Showing posts with label thyroid. Show all posts
Showing posts with label thyroid. Show all posts

Tuesday, July 19, 2011

Preparing for a positive postpartum experience after surviving a PMAD, Part Two

In Part One, I offered the background for how I came to an unexpected decision to have another child after surviving a devastating perinatal mood and anxiety disorder.  Today, in Part Two, I am going to offer a more practical perspective.  I will share with you the list that was written on that tattered sheet of paper nearly a year ago and also provide some insight into why those items made "The List" and offer some helpful tips or links so that you can learn more about the topics.  Some of what I share will be globally helpful and other resources may pertain more to what is available here in Atlanta, but I trust you will be able to research what might be more applicable to you in your part of the world if and when the time comes for you to prepare.  I also want to mention that these tips might be helpful for women who are at high risk for a perinatal mood or anxiety disorder, even if they are considering pregnancy or adoption for the first time or have not had PPD with previous children (i.e. those who have not suffered in the past).

  • Share feedings with your partner.
  • Contract with a baby nurse several times per week in order to get eight hours of continuous sleep regularly.
  • Have your partner be in charge of any older children during the night hours.
  • Create a "sanctuary" in a room that is quiet and dark (or whatever is calming and restful for you).
  • If possible, have two bedroom options for yourself.  One that is away from your spouse and any older children and one that can be shared with your spouse on nights when you have respite or want to spend part of the night together.
  • Consider buying a second freezer.  Stock up on prepared frozen meals either from a store or by cooking and freezing meals that can serve many people before you give birth.
  • Ask a close friend or family member to invite people to sign-up to bring you meals during the first 4-6 weeks after you give birth.  Choose times when you won't already have help cooking at home.
  • Put together snacks for yourself ahead of time so that you can easily grab something healthy to eat while feeding the baby or in between meals.  This is one of the things my postpartum doula did for me that helped to keep my energy up and kept me well-nourished.
  • Schedule childcare for older children and/or the baby in advance.  Try to get as many volunteers from your circle of friends, faith community or family members and then fill in with a paid babysitter when and if necessary.
  • Consider hiring a postpartum doula so that you have an ally and resource with expertise and experience available to you during those precious, yet fragile, first weeks at home.
  • Consider your older child's needs, if applicable, when thinking about school once the baby arrives for him/her.  Does your high energy child need more stimulation and physical exertion than you or others in your household can provide?  Or, will he/she be more clingy and need to spend more time with you, your partner and the baby once it arrives?
  • Be clear that any visitors (both long-term and for short visits) should plan to be there to help, not just visit with you and hold your baby.  It is much too draining for a new mom to "host" company when she is recovering from childbirth and sleep-deprived.  It's also not great for bonding when a plethora of others hold your baby during the first couple of weeks of life.  Consider creating a to-do list of things that visitors can do that will be helpful to you while they are in your home.
  • Talk with your partner about how they can help and support you.  Read "What Am I Thinking?" together.  Create a list of things your partner should (or shouldn't say) to help you.
  • Continue (or begin) seeing a therapist who specializes in PMADs regularly before and during pregnancy so that you can make your personalized plan together and he/she has background knowledge and a barometer of your mental health in order to compare if any changes in your mood occur.
  • If you have a network of PPD survivors or experts with whom you interact, share your plans to get pregnant or the news that you are expecting with them so that they can offer support and insights with you.
  • If your therapist is not your psychiatrist, continue or begin seeing one regularly before or during pregnancy so that if you plan for medication (or in case you find that you need it at some point) during or after pregnancy you have already established a relationship with him/her.  Or, find a treatment program and research it in case you find you want/need to participate.
  • If you were medicated during pregnancy or postpartum the last time you suffered, but have since gone off meds, discuss with your doctor the appropriate plan for pregnancy or postpartum this time.  Good doctors will evaluate your risk for relapse and help you to determine whether going on medication prophylactically or taking a "wait and see" approach is best for you.
  • Participate in a support group during pregnancy so that you are comfortable with the group and they know your background before you give birth.
  • Make several copies of the EPDS (a screening tool used for PMADs) so that you can take it a few times during pregnancy and each week postpartum to evaluate your mood and have tangible information for comparison purposes.
  • Make a plan for your physical recovery from childbirth.  If you are having a vaginal birth (or expect to) consider how you will help yourself to heal and rest after labor and delivery.  If you are having a scheduled c-section (or are at risk for an unexpected Cesarean), plan for a longer recovery period and research methods and resources that will help you to heal faster.  Since I decided to have a scheduled "natural" and family-centered Cesarean with #2, I purchased a special belt that was one of the best choices I made regarding postpartum health.  It allowed me to be much more physically active and experience less pain postpartum this time.
  • Plan to be screened for conditions that could mimic or exacerbate perinatal mood disorders such as thyroid disease, anemia, a vitamin D deficiency, etc.
  • Once you are able to and your doctor clears you to, plan to exercise.  The exertion can actually energize you and provide you anxiety and stress relief.  The endorphins are also excellent for women who have mood issues.
  • Consider planning ahead to do things that could potentially help your physical healing and mental health such as acupuncture, placenta encapsulation, massage therapy, cranio-sacral therapy, chiropractic, etc.
  • Review the list of risk factors for PMADs.  Consider how you might address them ahead of time so that you can feel they will have the least impact on your mental health.
  • If you had a difficult or traumatic childbirth or recovery, breastfeeding experience, or other complication previously, consider being proactive so that you can feel well-armed with information and experience this time.  This might involve taking a "class" or hiring someone such as a doula or lactation consultant who is an expert in the field so that you are well-supported.
The above bulleted points outline my personal plan shared in a way that could be applied to anyone in a similar situation or with a similar history.  It is not an exhaustive list, nor are any of the items a "prescription", nor does doing each and every thing on the list guarantee you a positive experience.  However, I have found that considering these factors and resources, as well as putting much effort into planning ahead allows you to be more prepared and aware in order to take the shock factor out of the picture.  Please take only your health care provider's advice  into greatest consideration when preparing for your personal and individual experience.  Together you will know best.

