel Syndrome and thyroid dysfunction. Gut bacteria are known to move past of the tight junction integrity of the gut into the blood stream. This is a problem if we are harbouring a higher amount of problematic bacteria. The ‘leaky gut’ also allows other things into the blood such as food particles or viral material which can wreak havoc on the immune system in general. Healing your leaky gut takes time and patience but it is well worth the effort in any autoimmune condition.
Celiac Disease
Celiac Disease (an allergy to gluten) is associated with a number of autoimmune conditions, including those affecting the thyroid. The prevalence of autoimmune thyroid disease in patients with celiac disease was suggested to be four times higher than that in the general population. The possible role of gluten in the cause of the anti-thyroid antibodies and the consequent organ dysfunction was suggested. It has been found that in patients who strictly followed a 1-year gluten free diet, there was a normalization of subclinical hypothyroidism, suggesting that in some cases, gluten withdrawal may reverse the abnormality.
High Androgens (Male Hormones)
High thyroid hormone increase the levels of free testosterone which can predispose women to conditions such as Polycystic Ovarian Syndrome. And on the flip side, high androgen hormone levels (such as DHEA or testosterone) in females with polycystic ovary syndrome increases the prevalence of autoimmune thyroid conditions. This means that the thyroid should always be investigated in conditions of high androgens and in women with thyroid issues, androgens should be monitored. A Low Glycemic Index diet has been found to help reduce androgens.
Sleep
Sleep deprivation is known to cause an increase in thyroid hormone although very few studies have looked at this. Most sleep deprivation studies have looked at thyroid hormone during 3-5 days of sleep deprivation followed by sleep restoration. However, this doesn’t come close to the sleep deprivation experienced by new parents or individuals who are under significant, sustained stress. Unrelenting sleeplessness very likely contributes to thyroid dysfunction and a range of other autoimmune conditions. New moms are encouraged to discuss this with their partner or to seek out support in order to have at least one night of uninterrupted sleep per week along with longer naps. This may mean pumping breast milk if you are feeding through the night so that someone else can look after your baby. This may sound unappealing to many mothers but it is essential if you are balancing your thyroid.
Stress
Aviva Romm, Herbalist, Midwife and MD discusses the Stress/Thyroid connection best in her book The Adrenal/Thyroid Revolution. She takes a deep dive into the science behind chronic stress and thyroid dysfunction of all sorts. Suffice it to say that stress is a major disruptor or health and happiness. If you think that stress is impacting your thyroid consider reading her book.
Supplement Therapies for Reducing Antibodies
The most important thing to keep in mind when treating autoimmune thyroid is that you are treating BOTH the immune system and the thyroid. This is an important concept because there are so many natural treatments for the thyroid but they do not all address the immune system. The primary focus in this list is regulating immune function and reducing thyroid antibodies.
Vitamin D: Vitamin D and calcium levels are significantly lower in Hashimoto Thyroiditis and Graves' Disease (70-77%) versus healthy individuals (20%). In addition, it was negatively correlated with antithyroglobulin and antithyroid peroxidase in Hashimoto's thyroiditis group. Vitamin D is recommended for patients with vitamin D deficiency.
Iron: Iron deficiency impairs thyroid metabolism. TPO is a heme (iron) enzyme that becomes active only after binding heme (iron). Autoimmune Thyroid patients are frequently iron-deficient since autoimmune gastritis, which reduces iron absorption and celiac disease which causes iron loss, are frequent co-morbidities. In two-thirds of women with persistent symptoms of hypothyroidism despite appropriate levothyroxine therapy, restoration of serum ferritin above 100 µg/l ameliorated symptoms. Women are susceptible to iron deficiency during pregnancy and while breastfeeding therefore, it should be continued in the form of a prenatal vitamin right up until you finish breastfeeding.
