Transcript:
Postpartum Thyroiditis | American Thyroid Association
Breastfeeding and Thyroidism – La Leche League International (llli.org)
*We apologize for any typos, misspellings or incorrect grammar. Our transcript is auto-generated by software that’s trying its best, just like all of us.*
Hey everybody, welcome back to the Milk Minute. Welcome, welcome. Heather, today we’re doing hypothyroidism and breastfeeding. You don’t, you haven’t looked at this at all. Yes! Brand new. That’s just what I always wanted! I just, you know, sometimes we have a plan and sometimes I look at it and I just go what if I didn’t do that and I did something entirely different.
You went rogue. And you were like, thyroids, that’s what we need to talk about. I mean, as I was like taking my thyroid medication last night, I was like, we haven’t actually talked about this. You’re like, other people also do this every day before breakfast, maybe I should freaking talk about that. Yeah, yeah, so, so anyway, that’s what we’re going to talk about today, but otherwise, how you doing?
Well, I’m still pregnant. So, that’s my life update. I just made you go to Outback Steakhouse, again, to eat another Chocolate Thunder from Down Under diarrhea dessert. And it was just as good as the first time. It was delicious. I’m a little too full right now. How are you? I’m so full of baby and cake and chicken and it was so good, though.
Yeah, it’s worth it. It’s worth the discomfort. I will eat that corporate food and listen to their Katy Perry playlist and… Really just sinking right now. You were strongly considering telling the very awkward waiter how attractive he was, and I was like, please don’t do that. He was so beautiful. His eyebrows were perfectly manicured.
But I feel like he was so awkward that he would have not been able to handle that, Heather. Well, you know who wasn’t awkward was the hostess because she said, Just the two of us? And I went, We can make it if we try, and she picked right up and she goes, Just the two of us, you and I. And I was like, yes.
That’s the hostess I need at Outback Steakhouse right now. It was great, we loved it. Yeah, well, you know, other than eating Outback, I am really busy because everybody’s having babies right now. Everyone but me. Right, which means I have to do a ton of home visits. So like, basically until 36 weeks, I see everybody in my office.
Then I do at least one home visit for everybody before they have a baby. And then after they have a baby, it’s mostly home visits. So I’ve been like very running around the whole freaking state. Every week and have narrowly avoided accidental animal adoption a few times. Oh my gosh, what? So, like, most of the people I see, I, I think, fit into the rural, like, farming category.
Like, there’s a lot of Amish folks and also just, like, folks with hobby farms and big farms that, you know, it’s like, it’s, it’s a lot of rural people. And if any of you guys live like that, you know, we kind of end up with a lot of animals we don’t need. And so there was one day a week ago where every person I saw tried to give me an animal.
What were they trying to give you? So the, the first person I saw in the morning as I was leaving, they were like, you don’t need any puppies, do you? Which is like, that was, that was bad. That was, I was almost left with a puppy because my favorite dog is like, probably not. He’s like not going to live a whole lot longer.
I think he’s like totally deaf and going blind. I’m like, Oh God, you’re getting like really old. And so I was thinking about that and they were like, you sure you don’t want a purebred border collie puppy? And then they all were like running around in the yard and I was like, I don’t know. I’m not sure. I have to go.
Oh that would be really, I don’t even really like dogs and that would be hard for me to resist because puppies are so cute, especially right after a birth where you’re like, Flooded with someone else’s oxytocin. Actually, the bad part is these folks are getting all home visits. So this is the beginning of their pregnancy.
So it’s going to be every time I see them, they’re going to be like, are you sure you don’t want a puppy until they’re all gone? Oh man. And then the next books I saw had baby rabbits and they were, they were joking a little bit more about that. Cause I think they’re going to eat them. So it’s fine. They were like, are you sure?
You know, go just take it from home. And I was like, I’m really sure about that. Actually don’t want those. Then the last folks I saw. They have goats, and they live in town. They’re sort of pet goats, and they, like, feel bad that they don’t get to run around. They’re like, you could just take them home and have them at your farm, and we could visit them there.
And I was like, I don’t need your goats. I don’t need your goats or your bullshit. Keep your animals. No, they’re super sweet. It is actually how I end up with a lot of animals. When friends are like, I just can’t take care of them anymore. What was the fowl that you ended up with? You came home with, like, a goose or something?
I ended up with… A turkey and two geese. That’s right. That way. That’s right. Oh my god. And a few chickens, but I mean, I don’t even know how many chickens I have. You could, you could just throw five in there and I’d be like, whatever. Also, I need a tadpole update because after I went to your house and I saw your baby pool that had been reined in.
Yeah. And then the frogs laid all the tadpole eggs and then half of them had their feet when I was there. So how are they doing? Okay, so a bunch are gone. Whether they just got eaten by something, because that’s like a buffet right there. Or they actually hopped out of the pool. I put like a little piece of wood in there so they could get out.
And the other half are still tadpoles and I’m like they’re probably just gonna like die. I don’t, it’s like, that seems like it’s taking too long and it’s getting really cold. Oh. So I don’t, but like, should I put them in the river? That seems bad. They’re definitely going to die in the river. So I don’t, I guess I’ll just.