Best wishes,

* In full disclosure, I have not received any compensation for writing this content and I have no material connection to the brands, topics and/or products that are mentioned herein.  The links provided are simply resources that I personally have found helpful.

Thursday, August 6, 2009

Possible cause for some depression in pregnancy and postpartum- thyroid and Iodine issues

From Mental Pro Dot Com:
Thyroid testing identifies the levels of several hormones, including T4 and T3, which are the most active of the thyroid hormones; and thyroid-stimulating hormone, produced by the pituitary gland that controls the production and secretion of thyroxine. When T3 and T4 levels rise, the pituitary secretes less TSH, which causes production ofT3 and T4 to decline, restoring balance. If T3 and T4 levels fall, secretion of TSH again increases, which boosts production ofT3 and T4.

Testing for T3, T4, and TSH levels is a good start if you have symptoms of hypo- or hyperthyroidism, but because the normal range for these blood tests is wide, it's possible to have thyroid dysfunction with so-called normal test results. Measurement of thyroid antibodies can provide additional information about the risk of depression and treatment prognosis. One report, for example, found that women with high levels of antithyroid peroxidase (anti-TPO) antibodies are more likely to become depressed than those without these antibodies. A subsequent study concluded that testing for antibody levels "seems necessary," especially in the elderly and in individuals who do not respond to depression treatment

While women are more likely to have thyroid hormone imbalance (especially hypothyroidism) than men are, a subgroup of women are at particular risk. Up to 10 percent of new mothers develop postpartum thyroiditis, chronic inflammation of the thyroid gland, and concurrent depression. This condition can be diagnosed with tests that check for antibodies against the thyroid. Research has shown that up to 50 percent of women who have high levels of thyroid antibodies during their first trimester develop postpartum thyroiditis and are subsequently at risk for postpartum depression. These women may be iodine-insufficient and will probably respond to iodine supplementation. Women who are significantly iodine insufficient and then become pregnant will become much more insufficient, because iodine is preferentially transported to the fetus. As the woman becomes more insufficient, she is likely to develop anti thyroid antibodies, and after delivery is more likely to develop postpartum depression.

