When my son was about 4 weeks old, I started noticing pain while swallowing. 

It wasn’t the usual type of sore throat, on the inside by my tonsils and tongue. Instead, it felt like a big sore lump at the front of my neck. It was tender to the touch (especially when his little meandering hand would accidentally bump it when we were nursing.) The sides of my neck were painful too, and when I’d tuck my chin at night, there was a sense of uncomfortable pressure. 

Looking in the mirror, the change was subtle. I don’t think I’d have noticed it otherwise because having a baby made it difficult to spend much time examining my reflection. I honestly thought it was just residual soreness in my neck from being hunched over while rocking my son to sleep. But one night, I was so frustrated by the discomfort that I flipped on the light in the bathroom and took a closer look. The bottom of my neck, under my cricoid cartilage (or as I jokingly call it, my “Eve’s apple”), there was some swelling. Where I normally could see my neck tendons extend all the way from my chin to my chest, their outline was obscured partly at the base of my throat from my inflamed thyroid. 

I knew right away what was going on. I had thyroiditis, a common postpartum health issue. 

The thing is, none of my healthcare providers had ever warned me about it. Instead, I knew what was going on because I’d learned about it in school and had actually treated a number of my own patients for it. In fact, it affects up to 8 out of every 100 pregnancies. 

Conventional medicine likes to break up our health into different systems. We see cardiologists for heart problems and GI doctors for poor digestion. We have endocrinologists and gynecologists and urologists. In some ways this is a good thing, because we end up with providers who really know their respective systems well. But on the downside, we lose sight of the fact that the systems of our bodies are all closely connected to each other. This is especially true with hormones, including reproductive hormones, thyroid hormones, and stress hormones. We even have a special name for this connection called the hypothalamic-pituitary-adrenal-thyroid-gonadal axis, or HPATG axis for short. The main takeaway of all this (for the purpose of our current conversation) is the fact that when one category of hormones changes, it affects all the other hormones too.

I often liken pregnancy to going through puberty in 10 months, and childbirth to going through puberty overnight. The hormonal shifts are enormous and extremely fast. For some reason, the body sometimes has a hard time leveling off after the rapid changes along one axis of the HPATG web (reproductive hormones), and the thyroid or adrenal glands end up suffering as a result. Some women even end up developing autoimmune problems because of this, if they have a genetic predisposition. 

Fortunately, I already had the anti-inflammatory herbs and supplements I knew I needed on hand and started taking them right away. Then, I hurried off to get my labs drawn as soon as the order was placed. I was extremely relieved that there were no signs of Hashimoto’s, an autoimmune condition which happens to be the #1 cause of hypothyroidism in women. I’m grateful that my thyroiditis quickly resolved and didn’t become a chronic issue, as is the case with autoimmunity.

How I Treated My Postpartum Thyroiditis

Thyroiditis in pregnant and breastfeeding women should be treated differently than thyroiditis in the general population for two key reasons. 1) The root cause is different (in most cases, hormonal shifts drive thyroiditis in the perinatal period, which isn’t always the case in other populations) and 2) The herbs and supplements that may be used to ordinarily treat thyroiditis aren’t all safe in pregnant or breastfeeding women. Here’s what I did to address my own thyroiditis:

1. Fish Oil

I was already taking 2,000 mg of cod liver oil daily and for 1 week, I increased the amount I was taking to 4,000 mg. The omega-3 fatty acids in cod liver oil are very anti-inflammatory, which is a key factor in moderating the inflammation that drives thyroiditis.

It’s important to note that not all fish oils are safe during pregnancy due to vitamin A content and risk for contamination with heavy metals. Fish oil can also increase risk of bleeding disorders and can interact with some medications, so check with your doctor before changing your fish oil routine or starting any of the other supplements I describe.

2. Probiotics

The liver and GI system are responsible for detoxifying hormones, and there’s a lot of detox that goes on in the postpartum period. In the third trimester, estrogen levels are six times higher than pre-pregnancy levels, and they dip even lower for breastfeeding women. That’s a lot of transition in a short time, which means a lot of work for the GI system.