Oh, I thought this was going to be a happy update where you’re like, my whole yard’s covered in frogs. No, there are a bunch of them did like end up getting out. I’m pretty sure. Cause we do a lot of frogs around, but they’re really tiny. Like when they’re adults. Like, when they’re actually frogs, they’re, like, smaller than they were as tadpoles.
Whaaat? Yeah. I don’t know shit about that, but that’s exciting. We’ve raised tadpoles a number of times with Griffin, and it’s always surprising, one, how long it takes, and two, how tiny they are when they’re finally frogs. Yeah, my kids are pissed that this baby’s taking so long. Like, really, legitimately getting mad.
Heidi’s like, I am mad that this is taking so long, and I’m like, me too. Yeah. Girl, same. Well, anyway, I’m ready to have my mind blown, but do we have any Patrons to thank? We do! We have a patron to thank, our new patron, Grace. I’m very thankful for your support, Grace, and for anybody else who wants to join us on Patreon.
You get a bunch of bonus material and you get full access to Beyond the Boob. Did we get a new one this morning? I think we did. Let me double check. I think we did. Hold on. Yes, we did get a new patron this morning, Aimee Tebay. Ooh, Aimee. Yeah, or Tebay, I’m sorry, that might not be right. But thanks for joining, Aimee.
Thank you very much. And we have a special shout out, an Irish shout out. Well, I’m not going to do it. In an Irish voice, but we’re going to give a shout out to an Irish friend. We are not doing accents. Special shout out to a friend of our audio editor and to her colleague for recommending our podcast.
These are lovely ladies living in Ireland, Susan, Aideen Aimme and Veronica at CUMH Midwives and Lactation Consultants. Wonderful. Yeah, that’s really cool that We have some buddies over there that are recommending us. Yeah, in Cork! We love it. We’re super happy that our editor moved over there because we get really cute pictures of things that she sees now and then.
And it just seems like a lovely place to live. Yeah, and it just makes the world seem a little bit smaller in the best way. Which is nice. I want to go. Yeah, maybe, I do too. Maybe we’ll take a podcast vacation sometime. Podcastcation! Those words do not merge. Alright, I tried. Alright, and I do have a question from a listener today.
Okay, let’s see. So this is from another Heather in our Facebook group. All Heathers are crazy. I’ve never met another Heather where I was like, she’s normal. I don’t know anything about this Heather, but I’ll read her question to you. Okay, perfect. So she was wondering, can you transition from exclusively breastfeeding to just formula during the day and nursing at night?
My baby’s three months old and I’ll be returning to work. I hate pumping, so I’m hoping daycare can bottle feed formula and I can nurse when I get home. Will my body adjust to this? I have a few weeks before I transition and I want to do it the right way and not too soon where I stop producing completely.
You’re at a weird time, friend. Yeah. The three months is a weird time because yes, things are technically established with breastfeeding. And yes, there are some kids that sleep through the night at three months old, but we do see that. You know, also, gosh, and you’re choosing to feed overnight, which is decreasing your sleep.
It’s, it’s a tough one. I think, you know, I would say if you chose to do that now, you would have a, you, it would be pretty likely that you would lose overall supply. If you chose to do that at like six months or 12 months, you would have a much greater chance of success where you could formula feed during the day and have really good success just breastfeeding the rest of the time.
But it’s a little early for me to say, like, definitely go for it. But you know, if, if you still want to try it and see what happens, if you did that really slowly, You might still, like, be able to kind of be like, Oh, actually, it’s not working. Let me go, go back and start pumping. And also, let’s, we could talk about your pumping.
Like, I would love to do a whole consult with you to talk about what it is about pumping that you hate so much. I mean, yeah, it’s not great, but is there a way that we could just pump less or pump more efficiently or save you a lot of time on the washing or make it more comfortable for you? You know, just to, like, buy you even an extra month might give you a little bit more of a cushion.
And without meeting your baby, it’s hard to say because there are some kids that will suck on anything for any amount of time or volume. They’re just like, I’m just happy to be here, suckling away. And other babies will like pop off, look you dead in the face and be like, how dare you? How dare you put this half empty boob in my mouth?
You were the rudest mommy there ever was. Yeah. So it’s, it’s tricky. Like if I had to give you a yes or no answer right now, I would say. This is not a great time for that. Yeah, I would say this is a great time for a consult. That’s what I would say. Absolutely. We’d be happy to do that with you. For sure.
Because also, this seems like a client that goes from very unhappy to very, very happy when we adjust a couple things. Hopefully. That’s our goal, right? And we see that a lot where people come in with, you know, they, they feel like they’re at the end of the rope. They have a million problems, but it’s like, sometimes if we can just fix.
One thing, overall quality of life is significantly improved. Or it might be just giving you permission to just formula feed. Yeah. And just be done. And that’s also great. Yeah, absolutely. You know, whatever you want, you can do whatever you want. Okay, well let’s take a little breaky break. And then we’ll talk about thyroids.
Okay, that little booger in your neck that’s just wreaking havoc. Just hangin out there. Alrighty!
And they give you a hot cup of tea and let you sit on the couch and talk about all the issues, not just the breastfeeding issues. What a cozy fantasy. Is there anywhere that’s real? Oh, it’s real, girl. It’s real. And I’ve been building it for quite a long time. My business is called Breastfeeding for Busy Moms, and me and every member of my team are trained in our three major tenets, which is accessibility, kindness, and empathy.