Selenium: Selenium is needed for the conversion of T4 to the active thyroid hormone, T3. Selenium also decreases anti-thyroid antigen antibodies and lymphocyte infiltration. There is evidence from observational studies and randomized controlled trials that selenium can reduce TPO-antibody concentration, hypothyroidism and postpartum thyroiditis. Women at risk of postpartum thyroiditis may benefit from selenium supplementation to prevent Autoimmune Thyroid. Deficient selenium can indirectly cause damage and fibrosis to the thyroid tissue. Caution needs to be taken when supplementing with selenium and concurrent iodine deficiency. Iodine status should be assessed as the two work together to produce thyroid hormones.
Inositol: Some research has shown that myo-inositol when used in combination with selenium can further reduce anti-thyroid autoantibodies – both anti-TPO and anti-Tg antibodies and also helping to improve thyroid function and TSH levels – then selenium can do alone.
DHEA: In one small study, supplementation of DHEA showed an inverse relationship with thyroid antibodies. I normally wouldn’t mention this due to the small study size but found it interesting given a) the relationship between autoimmune thyroid and blood sugar dysregulation and b) the relationship between elevated androgen hormones and dysregulated thyroid. I have seen a big difference in quality of life when women who test low in DHEA are supplemented as well as negative consequences when women who are not deficient are supplemented (as happens sometimes in fertility treatment). I think it is worth testing and supplementing if thyroid antibodies are present. It is available over the counter as a supplement in the US while you require a medical prescription in Canada.
Other Supplement Therapies in Thyroid Conditions
Let’s talk about a few nutritional essentials for supporting thyroid health. The sequence of thyroid hormone conversion is long and involves a number of nutrients. But there are a few nutrients that have significant consequences for thyroid health if deficient or excessive. The nice thing about this list is that they can all be tested with blood work. If you are deficient in any of these nutrients – it is helpful to supplement whether you are in an overactive or underactive thyroid state.
Vitamin A: Vitamin A is thought to assist with the re-uptake of iodine during thyroglobulin and thyroid hormone synthesis. In countries with Vitamin A and iodine deficiency there is a high rate of goiter (thyroid gland enlargement) and hypothyroidism. Thyroid stimulating hormone (TSH) was reduced with Vitamin A (and iodine) supplementation. Vitamin A deficiency is associated with decreased iodine uptake.
Iodine: Iodine is needed for the creation of thyroid hormones. Public health initiatives have added iodine to table salt in the hopes to add iodine to North American diets. Iodine levels should always be tested when considering supplementation. Supplementing iodine in non-deficient individuals can aggravate certain thyroid conditions. In addition, because iodine deficiency is commonly associated with goitre and hypothyroid – it is an overlooked deficiency in other conditions (ex. Hyperthyroid) AND sometimes inappropriately used where prescription is standard (ex. Goitre/Hypothyroid). Caution should always be used with iodine if you are already on thyroid medication. It is hard to know when and when not to use iodine – my suggestion: always test levels first with a serum iodine blood test.
Vitamin B12: There is a high prevalence (approximately 40%) of B12 deficiency in hypothyroid patients. Traditional symptoms are not a good guide to determining presence of B12 deficiency. Screening for vitamin B12 levels should be undertaken in all hypothyroid patients, irrespective of their thyroid antibody status.
Zinc: This mineral is involved in more than 300 enzymatic reactions. Zinc is also involved in conversion of T4 to T3 and activation of T3 receptors. Moreover, thyroid hormones influence zinc metabolism affecting its absorption and excretion.
Tyrosine: Along with iodine, this amino acid is important for the formation of thyroid hormone. It works well for some people and not for others. Caution should be used if you are on thyroid medication already or if you have thyroid antibodies. Tyrosine should be recommended with the help of an experienced health care provider as it can not be tested with a simple blood test.
Autoimmune Thyroid Healing Recommendation:
If you are a mom who suspects a thyroid issue or who has recently been diagnosed with a thyroid issue consider the following recommendations. Plan to follow your program for at least 12 months. Remember, there is opportunity for healing!
Consume an Anti-Inflammatory Diet: Reducing systemic inflammation is supportive of immune function.