In recent years, studies of depression have shown that some people who take antidepressants respond better if they also take T3. In one particular study of patients who had hypothyroidism, those who took a combination ofT3 and T4 had better results in regard to mental and emotional symptoms than those who took T4 alone. Unfortunately, most patients with hypothyroidism who are treated conventionally usually take only T4. Occasionally patients are given T3 (as the medication Cytomel), which must be taken several times a day and can cause mood and energy swings. To prevent these problems, a physician could prescribe long-acting T3, which is available from compounding pharmacies. Today, however, I would certainly try therapeutic doses of iodine before prescribing long-acting T3.

Friday, January 23, 2009

Thyroid issues and PPMDs

UGH- So on Tuesday my doc ran a thyroid test on me. Since I was diagnosed with Postpartum Thyroiditis in Jan. 08 and it had been a year (6 months longer than I should have waited for a re-test) he wanted to see if my condition had improved. Today I got the news that at a broad level I am still experiencing hyperthyroidism. I am kind of bummed. I wish that I would have retested sooner in case I could have felt better for the last 6 months by making some changes. I procrastinated. :( At any rate, I have been extremely fatigued lately which seemed strange to me at first. When I asked the LNP about it she said that I could perhaps be tired from my thyroid working so hard and that even though most women with cases of hyper are anxious and literally hyper that my fatigue could be related. I hope so...Last night I slept for 8 hours and then took a 1.5 hour nap this morning because I was so exhausted. I hate that I feel so low on energy in the morning. It makes me sad because that's the time I would like to be spending with L. playing and having fun. I am supposed to go in for a full screen next week; I will keep you updated on the results. In the meantime, please read up on the relationship between thyroid issues and the postpartum period...

Hyperthyroidism – or having an overactive thyroid gland – can pose special concerns during pregnancy. When the body delivers too much thyroid hormone, both the mother and the baby can suffer. Miscarriages, premature births, and intrauterine growth retardation can occur when the disorder goes undiagnosed or untreated. Pregnant women with hyperthyroidism can also develop high blood pressure, and are at greater risk of heart conditions.

Nearly all new mothers find that the weeks and months following the birth of a baby are difficult – most report some pain after childbirth, worry over the baby’s health, sleep deprivation, feeding anxiety, especially if the baby is not nursing well, fatigue, mental confusion, and of course, the infamous “baby blues.” While all these symptoms are normal, most disappear within a few months.

But some women suffer more intense, longer-lasting postpartum troubles that can threaten their own and their baby’s health – and these troubles may be directly related to the thyroid.

". . . as many as 10 percent of women may suffer thyroid problems after childbirth."

If you feel exhausted, depressed or are having trouble concentrating beyond the initial postpartum period, or you are really struggling more than other new mothers with debilitating fatigue, hair loss, and depression, you should ask your doctor to check your thyroid levels.

Postpartum thyroid difficulties are common – as many as 10 percent of women may suffer thyroid problems after childbirth. Thyroid disease can surface in someone who has never had thyroid problems before – or in women who have been previously diagnosed with hypo- or hyperthyroidism.

Let’s look at some of the more common questions and concerns about the thyroid in the postpartum period:

I’ve never had a problem with my thyroid gland before – but now I’ve been diagnosed with postpartum thyroiditis. What is it, how did I get it?

Postpartum thyroiditis is a condition in which the thyroid becomes inflamed and dysfunctional after delivery, due to antibodies. Antithyroid antibodies circulate in the body, causing either too much or too little thyroid hormone to be released. Too much thyroid hormone will cause you to have an overactive thyroid gland, while too little will result in an underactive thyroid.

Postpartum thyroiditis typically follows a pattern: at first, you become hyperthyroid, and might feel breathless, nervous, mentally confused, have unexplained weight loss, or trouble sleeping. This phase usually appears anytime between one and four months after the birth of the baby.

In the second phase, which usually shows up three to eight months postpartum, the body’s hormones are again out of whack. Instead of releasing too much thyroid hormone, the body releases too little, and you become thypothyroid. Symptoms of this stage might be depression, fatigue, weight gain or difficulty losing weight, and an enlarged thyroid gland or sensation of pressure in your neck. Checking your TSH levels will clue you – and your healthcare providers - as to what’s going on.

In my case, my postpartum TSH bounced around like a rubber ball. I went from hyperthyroid immediately postpartum, to the top of the normal range, nearing hypothyroid levels, just weeks later, back to hyperthyroid, and back to hypothyroid, with only tiny dosage adjustments. It appeared that my hormones were fluctuating wildly.