If you want to book a consult with Heather or anyone else on her team, you should head over to breastfeedingforbusymoms. com. We do accept some limited insurance and we’d be happy to walk you through it if you want to give us a call. And that number’s on Google. So go sit on the cozy couch with Heather at Breastfeeding for Busy Moms.
Love you guys.
Welcome back, folks. Let’s talk about hypothyroidism. Can you just give me a quick breakdown, or is this gonna feel like an anatomy class? Both. So, can I just say a quick caveat? If anyone out there is, like, a cellular biology specialist, I would prefer if you just I skipped ahead like 20 minutes because I feel like my explanations of this is going to be like a little embarrassing for that.
But hopefully we’ll help everybody else at least remember like 9th grade biology. Because this is really complicated and I don’t fully understand it, but… I, I feel like I’ve got enough of an understanding here also I have hypothyroidism, I have Hashimoto’s disease, so it’s, it’s a little close to my heart here.
It’s, it’s complicated, but also not, you know, it’s a little of this, it’s a little of that. I’m trying to stay on the not complicated side of things. We’re going to, like, take a little bit of a left turn to Complicated Alley and then right back out. Okay. We’ll get, we’ll get you right out of there. But this is pretty common.
Yes. Which is why we wanted to talk about this because there are people, a lot of people that struggle with this and a lot of times we find it in lactation. Absolutely. So one in eight women will experience this in their lifetime, which is significantly more than men. And partially that’s because women are more likely to have autoimmune diseases, and this is often linked to an autoimmune disease called Hashimoto’s.
In addition, Having a baby can trigger this. Okay, so. We still live longer though. So we have a condition called postpartum thyroiditis, which I’m going to kind of include in this a little bit because that is sometimes hypothyroidism, but I’m not going to go deep into it because that’s confusing. By the wayside note.
Theo, my son, who’s 10, asked me the other day, Mommy, why do men die faster than women? And I said, what do you mean faster? And he goes, you know, like younger. And I said, Oh, because they’re dumber. My husband started laughing and I said, well, it’s true. And Theo said, what do you mean? And I was like, well, they die in more accidents because they make poor choices.
They drink and drive more. They do a lot more risky behaviors and they eat worse. So they end up with more, you know, more diseases. And but even with it all stacked against us, like more hypothyroidism, more autoimmune, more cardiac disease, more cardiac disease, they still find a way to beat us to the end.
Yeah. True that. Okay. So yeah, on that note, let’s talk about thyroids. As you said, it’s a little booger in your neck. It’s a little butterfly shaped gland, like at the very base of your neck. And if you’ve ever seen anyone with a goiter, like a lump at the bottom of their neck, that’s an inflamed thyroid or a nodule.
I have a small nodule that’s, it doesn’t do anything. It just sits there looming like someday it might grow and try to choke me out. But until that time, we’re just going to watch it. Yeah, mine is slightly palpable sometimes because I have a thyroid disease. Like usually you shouldn’t be able to feel this that significantly when you’re palpating the neck, but sometimes you can and that’s fun.
But anyway, this gland is part of the big hormone game. It secretes hormones that play an important role in Basically, everything in your body is actually how I’m going to summarize that. Particularly, it does affect reproductive processes and lactation. Okay. And my big question, cause I actually didn’t really think about this before.
It was like, why does it affect lactation? Exactly. I kind of knew the very basics and I was like, let me, let me just research this a little more. Cause we all know like, oh yeah, you know, you have a hyperthyroid you’ll make more milk. You know, bada bing, whatever. But, and I was kind of expecting a simple answer.
Well, if you, first of all, back up. Because if you look at the symptoms of hypothyroid, it hits everything. Have you had dry skin, weight gain, hair loss, depression, difficulty sleeping, heat and cold intolerance? Right, and the list goes on like brittle nails. Are you constipated? Right. It’s like everything. It is everything.
And… All of these symptoms have overlap with pregnancy and postpartum norms. Okay. Right. Because like, oh, your reproductive system is also jacked up, too. Right. So you could have, you know, messed up periods. So being really tired and having skin changes and blah, blah, blah. This is why thyroid issues go undiagnosed a lot of the time in pregnancy and postpartum.
And because for a lot of people, their You know, these little things are like, Oh, it’s an inconvenience I shouldn’t really complain about. I don’t need to go to the doctor because I’m a little bit tired and my hair is kind of thin, you know? You’re like, it’s dry skin, but it is February. Right, and, you know, I almost didn’t go to any provider about mine in my last pregnancy because I was like, wow, I’m so freaking exhausted all the time.
Maybe it’s because I can’t stop vomiting. You know, that’s definitely why. And then I’m depressed. Maybe it’s my hormones. Yeah. And I eventually asked. An NP friend of mine to run some labs for me, and I was like, can you just run my thyroid labs? Like, I just, I don’t really think it’s that, but maybe it is, and I came back and she was like it’s probably that.
You’re like, so, it’s a shit show in there. It wasn’t actually that much of a shit show then, but it just continued. To become one. And then I actually, on top of it, experienced postpartum thyroiditis, where my thyroid went from like a little bit shitty to absolutely fubar in the postpartum. Fubar? Yeah, fucked up beyond repair.
What? Why have I never heard that? I don’t know. Oh, that’s ridiculous. By the way, she looked me dead in the face when she said that with her, her thumb and pointer finger put together. She said, FUBAR.