Consider a Hypoallergenic/Gluten Free Diet: Removing foods that are frequent irritants can help reduce inflammation. Going gluten free is a specific treatment for autoimmune thyroid as it has been shown to be a common allergen in autoimmune thyroid patients. Whether you tests positive or not for Celiac Disease you may still notice positive change by removing it from the diet for a minimum of 3 months. A Hypoallergenic diet may also help to heal leaky gut which is an added benefit.
Consume Filtered Water: Tap water is high in fluoride and other treatment chemicals that interfere with thyroid function. In addition, it tends to have an acidic pH which aggravates overall inflammation. Consume fluoride-free water with a pH between 6.5-7.5.
Protein Consumption: Consume an adequate amount of protein (0.8-1.8g per kg of body weight). The average person needs about 60g per day. An overall low calorie diet or low protein diet often fails to provide essential proteins which help form the structure of important hormones like thyroid hormone, insulin and immune system cells.
Fat Consumption: Omega 3 fatty acids not only reduce inflammation but support healthy immune function. In fact, fats in general are really important for neurological and immune system function and the deficiency of fats have been implicated in autoimmune disease across the board.
Be Mindful of Brassica vegetables (>1kg per day): Broccoli, broccoli rabe, kale, turnip, Brussels sprouts, Chinese cabbage, and cauliflower contain phytochemicals that inhibit iodine uptake in the thyroid and affect overall function. You usually would have to eat a lot of these foods for it to be a problem but some people are more sensitive than others.
Be Mindful of Soy Consumption: There is a concern that the isoflavones in soy may interfere/inhibit iodine absorption at the thyroid. Research on this topic is mixed. One study found that ingestion of over 30g per day of soy in addition to other phytoestrogens induced hypothyroidism and reversed it when these foods were stopped. However, this diet also reduced cardiovascular risk factors. As with most things, it is likely a balance.A moderate consumption of healthy soy is likely to have health benefits but must be monitored in thyroid conditions.
Herbal Medicines: There are many herbal medicines such as ashwagandha and guggul that support the thyroid but they have different effects depending on your unique health history. It is important to consult a professional if treating active thyroid disease with herbal medicines.
Sleep: Try to get a minimum of 8 hours of uninterrupted sleep a night. From a traditional medicine perspective the hours between 10-midnight are the most important for restorative sleep. Try to get into bed by 10pm.
Reduce Your Stress: When you are under stress, your adrenal gland tells your thyroid gland to slow down. The adrenal gland also sends out messages to increase your immune response which can ultimately lead to inappropriate immune responses (autoimmunity). Read more about this.
Resources:
Agretti, P., De Marco, G., Dimida, A., Ferrarini, E. and Tonacchera, M. (2018). In vitro effects of natural phytoestrogens on sodium/iodide symporter mediated thyroid iodide uptake by using a differentiated TSH-dependent cell line. Journal of Functional Foods, 40, pp.438-446.
Bakr HG, Meawed TE. Relevance of 25 (OH) Vitamin D deficiency on Hashimoto's Thyroiditis.
Egypt J Immunol. 2017 Jun;24(2):53-62.
Balucan FS, Morshed SA, Davies TF. Thyroid autoantibodies in pregnancy: their role, regulation and clinical relevance. J Thyroid Res. 2013;2013:182472.
Beard JL, BorelMJ , Derr J . Impaired thermoregulation and thyroid function in iron-deficiency anemia. Am J Clin Nutr.1990;52: 813–819
Boelen, A.; Wiersinga, W.M.; Fliers, E. Fasting-induced changes in the hypothalamus-pituitary-thyroid axis. Thyroid 2008, 18, 123–129.
Brossaud J, Pallet V, Corcuff J-B. Vitamin A, endocrine tissues and hormones: interplay and interactions. Endocrine Connections. 2017;6(7):R121-R130.
Contempré B, Duale NL, Dumont JE, et al. Effect of selenium supplementation on thyroid hormone metabolism in an iodine and selenium deficient population. Clin Endocrinol (Oxf). 1992; 36(6): 579–583
Di Bari F, Granese R, Le Donne M, Vita R, Benvenga S. Autoimmune Abnormalities of Postpartum Thyroid Diseases. Front Endocrinol (Lausanne). 2017;8:166.
