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Re: New to Effexor--Postpartum Thyroiditis » Molly

Posted by Noa on January 16, 2001, at 16:11:46

In reply to Re: New to Effexor, posted by Molly on January 16, 2001, at 14:59:15

Either. Actually, both--usually it is overactive at first, and then underactive. It is an inflammation of the thyroid after pregnancy. Apparently, it affects about 5% of women postpartum.

And, symptoms of hyper (overactive) thyroid can include nervousness, anxiety, restlessness, etc., even panic attacks.

For more info, I recommend this article:

Postpartum Thyroid Problems:
Frequently Asked Questions About Thyroid Problems After Pregnancy

by Mary J. Shomon

which can be found at:

Also, I've clipped part of another article, just the section dealing with PPT:

K-C Loh,* Y-C Chee‡


Postpartum thyroiditis (PPT)

PPT is an autoimmune condition that occurs in approximately 5% of women during the first year postpartum. The clinical presentation is characterised by a hyperthyroid phase occurring in the first three months postpartum, followed by a hypothyroid phase between 3-6 months after delivery, with spontaneous recovery in the majority of patients.44,45 However, about half of the patients present with hypothyroidism without clinically apparent preceding thyrotoxicosis, and 25-30% of hypothyroid subjects eventually develop permanent hypothyroidism.46 PPT can also occur in patients with Graves' disease or Hashimoto's thyroiditis.47

Symptoms during hyperthyroid phase include tachycardia, excessive sweating, and rapid post-pregnancy weight loss. Thyrotoxicosis in PPT is usually mild and self-limiting (2-8 weeks' duration), and is distinguished from relapsing Graves' disease by a low RAIU (study contraindicated if the mother is breast feeding). ß-blockers can be administered if symptoms are severe. Antithyroid drugs are not useful in PPT because thyrotoxicosis is secondary to hormone release from the damaged gland. Observation is important because many patients become hypothyroid before recovering normal thyroid function.44-46

The duration of hypothyroid phase is variable and symptoms may include depression, fatigue, lethargy, inability to lose weight, and emotional lability. Painless goitre is a common finding. In symptomatic patients with biochemical evidence of hypothyroidism, treatment with levothyroxine is indicated. Patients who recover from PPT should be warned of the increased risk of recurrence with future pregnancies, and of developing permanent hypothyroidism in the future.44-46

Antibodies against thyroglobulin (Tg) or thyroperoxidase (TPO) have been reported in about 75% of patients with PPT. Although there is no consensus, systematic screening of thyroid autoimmunity in the early stages of gestation may allow specific monitoring of susceptible individuals, as approximately 50% of women with a positive test for thyroid antibodies subsequently develop PPT.48 In a large prospective study, women with positive anti-TPO antibodies detected during antenatal screening at 16-week gestation were found to have increased prevalence of thyroid-related symptoms in the postpartum period compared to the antibody-negative group. Interestingly, thyroid-related symptoms were present in both groups of thyroid antibody-positive women with and without thyroid hormone abnormalities, suggesting that symptoms may appear well before biochemical abnormalities become apparent.49

Other causes of postpartum thyroid dysfunction

About half the women with Graves' disease suffer a relapse after delivery. Relapse of Graves' disease in the postpartum period accounts for the remaining 10-15% of cases of postpartum hyperthyroidism.50 From a clinical standpoint, it may be difficult to distinguish hyperthyroidism caused by Graves' disease from an episode of PPT, and both conditions may occur in the same individual. In the majority of cases, hyperthyroidism due to Graves' disease occurs later in the postpartum period (between 3-6 months) as compared with the transient thyrotoxicosis of destructive thyroiditis. Affected mothers who breast-feed their infants should preferentially use propylthiouracil as less than 0.1% of the ingested dose is secreted in the breast milk. Nonetheless, propylthiouracil should be given in divided doses after each feeding, and the infants monitored closely with frequent thyroid function testing. Similarly, radioactive iodine treatment is contraindicated in nursing mothers.51

Hypothyroidism in the postpartum period may occasionally be contributed to by postpartum pituitary failure, which results from pituitary apoplexy (Sheehan's syndrome) or lymphocytic hypophysitis.52,53 In these situations other pituitary hormones are usually affected, and serum TSH is not elevated in the presence of low thyroid hormones.




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