And I was I thought that was like a well-known term. I’m so cool now. It may not be though. Okay. Anyway, so, so yeah, I, I felt like I understood this until I looked into it, and now I feel like I don’t. You know how that happens, so let’s talk about it. Okay. So how does the thyroid affect lactation? I’m just gonna focus on that.
Alright, so here, one thing is that we know that the thyroid hormones T4 and T3, right, we have T4, T3, and TSH, which is the thyroid stimulating hormone. T4 and T3 have a positive effect on milk secretion. So when they’re at normal levels, we see better milk production. So, T4 and T3, this is our 9th grade biology, so follow me raise the activity of this enzyme called adenylate cyclase.
You got it. Okay. And so this enzyme catalyzes the conversion of ATP. Do you guys remember ATP? That’s energy. Mm hmm. Yeah, ATP is the energy carrying molecule of the cell. And so it helps that convert to C AMP. C A M P, but I think we say it’s C AMP, and C AMP is like a messenger that helps to regulate cell function.
Okay, so these are really important to make the cells in our body just like do what they’re supposed to. So like without C AMP, like every cell in the body, all the cells just have ADHD and they’re like, what should we do? They just don’t do what they’re, what they’re supposed to. So, you know, this amount of T4 and T3, 3 raises that enzyme activity and it raises the amount of that C amp, okay, particularly in the tissue of the mammary gland.
Oh. Oh. Right? So, these thyroid hormones give those cells in your breasts more energy and better communication. Okay! So, this C AMP content is at its maximum at the end of pregnancy and then it progressively falls during lactation. So, like, when we’re building up to lactogenesis, right? Which makes sense.
It’s like there’s a little dictator in there going, Does everybody understand their assignment? Okay! Right. Pull it together. Here’s all your energy cards. You’re going to cash these in as soon as that placenta comes out. And then by like nine, 10 months postpartum, they’re like, we don’t care anymore about this job.
Exactly. And so when we have less and the, sorry, C AMP stands for cyclic adenosine monophosphate, just by the way. Anyway, so when we see the, the changes in that C AMP content has a very strong relation. to the adaptability of the mammary gland and its responsiveness to hormones. Oh, so that’s why those people that try to power pump, it does nothing for.
Right. So if we don’t have this ATP converting to C AMP, our cells in our breasts just are like, I’m sorry, prolactin? Who’s that? Don’t care about her, you know? They just don’t care. They’re like fingers in their ears. They’re like, la la la, I can’t hear you. They’re like Daria. I’m just like, oh, never mind.
Yeah, so that’s one side of the picture is cellular. The other side, we’re going to look at hormones. So thyroid hormones are also very closely tied to Basically every reproductive hormone that we have, just all of them. So they indirectly affect the synthesis, secretion, and action of all of those hormones, because why not?
And, both, they both regulate those hormones and are regulated by those hormones. It’s all loops, guys. It’s, it’s, you know, I read a couple of papers about this where I was like, wow, I hate how tied up this is. These are together because I hate, I hate that for me. It’s like every loop in the body is a closed loop.
It is. Yeah. And the pituitary gland, the hypothalamus and the thyroid are just in constant, like, chatter with each other in several directions. Okay. So it’s not fun if your thyroid is just out of that game and it just steps out and it’s like, peace out, friends. Have fun without me. Because that’s what hypothyroidism is.
It’s just like your T4 and your T3 are dropping, your TSH is really high because it’s like hello, we have to stimulate this thyroid and then nothing is happening. It’s like your thyroid is constantly getting defibrillated and it just won’t, it just won’t live. Right. So. You know, that’s why now I can see why when your thyroid is interrupted, everything else gets messed up.
And that’s just looking at reproductive stuff, right? That’s not even looking at any other bodily function that is also affected by the thyroid. Turns out it’s really important. Well, darn it. Yeah. So anyway, that’s what’s happening in my body all the time, and I don’t like that. So anyway, in conclusion, when the thyroid doesn’t function well…
It can both change your baseline hormonal levels that support lactation and the functioning of the mammary glands at a cellular level. And so, let me just clarify something and you can tell me if I’m right. So, your thyroid can develop insults. Many different ways. So one of which is pregnancy, where pregnancy just destroys it for whatever reason.
Then there’s the autoimmune, where your body starts attacking it. And then there’s environmental, where it could be like, you know, some kind of toxin that attacks it or something like that, right? Yep. Iodine plays a big role. Iodine does. In that. So if you are only eating kosher salt, you might want to get some iodine somewhere else.
Yeah. And what am I missing? Surgical, so if you, if you do have a nodule and they have to remove it, there’s a chance that it’s damaged in the surgery. I don’t know what other causes might be other than some people just get diagnosed with this seemingly out of the blue, you know. Yeah, so it’s genetic. So it used to be, and this is, this is how we learned it in school, and it’s not right and it makes me mad, but fair fat and 40, if they have fair skin, if they’re overweight, and if they’re 40 years old, they’re at risk for hypothyroidism, where it just kind of like shits out after a while.
Yeah, it’s so I feel like the very interesting part of my particular medical history is that my mother developed hypothyroidism when she was pregnant with me, her second child. And that is also when I developed hypothyroidism in my second pregnancy. Well, good. We found the one thing you and your mom have in common.