Felker P, Bunch R, Leung AM. Concentrations of thiocyanate and goitrin in human plasma, their precursor concentrations in brassica vegetables, and associated potential risk for hypothyroidism. Nutrition Reviews. 2016;74(4):248-258..
Fontana, L.; Klein, S.; Holloszy, J.O.; Premachandra, B.N. Effect of long-term calorie restriction with adequate protein and micronutrients on thyroid hormones. J. Clin. Endocrinol. Metab. 2006, 91, 3232–3235.
Fröhlich E, Wahl R. Thyroid Autoimmunity: Role of Anti-thyroid Antibodies in Thyroid and Extra-Thyroidal Diseases. Front Immunol. 2017;8:521.
Han, R.; Li, A.; Li, L.; Kitlinska, J.B.; Zukowska, Z. Maternal low-protein diet up-regulates the neuropeptide Y system in visceral fat and leads to abdominal obesity and glucose intolerance in a sex- and time-specific manner. FASEB J. 2012, 26, 3528–3536
He, L., Shen, C., Zhang, Y., Chen, Z., Ding, H., Liu, J. and Zha, B. (2017). Evaluation of serum ferritin and thyroid function in the second trimester of pregnancy. Endocrine Journal, 65(1), pp.75-82.
Jabbar A, Yawar A, Waseem S, Islam N, Ul Haque N, Zuberi L, Khan A, Akhter J. Vitamin B12 deficiency common in primary hypothyroidism. J Pak Med Assoc. 2008 May;58(5):258-61. Erratum in: J Pak Med Assoc. 2009 Feb;59(2):126.
Lerner A, Jeremias P, Matthias T. Gut-thyroid axis and celiac disease. Endocr Connect. ;6(4):R52–R58.
Nishi M. Diabetes mellitus and thyroid diseases. Diabetol Int. 2018;9(2):108–112. Published 2018 Mar 9.
Ott J, Pecnik P, Promberger R, Pils S, Seemann R, Hermann M, Frigo P. Dehydroepiandrosterone in women with premature ovarian failure and Hashimoto's thyroiditis. Climacteric. 2014 Feb;17(1):92-6.
Pereira JC Jr, Andersen ML. The role of thyroid hormone in sleep deprivation. Med Hypotheses. 2014 Mar;82(3):350-5.
Rayman MP. Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proc Nutr Soc. 2019 Feb;78(1):34-44.
Sathyapalan T, Manuchehri AM, Thatcher NJ, Rigby AS, Chapman T, Kilpatrick ES, Atkin SL - J. The effect of soy phytoestrogen supplementation on thyroid status and cardiovascular risk markers in patients with subclinical hypothyroidism: a randomized, double-blind, crossover study. Clin. Endocrinol. Metab. - May 1, 2011; 96 (5); 1442-9
Schmidt M, Voell M, Rahlff I, Dietlein M, Kobe C, Faust M, Schicha H. Long-term follow-up of antithyroid peroxidase antibodies in patients with chronic autoimmune thyroiditis (Hashimoto's thyroiditis) treated with levothyroxine. Thyroid. 2008 Jul;18(7):755-60.
Vella, K.R, et al. NPY and MC4R signaling regulate thyroid hormone levels during fasting through both central and peripheral pathways. Cell Metab. 2011, 14, 780–790.
Yu X., Shan Z., Li C., et al: Iron deficiency, an independent risk factor for isolated hypothyroxinemia in pregnant and nonpregnant women of childbearing age in China. J Clin Endocrinol Metab 2015; 100: pp. 1594-1601
Zimmermann MB, Wegmuller R, Zeder C, Chaouki N, Torresani T. The effects of vitamin A deficiency and vitamin A supplementation on thyroid function in goitrous children. Journal of Clinical Endocrinology and Metabolism 2004. 89 5441–5447.