It's well known that the postpartum period can trigger a variety of thyroid and hormonal problems in women who have never had any thyroid problems prior to pregnancy. In someone who is already "hormonally compromised," it's even more likely that the postpartum period can be a period of hormonal upheaval.

If I have postpartum thyroid problems, will I have thyroid problems forever?

It's impossible to say. A majority of women will return to normal, several months to as much as a year after postpartum thyroid diagnosis, and will never have another problem. Otherh women have postpartum thyroid problems after every pregnancy, but otherwise things return to normal, until menopause. Some women – possibly as many as 30 percent, however – remain hypothyroid because their thyroid glands were too heavily damaged by the imbalance, or because the pregnancy has activated an inherent case of autoimmune thyroid disease.

For those who have a gradual return to normal, you and your doctor will need to do frequent TSH tests in order to monitor your drug dosages and gradually taper you off as your TSH returns to normal.

Keep in mind, however, that once you've had an episode of postpartum thyroid problems, you are much more likely to later develop a thyroid problem during a period of stress, subsequent pregnancy, or during menopause.

What can I take to treat this?

Patients who are hyperthyroid can take beta-blockers like Atenolol or Propranolol. In some cases, antithyroid drugs may be given. Again, choice of antithyroid drug -- Tapazole or PTU -- depends on whether you are breastfeeding, because breastfeeding mothers cannot take Tapazole.

Hypothyroid patients will be prescribed thyroid hormone replacement, such as Synthroid, Levoxyl, Unithroid, Armour, or Thyrolar.

Ever since I had my baby, I’ve been horribly depressed. Even though he’s six months old, and a wonderful, healthy baby, I don’t even want to get out of bed in the morning. Is this just postpartum depression, or is there something more going on?

It could be true postpartum depression, it could be sleep deprivation, it could be other hormones at work. The only way to find out is to talk to your doctor, and have some tests run.

In my case, when my daughter Julia was around five months old, I still couldn't shake the major exhaustion, and a gray, depressed feeling that had descended on me about a month after her birth. I went to my regular doctor, sure that I must be suffering from postpartum depression. The doctor, however, decided to run some hormone tests before recommending an antidepressant. It's a good thing she did, because she discovered that I had various hormonal imbalances in addition to my thyroid edging out of normal range into hypothyroid TSH levels again. She prescribed some natural hormone replacement and changed my thyroid hormone dosage, and soon, it was as if the fog had lifted and the world was a happy place again.

Fairly early on postpartum, pay close attention to symptoms of any hormonal imbalances, and have all your hormone levels tested periodically, including thyroid, progesterone, testosterone, and estrogen as well.

In order to correctly diagnose postpartum thyroiditis, your healthcare provider first needs to distinguish it from Graves’ disease. To diagnose Graves, he or she can perform a radioactive iodine update test, as well as taking TSH and T4 level readings. A diagnosis of Graves’ disease would show a high reading of radioactive iodine uptake, while postpartum thyroiditis would show a low one.

If you are nursing, you’ll need to stop for three to five days, since radioactive iodine can appear in breast milk.

I had postpartum thyroiditis after my first pregnancy, got treated, and felt back to normal in a few months. Now I’m pregnant again…is it likely to reoccur?

No one knows for sure. However, if you have a prior experience with postpartum thyroiditis, it is possible that you will get it again. Talk to your doctor about your chances, and be proactive in getting follow-up appointments and retests of TSH and T4 during pregnancy and after delivery.

Help – I’m desperately trying to nurse my new daughter, and it’s just not working out. She’s not having enough bowel movements or wet diapers, and she just doesn’t seem satisfied at the breast. I’ve checked with lactation consultants and they say the baby’s positioning is just fine, and that I just need to feed her more often. I don’t think I’m making enough milk. Could this have anything at all to do with my thyroid disorder?

It very well could have EVERYTHING to do with your thyroid disorder. Often, a period of low milk supply may in fact be a sign of postpartum thyroid problems. However, only a check of your TSH and T4 levels will uncover the truth. In the meantime, continue working with your lactation consultant. For in-depth information on breastfeeding with thyroid problems, see: Breastfeeding and Thyroid Disease.