Postpartum depression or postpartum thyroiditis?
My own experience with postpartum depression started 6 weeks after the birth of my first child, Annika. I remember clearly that it was a Friday, Annika was “colicky” (or so they said) and had one of her fits of crying that lasted about 45 minutes. Me, I cried for three hours straight.
Before having Annika I knew I was passionate about treating children with naturopathic medicine, but it wasn’t until I became a mother that I realized the need for treating moms as well.
Treatment of postpartum women is a huge part of my practice here in Missoula. It is sadly underreported, undertreated and frankly I have found conventional medicine to have very few treatment options available for women who don’t want pharmaceuticals.
That’s why I have devoted a percentage of my practice time to research and making videos and blog posts to help women with PPD. (10-15% of postpartum women!)
My approach to PPD treatment (just like my approach to treatment of many other conditions) is to figure out the underlying cause. I’ve got to tell you, in my practice probably 9/10 times my patients that come in to me with depression have something else going on. In fact, I’ve never seen normal lab values in a patient with depression. That’s because depression happens quite frequently ANY time the body runs out of resources. You have iron-deficiency anemia? Guess what, you’re oxygen deprived and you will feel awful. You have kidney problems? Guess what, your body can’t keep a correct electrolyte balance! You have intestinal problems/dysbiosis? Guess what, you can’t absorb nutrients like B vitamins to keep your cells running. (I will talk about these other problems in more detail in future episodes.)
Ditto for thyroid gland problems.
So here is the thyroid gland. It is a little hormone-secreting gland that sits in the front of the neck, you can gently touch the gland right underneath your adams apple. It normally enlarges in pregnancy because you need extra thyroid gland to support you and your baby.
The thyroid gland basically sets the metabolic rate for the entire body. That’s why people who have too much thyroid (called HYPER thyroid) feel like they’ve had too many cups of coffee. If you have LOW thyroid you typically feel sluggish, fatigued, depressed, and often have dry skin, hair, nails. Basically if you don’t have enough thyroid gland your cells don’t have enough energy to operate. It is no surprise that someone with low thyroid gland function would feel fatigued!!!
More about the thyroid gland: 1) it requires iodine to make thyroid hormone. This is why women should keep taking moderate levels of iodine (like a good quality prenatal) even in the postpartum period. Do NOT take excess iodine. 2) it is inhibited by soy, peanuts and uncooked Brassica vegetables (like broccoli, cauliflower, kale, etc). This is a bit overblown in popular media – it is only raw veggies that really significantly affect thyroid function (in very large amounts). 3) it requires a protein to shuttle the hormone around to various places in the body.
Measuring thyroid gland. Most physicians will screen you for thyroid problems by using TSH (thyroid stimulating hormone). It is confusing for people because a HIGH TSH means you have LOW thyroid gland function. TSH is what the pituitary gland secretes. (it’s in the brain. Yes, it looks suspiciously like a member of the male anatomy, only much much tinier). It is the brain saying “hey, there’s not enough thyroid hormone, we need more”. The thyroid gland itself receives that message and is supposed to make more. BUT if it CAN”T produce more then the TSH will keep going up and up.
You need to test more than just TSH. Some doctors will only test TSH – this is a mistake. Normal low thyroid (hypothyroid) conditions have a high TSH and low T3/T4 (thyroid hormone) – but not everyone has a “normal” thyroid condition! As a natuorpathic physician I want to know the levels of your thyroid hormone (T3/T4), plus the amount of binding protein (thyroid uptake or TU), the amount of free hormone (FTI or free thyroxine index), and maybe even a measurement of how thyroid gets converted (reverse T3 or rt3 – a measurement of degradation of the hormone).
Then we need to know if there is an autoimmune condition happening. Postpartum thyroiditis affects 5.4% of the general population! Whoa!
Postpartum thyroiditis has a variable course. Some women fluctuate between hyperthyroidism and hypothyroidism. (This is why it is so challenging to treat!)