Which is, unfortunately, I have her crap ass thyroid. Thanks, Mom! Although she was never diagnosed with Hashimoto’s, and I don’t know if that’s simply because, like, It just wasn’t a thing then and no one has cared since, because it doesn’t matter for her treatment, I guess? Or, it isn’t the cause of her thyroid issue?
I have no idea. I don’t know. She may never know. We don’t really talk much though, so I’m not, just not really sure. Well, you can bond over your shitty thyroids. Absolutely, but I, I had called my sister when she was pregnant and I was like make sure you get your thyroid levels checked in this pregnancy and then also postpartum and then also if you have another pregnancy, okay?
She was like, alright, noted. Alright, we’re gonna take a little break, breaky break, and then we’ll be right back to talk more about things like diagnosis and treatment and how we manage this to support breastfeeding.
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Okay, so let’s talk about how we diagnose this and I can tell you kind of what I’m looking at whenever a patient comes in, especially with low milk supply. So for example, I had a patient who I’d been seeing for a while and we were beyond the two week postpartum. point where, you know, we’re at peak exhaustion.
Baby blues are kind of like, you know, we’re out of that realm of baby blues where it might be moving into more like postpartum depression, anxiety stuff. You know, so those initial two weeks, it’s like really hard to differentiate. One diagnosis from another. But as time went on, and I saw that her milk supply wasn’t responding to the things that she was doing with the pump, that her depression was getting worse, not better, that her fatigue was getting worse, not better, that every time we talked about a potential plan to increase milk supply, I could see the look on her face where she was like, I don’t have it in me.
Disconnecting from it. I don’t have it in me to do this. And also brain fog. So that’s the other thing. I was just gonna ask. Yeah, brain fog is a really interesting symptom because it’s so… Hard. To differentiate between, like, brain fog from a disease versus you’re just not sleeping enough because you have a baby.
Right, right. And so the way I kind of differentiate it or explain it to patients is, can you do simple addition? Like, if you needed to balance your checkbook, or like, leave a tip, could you… Math. Could you math one plus four? And they’re like, the math ain’t mathing, girl. Yeah, and I’m not talking like they can’t remember the name of a fork, because that’s pretty common, postpartum, where we lose words for things.
But if your brain is like, sloooow. It truly feels like that, you know. That was definitely one of the things that made me want to get my labs checked because I had experienced depression before and exhaustion and fatigue and never felt like it affected my mental capacity as much as my thyroid being jacked up does, you know, and I would, you know, and I was pregnant, right?
So I was like, Oh, my brain’s just not working great. But I would like stare at my chart and just be like, Nothing’s in my brain. Yeah. I don’t know. Don’t know what to type there. Or like repetitive things that you’ve done forever that should be second nature is no longer second nature. Where you’re going to get in the shower and you’re like, wait, do I shampoo first?
Do I turn the hot water first or the cold? Yeah. And you’re just like, man, this is really. I am not okay. And you know, the other symptoms kind of reveal themselves like constipation, pretty common postpartum because of pelvic floor stuff, lack and pregnancy, lack of sex drive. Well, duh, you just had a kid, dude, the hair loss kills me.
The hair loss. We expect it. We’re like, we expect it in the postpartum. Yeah. But the hair loss from this, we don’t see in like one big flush. It’s like continual and it patches not just in the front, but like. All over. So the reason why lactation consultants are so key here is because the milk supply is the one thing that really, really, truly stands out when they’re doing all the things, when they’ve had the prenatals with you, when they’ve done everything they can do to set themselves up for lactation success and their body is not responding.
There’s something going on in the body. Did they lose too much blood? Or is there thyroid crapping out? Like, either way, we’re running labs to figure out what’s going on. Yes, absolutely we are. And, you know, most commonly we’re going to see this hypothyroidism whether from Hashimoto’s or it’s a genetic issue or something.
Sometimes, though, we’re going to see a little bit more complicated sequelae of events in postpartum thyroid dysfunction or thyroiditis. And this can be like a number of diseases, but I just want to touch on it a little bit because for about 20 percent of folks that experience this, it becomes chronic hypothyroidism, and it can severely affect your milk production in those first few weeks too.
So, we have a couple types, like Sheehan syndrome is part of this too Graves disease, you know. And it’s a much smaller percentage of people, about 5 7 percent of folks will experience this in the postpartum. But it can begin actually with hyperthyroid symptoms and then progress to hypothyroid symptoms.
So it can be more difficult to diagnose because we have like these really big range of what’s going on. You’re at a greater risk if you’ve had diabetes or if you smoke. And, you know, again, like, We’re, we’re having these symptoms that could just be anybody’s postpartum symptoms. So we just want to be on the lookout and taking labs whenever we’re suspicious of that.
And let me just say that the ranges of normal can vary greatly. But what I’m looking for, because I have a much narrower range, When I’m looking at symptoms, especially for milk production for milk production, so I’m looking at a TSH. I want to see it between 0. 5 to 1. 5. And so most traditional ranges, if it goes up to five, you’re good.
If it’s above five, it’s too much, right? And I’m like, so for me, it’s a much tighter window. If somebody is like a 2. 85 TSH, I’m like, no, that’s hypo. I don’t know if you’re, you’re clinical, but you’re, you’re symptomatic, you know? So like, yeah, look at that. And that’s really challenging too, because we have some people who we would call subclinical.