The ability of the body to detoxify these old, ‘used’ hormones depends largely on the microbiome. This subset of bacteria is appropriately termed the ‘estrobolome’ for its function in clearing out old estrogen compounds. A buildup of estrogen byproducts can contribute the the hormonal storm that drives thyroiditis, so I started taking a probiotics with a large variety of strains in addition to my prenatal probiotic to help support the diversity of my gut and its ability to detoxify estrogen.

3. N-Acetyl Cysteine

A chemical called glutathione is one of the body’s main weapons against oxidative stress and inflammation, and supplementing with it is very effective in treating conditions related to oxidative stress such as thyroiditis. However, there isn’t a lot of data regarding its use in pregnancy or during breastfeeding.

N-Acetyl Cysteine, on the other hand, has the effect of bolstering up the body’s own stores of glutathione, creating the same antioxidant effect without the potential risks of taking oral glutathione. NAC has been shown to be both safe and effective during pregnancy. I took a dose of 1,000 mg for 10 days, then discontinued.

4. Vitamin C

Vitamin C plays an important role in helping the body recycle its glutathione stores. I took 2,000 mg of Vitamin C daily in the form of chewable tablets for 1 week.

5. Rest, water, calories, nutrients…

Possibly the most important of all was getting back to the basics of self-care. During this time, I cut back on my daily walking and spent more time resting in bed with my baby, focusing on conserving energy and allowing my body to heal. I also paid extra attention to my water intake, focused on getting plenty of meals and snacks to keep my calories up (and avoid putting my body under even more stress) and made sure to eat plenty of nutrient-dense foods like organic butter, red meat, berries and leafy greens.

I count myself very lucky not only because I recovered quickly, but because I had access to the information I needed to start taking steps right away. So many providers never talk to their patients about the risk of thyroid problems after childbirth, so they end up going undiagnosed for a long time. That’s because not every case of thyroiditis presents with neck pain like mine did. Other symptoms can include weight gain (which gets blamed on pregnancy or “baby weight”), hair loss (again, blamed on “postpartum hormones”), extreme fatigue (“it’s just because you aren’t getting as much sleep”), constipation (“here, take a stool softener…”), depression (postpartum depression is a thing, but so is hypothyroidism), dry skin, feeling cold, a puffy face, muscle weakness, joint pain, brain fog and more. 

What to Do if You Think You Have Postpartum Thyroiditis

If you suspect that something is running amok with your thyroid, get tested! The sooner a diagnosis is made, the sooner you can start doing something to improve your health. However, keep in mind that it’s not a good idea to just assume you have a problem with your thyroid and treat it on your own. Even if you are 100% correct that your thyroid isn’t functioning well, it’s important to discern whether or not there’s an underlying autoimmune problem because the problem should be addressed differently if there is. Failing to acknowledge autoimmunity can make the problem even worse. (Autoimmune thyroiditis is the most common type of thyroid problem. Click here to learn more about the different types of hypothyroidism.)

• Ask your doctor for a comprehensive blood test including the following: TSH, free and total T3, free and total T4, reverse T3, throxine-binding globulin, anti-Tg antibodies, and anti-TPO antibodies. Ask for nutrient panels too, including vitamin D, zinc, selenium, iodine, and omega-3’s
• Support your microbiome by consuming 30 different types of plants weekly (remember that nuts, whole grains, seeds, legumes, fruits and vegetables all ‘count’ as plants)
• Regularly consume wild-caught fatty fish like salmon to maintain healthy omega-3 levels
• Make sure you get enough sleep, ideally 8-10 hours per night in the winter
• For personalized care, make an appointment with a functional medicine physician who can help you in identifying the root cause of your health concerns and support the optimal function of all your body’s systems. If it’s not your thyroid, it’s something else, and you deserve to have it addressed so you can feel your best!

---