The symptoms of hypothyroidism include fatigue, depression, cold intolerance, thinning hair/nails, dry skin, and a feeling of “slowness.” In hyperthyroidism many women feel anxiety, fatigue (like a “burnout” fatigue) restlessness, palpitations, migraines and more.
Autoimmune thyroid conditions are diagnosed by measuring antibody levels. Anti-TPO and Anti-TG are antibodies against different parts of the thyroid gland (or, rather, different parts of the process of making thyroid hormone). Anti-TPO is usually king, but if I am really suspicious I”ll order an anti-TG too.
Treatment for thyroiditis. “Selenium decreased the incidence of PPT as well as permanent hypothyroidism when compared with a placebo control group.” I like selenomethionine the best for treatment of autoimmune thyroid problems. Antioxidants are huge – turmeric, by the way, has been shown to help many inflammatory conditions, including pain! I recommend liberal amounts of turmeric to be eaten with food to decrease inflammation and possibly help with autoimmune conditions. It needs to be eaten with fats for best absorption. Probiotics are one of my favorite immune modulators – but you MUST MUST MUST get a high quality probiotic, not the junk that is sold over the counter at a supermarket. (Culturelle brand is pretty good, you can find it most places. I have a few others that I really like that I carry in my office. Honestly, the rest is garbage.)
I do a lot of treating intestinal dybiosis too – it contributes to the general antigenic load which can stimulate autoimmune conditions.
Oh, and yes, the emotional component. I have yet to see an autoimmune patient without some sort of emotional component. That is one of the greatest parts about being a naturopathic physician – we recognize that healing occurs on so many levels all at the same time.
I hope this was helpful! Please comment below if you have experienced postpartum depression that was due to postpartum thyroiditis or hypothyroidism. I would love to hear your stories.
KatelynSeptember 1, 2017 at 6:24 pm
Hi Dr. K,
I live in Iowa where Naturopathies can’t practice. Is there anyone you’d personally recommend to see? I would love to be tested ‘just in case’.
Erika KrumbeckSeptember 8, 2017 at 7:00 pm
Oh bummer! You may want to look for an Integrative Medicine or Functional Medicine physician. I definitely recommend getting tested if you have any symptoms. Good luck!
MeganSeptember 21, 2014 at 4:20 am
I live in Portland, Oregon and stumbled on your site, feeling many of these symptoms 8 months after the birth of my second child. Trying to find help naturally rather than the drug route which is what my midwife is recommending. Any paths for me or do you have recommendations in Portland?
Dr. Erika KrumbeckSeptember 21, 2014 at 7:13 pm
I recommend finding a naturopathic physician in Portland to help you out. You can check out http://www.naturopathic.org and click on the link “Find a Doctor” to find an ND near you.
Claudia GuyAugust 25, 2013 at 7:16 am
Thanks Dr. Krumbeck,
This is well explained and in simple terms. I’m glad to see this very common condition addressed. PPT or PPD is so much more common than we admit. Addressing this, in effect, helps families. If fact, preventing PPT is probably best.
Is there hope that PPT is reversible, or does the practitioner continue to manage it as an autoimmune disease?
Dr. Erika KrumbeckAugust 25, 2013 at 11:29 am
For a subset of women with PPT the thyroiditis continues as a lifelong hypothyroid condition – which allopathic medicine treats with thyroid hormone medication continuously. I am hopeful that if naturopathic medicine can address the underlying cause early enough that we can prevent much of the permanent damage that occurs, and thus reduce the need for lifelong hormone. I think it is also critical to try to identify women before conception and treat inflammation and autoimmune disease early. Remember to treat the individual, not the disease!
Maggie LutherAugust 13, 2013 at 11:01 am
Thanks Dr K
What a wonderful explanation of the overlap in similarities of pp depression and thyroid disease. Love the slideshow. I agree that most probiotics are best bought at a coop or whole foods type store to make sure you get a good source. Lactobacillus is super important for the small intestine (like culturelle) whereas Bifidobacterium species are so important for the large intestine/colon. Getting a product with both genus and multiple species is the best bet for a quality product.