Where their labs look totally frickin fine, but they’re symptomatic or vice versa. We’re just like, these aren’t, this isn’t the classical picture that we’re seeing. And so you really do have to have a provider who’s looking at that whole picture in order to get the help that you need. You know, like my…
My initial labs with this were like, Eh, on the edge of normal, and I was like, Yeah, but like, look at all these symptoms I have. Like, could this explain it? And that’s when we run the antibodies. Exactly, and my TPO antibodies were like, through the roof. Yeah, I mean, because your body is also still young.
Like, you’re a childbearing age person, so it’s gonna try to compensate. So, you might have an underlying autoimmune disorder, and your TSH labs might look like, okay. You know, not perfect, but okay. But if you’re symptomatic and it just does not feel right, get the TPO antibodies done. You probably have enough diagnoses to list on there that your insurance will pay for it.
Plus you just had a baby, so it should be covered. And yeah, I’ve seen that before too, where you’re just like, holy crap, this thing was through the roof. Thank God we caught it. Yeah, exactly. You know, and for a lot of people, When we start treating this, we do have success in fixing their milk supply, but I have to say that’s not everybody.
And so I do want to talk a little bit about like management and support while breastfeeding because you know, we kind of have the two pictures, one where we have preexisting thyroid disease and we’re like, okay, we already know this is a challenge that we’re facing. So we’re going to treat your Postpartum a little bit differently from everybody else’s and we’re going to be taking your thyroid labs more commonly in pregnancy and postpartum Than we would otherwise for you.
Mm hmm, you know, like I think I did my monthly for a while But can I say that in my patients that I have? Worked with the people that already know that they have an issue with their thyroid that are stable on medication when they get pregnant They don’t usually have an issue. Yes, and that’s the key if you’re stable on medication The problem for a lot of people postpartum is that they that changes?
Mm hmm Well, they’re getting they are already in with an endocrinologist though And that’s the thing like a lot of my patients that we find it. They can’t get in for months And so I’m left there being like, okay, I guess I’ll start you on a spit of Synthroid because I can’t leave you like this. But you know, then dosing that is really tricky.
It can be. Yeah, it can be. You know, and you just kind of have to like dose and then get labs and then dosing. And you’re like, oh, is it, is it working? But like six weeks is a long time to wait. And that’s why I don’t, I’ll usually go ahead and do it, you know, with obviously consent of the patient and like talking through it with them and be like, I am not an endocrinologist, but I can math and your labs are crap.
And a lot of people do manage thyroid disorders just with their GP to if they’re responsive to medication, you know, so I think it is a really good idea to get that addressed as soon as possible. And, you know, Because if, if you’ve got low milk supply chronically for six weeks, and then we get your thyroid on board, it might be too late to totally build you up to a full supply, you know?
And I hate to say that. It’s like, it breaks my heart to be like, we might not fix that. And so I do always want to, like, when we come up with that diagnosis, when we sit people down, I’m pretty realistic about it. I’m like, hey. Yes, we found the cause of your low milk supply, most likely. However, we might not be able to fix it that soon, right?
Like we’re going to get you in with the appropriate doctors and the appropriate medications and whatever. However, like it’s going to be a minimum of a few weeks until we even get your, we have a hope of getting your levels at the right place, you know? Yes. And I feel like when we treat with Synthroid or Nature Thyroid or Armor Thyroid or something like that and we get you feeling a little bit better, you’re usually in a much better mental place to work through the next step.
And I will say, like, in my personal experience, I mentally felt better two weeks after getting on meds. I had to start at a pretty high dose. And my, my doctor was like, we can start you at a low dose and work it up. But like, I’m pretty positive this is not going to be enough for you. You know, like, so do you just want to start at the high one?
I was like, sure, whatever. So the first week was a little crazy. I was like, whew, this is different. I have so much energy. It just, it actually just really raised my anxiety level. Which happens to a lot of people because you’re, Blood pressure and heart rate are very responsive to thyroid hormones. So having your heart rate increase and your, you know, your sweating increase and all that makes like that all triggers anxiety.
So that could happen. Right. So that’s another added layer of like, Oh, now, now you have extra anxiety on top. I remember you during that time, I’m sure everybody’s listened to the podcast this whole time. Also remember she was a vibe. Yeah, I’m good now. But you know, like personally, it took me like eight or nine months to get to a point where I was stable on medication, you know, and it didn’t overly affect my milk supply, which is always an interesting thing.
Like I have seen people whose thyroid labs are terrible and their milk supply is fine. And other folks who it’s just out of range and they’re making no milk. But also you had the baby that was nursing appropriately from the beginning and it wasn’t your first baby. You know, if you have a thyroid issue and you get the baby that won’t latch right away or is jaundice or 36 weaker or something like that, and it’s your first, you’re already at a disadvantage for building those receptors on your glandular tissue.
And you know, that’s time sensitive. You know, you can’t, you can’t do much about that. Like you said. And that’s why, like, if we know this is a problem, we are truly going to focus on optimal milk removal and stimulation, right? Like, that is… One of the only things within our control that we can do to positively affect your milk supply.
So, you know, just like anybody else, or we’re like, hey, you have a risk factor for low milk supply. So let’s really focus on, you know, making sure that your baby is feeding effectively and often within the first two weeks. And we’re not, you know, letting them sleep too long. We’re not saying, okay, you know, it’s fine that they’re not feeding well.
We’ll just give them some formula and skip a feed. Like, you know, those things might impact you a lot more if you have a thyroid issue. But I think also you can still make the choice to do that, but it’s consented choice where you’re like, okay, like I understand the risks of this and I’m still going to do it.
Right. And you know, for folks in this situation, sometimes I’ve also been like, all right, we’re going to do that and like maybe work with some galactagogues. I’ve seen the oxytocin nasal spray recommended, but more than anything, I’m just like frequent feeds, frequent pumps, whatever we need to do to get that milk out is, is going to be a real game changer here.
And we’re also doing medication . Mm-Hmm. . So, you know, it’s like we have this two-pronged approach and the medications, every medication I’ve ever seen for hypothyroidism is safe for breastfeeding. Yep. Not true for hyperthyroidism. Right. So that is a different episode. We won’t do some other time. That’s actually harder to treat.
It is. But for hypothyroidism, we’re essentially just replacing your natural thyroid hormones with either a synthetically made one like levothyroxine or. Like a desiccated animal thyroid like the Nature Thyroid or whatever. I don’t think they make Nature Thyroid anymore. It’s something else now.
Armor Thyroid. Yeah. One note, though, is that some people need to have, like, radioactive tests and treatments done with, like, severe thyroid issues, so you, like, might, you know, some people want to delay those or, you know, whatever, but definitely make sure you’re looking into, like, the safety of those procedures during breastfeeding.
A lot of the time that contrast dye is totally safe to breastfeed right after, you just would want to double check. I think also, let me just add that a lot of times. Your stress level is really high because we might be seeing frequent pediatric visits for weight gain issues. Yes, those are the most stressful thing.
Oh my God. Yeah. And so… You put that baby on the scale, you’re like, don’t even tell me what that’s… Well, and a lot of the language that providers use during those visits make it feel very much like it’s your fault. And… It sucks to then find out that it is your body. Yeah. And so we have to kind of go through a grieving process there.
And, you know, you don’t want to have to wait three months for an endocrinologist to come in and not be super warm and fuzzy, most likely. So lactation consultants, if you’re listening out there, like understand that you might be that person that helps them grieve. Yeah. The fact that like, oh no, my body is a little bit broken because of whatever, whatever, whatever.
And. It’s okay and we’ll fix it and we’re going to do the best we can to make this better. But that knowledge actually comes with a lot of power because at least you can get off that crazy train of like triple feeding or whatever. You can make a better decision for infant weight gain and milk supply.
Yeah and, and I really, I, I do like to be Kindly honest with folks about this, because I don’t want to have somebody triple feeding for six months, you know, when realistically, if I had just said, Hey, like, you know, at this point, I’m not sure that we’re going to build your milk supply more. How would you feel about, you know, doing formula for this portion of feeds and then breastfeeding for this one or whatever, like having that conversation five months earlier could really save your mental health.
And save you a lot of time and suffering sometimes. So I, I think it’s I think it’s good as a patient to say, Hey, like, what do you see the trajectory of this being like, do you do you feel like we’re at a point where we could really build milk supply if I get my like hormones under control with some medication?
Or do you feel like that’s not realistic in this situation? That’s a hard conversation. It is, but it’s so important, but also the hardest part is making the decision because usually what I’ve seen is after we make that decision together and they take that pressure off their shoulders, they’re like, Oh my God, this is so much better.
Even if it’s one bottle of formula a day, you can just see it. The next time I see them, they’re like, I’m actually totally fine with this. And they’re like, I was feeling very let down about myself, I was feeling mad at my body, but it turns out nothing bad happened when I added one bottle of formula, I’m able to maintain at 20 ounces of breast milk a day, and one bottle of formula, and we’re good to go, and I’m happy, and blah blah blah, and I’m like, great, move on.
Yeah, absolutely, yeah, so it’s I don’t know. I, I just really want all of my other Hashimoto’s babes out there to know that they’re not alone. Hashimoto’s babes! And, you know, that this is a very common problem. We forgot to mention the hair growth on the chin. I don’t have that. No. But a lot of people do. Huh.
Yeah, hair stops growing where you want it to, starts growing where you don’t. It’s just that’s what it is. It’s a really weird time. I still have too thin hair. Like, even with my hormones, like, at the right level. I still have hair loss and it just is what it is, I guess. I don’t know. Getting, getting older, bud.
That’s what we’re doing. I, yeah, my, my head’s just like, what if you just didn’t now? How about, how about not? My hair is so voluptuous right now from this pregnancy, I am already sad that it’s gonna all fall out. I’m nervous for you. Me too. We’re gonna have to shave my head again. It’s okay, I’ll shave with you, you know?
We’ll just do it together. Oh my god. Sounds good. We’ll get some really nice wigs. How about that? That sounds fabulous. I actually saw a super sweet story, Heather, where this, this woman and her son, she had cancer and her son grew his hair out to make a wig for her. And it looked so good. It was like the perfect color.
You know, it was like they had the same hair color and the same hair type and he basically made her a custom wig. That’s so sweet. Theo would do that for me. Griffin would not cut his hair for me. Well, Griffin has the hair of an angel, so. Griffin just… Like, I, I feel like he has, like, the hair that every woman wants.
Truly. It’s like, so beautiful. And he takes such bad care of it. Yeah. Like, dude, there’s a literal stick in your hair. Like, it’s like matted into your hair. I brushed your hair yesterday. He’s like, yeah, yesterday. Yeah, that was a whole day ago, mom. What did you do? Oh my gosh. All right. Well, what do we do as far as reminders for breastfeeding for people that are struggling with hypothyroid or might be okay, so We’re going to remind you about cues of effective feeding so you know how to monitor your own situation, right?
So, we’re looking at poops and pees for baby, we’re hearing them gulp and swallow while they feed, and you’re feeling breast changes, right? More full, less full as baby feeds and whatnot. You know, if you need to take baby’s weight more often, you can just go for weight checks at the doctor. It doesn’t have to be a full appointment or at your lactation consultant or whomever.
We’re gonna take your damn thyroid medication every day. Every single day, friends. And I say this with vehemence, because I do not! And I… You know how I know that I’ve been bad about taking it? Is that the pharmacy calls to tell me it’s time for refill and I have like two weeks left. Maureen. I get like 90 day supplies and I’m like, Bad girl.
You’re going to get kicked out of the Hashimoto’s Babes Club. Oh goodness, and we’re going in for our labs when we’re supposed to, so put reminders on your phone, put it on your calendar, yeah, and we’re just going to keep that up. Alright, well I hope this was helpful for you all. I think it was. There was at least one person out there that was like, I’m going to get my thyroid checked.
I think this is what’s going on with me. Go give them some blood, friends. Yeah, it’s just a little, just a little, just a little bit of blood. Yeah. Not too much. Not too much. It’s not. Alright, good. Well, let’s take a break. And when we come back, we’re going to give an award to a friend.
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Alright, welcome back everybody. I have a really fun award to give today. Okay, let’s hear it. Who’s getting an award? Alright, this award goes to Sarah Woods. The brave new employee at Breastfeeding for Busy Moms. She is a family nurse practitioner who is going to be offering women’s health care to our moms.
So if you are a patient of ours and you want to continue seeing us for birth control pap smears, problem visits, sick visits, my vagina itches, you know, I need my Zoloft refilled. Yeah. We have now a person for you. I love that. Yeah. Well, it can’t be me. No, and, and honestly, it’s like we have enough places to be going, you know, that we’re not making appointments for ourselves.
They’re for baby. So, so it’d be great if, you know, when I made my lactation appointment, you had said, Hey, do you need an appointment for anything? And you could say, actually, could I just. Yeah. After that, could I go see Sarah? Yeah, exactly. To get my pap. Yeah. Haven’t had that done or I need my next one. I can’t remember the last time I had a pap.
Maybe I’ll come get one. Maybe you should. And Sarah is also still breastfeeding her 15 month old. So she, she mentioned that in her interview. I was like, so breastfeeding. Are you like? familiar with that and she’s like, still doing it. Perfect candidate for the job. It’s her second baby and she’s still nursing and she’s just cute as pie.
And I was like, welcome to the, the wild west over here. When is she starting? January. Oh, good. Well, make me a pap appointment. I’ll be your first. You’ll be the first one. We’re getting her all set up. So as soon as credentialing and all that goes through, we’ll be able to take all the insurance and, you know, be a lot more full service.
Well, should we give her the Brave New World Award? The Brave New World Award. Yes. Sarah, thank you so much for taking a chance on us at Breastfeeding for Busy Moms. And I think that means we’re going to rebrand a little bit and we’re going to be… Busy Moms Healthcare. Oh, I love that. I love it. And so then we’re going to have Busy Moms Women’s Health, or…
How do you always drop this stuff on mute? You don’t like never tell me when we’re not recording. You’re always like, Oh, just FYI, big life change. It’s fine. It’s fine. I don’t know why. It’s just… Hahaha. How I roll, you can ever text me and be like, I’m changing the name of my entire business. You’re like, what if I said it on air to thousands of people?
Well, because I’ve been afraid to do it because it’s daunting. So now that I’ve put it out there, now I have to do it. Yeah. So yeah. Can you just add it as a trade name? Something like that. Something like that. So then it’ll be less paperwork and then you can just change your sign. Yeah, yeah. Pretty much.
Yeah, the parent company will be Busy Moms Healthcare and then we’ll have different arms of it. Love that. That are like a DBA. Doing business as. Doing business as. Blah, blah, blah, blah. So whatever the Secretary of State tells me to do with that, that’s what I’ll do. Whatever they tell me to do is what I do at this point.
They send me things in the mail, I fill them out, I don’t know what they mean, I send them back, all is well. That’s how I feel like it happens. I know none of it. Oh, we’re fine. We’re totally qualified to start businesses. We’re super qualified. And so are you at home, you busy, busy parents. I thought you were going to say, you busy bitches.
Maybe we should have said that. Maybe we should. That’s what we meant. I’m going to go have this baby now, please. Goodbye, everybody. Hey, you know what you should do actually before you go? You should please join our Patreon, okay? Because Heather’s about to have this baby. She’s about to take an unpaid maternity leave.
We got a mouth to feed. So consider this part of her maternity leave fund and go over to Patreon. com slash milk minute podcast. Join our Patreon. You will get first dibs on the birth story. Okay? All right, so go do it. Go do it. Bye. Bye.
