Post-partum, breastfeeding, and thyroid levels

[SilverMoon010]

My baby is just about 3 weeks old.  I have hypothyroidism and the last time I had my levels checked was 36 weeks pregnant.  My levels were fine at that time.  I am hearing all different things from different people. I had a hospital birth and one lactation consultant told me to get my levels checked within a week of delivering my baby, another one told me 3 months afterwards.  I just called my endo and he told me to come in mid-March to get my levels checked.  I feel like mid-March is too long to wait because I know the medication (I take Armour Thyroid) passes through the breast milk and if your levels are off, I would assume the baby is getting that too.  (I've tried researching this but am unsure what that actually means for my baby.) I also know that it can affect your milk supply as well but so far I don't seem to have that issue so I'm assuming my levels are okay (for now anyway).

Anyway, for those who have hypothyroidism, are breastfeeding, and are on medication, when did you get your levels checked after delivery, and were they off by a lot?

Edited by SilverMoon010 - 2/20/12 at 10:19am

[LittleBirdy]

I had mine checked at about 7 weeks PP.  My TSH was a little lower than it had been during pregnancy, but still within an acceptable range - no medication adjustment was need.  (I also take Armour thyroid.)

I would think at 1 week PP ALL of your hormone levels are adjusting, so it would seem like you might get false results at that point?  This is just a guess though, I haven't done any research on it or anything.

[SilverMoon010]

Originally Posted by LittleBirdy 

I had mine checked at about 7 weeks PP.  My TSH was a little lower than it had been during pregnancy, but still within an acceptable range - no medication adjustment was need.  (I also take Armour thyroid.)

I would think at 1 week PP ALL of your hormone levels are adjusting, so it would seem like you might get false results at that point?  This is just a guess though, I haven't done any research on it or anything.

I agree.  I thought one week sounded too soon too.  I think when I go back to my OGBYN for my postpartum visit at 6 weeks, I will have them draw my blood work then to see where my levels are.  I'm afraid getting tested any sooner would reveal false results.

[ThankfulMama]

My endo drops me down to my pre-pregnancy dose of synthroid after I deliver (without bloodwork first) and then I am to go in 4 weeks later for bloodwork.  If you are feeling off I would ask for bloodwork sooner to be sure.  Otherwise I think you should be OK.

[UrbanMamma]

My thyroid disease started after baby number 1, so I have no experience adjusting levels immediately post-partum.

That said, I've never read (and I've done extensive research professionally and personally on this) that excess amounts of thyroid hormone from Armour (or Levothyroxine) would show up in breast-milk if overdosed.  Any references for that?

As a metabolic hormone on the endocrine system (which also includes prolactin), an off level can affect supply (the only time I've struggled with supply is when my TSH is high) BUT I'm not thinking it would transfer in great amounts.  Also, I'm not sure you are putting baby in danger as baby's own thyroid is up and running towards the middle/end of the 2nd trimester and theoretically should be able to adjust its own supply of hormone (from its own body or the tiny bit from your milk).

I've heard of endos dropping immediately down to pre-pregnancy dose upon delivery and of endos waiting a couple of weeks. T4 has a half life that makes tracking relatively small dosage changes almost impossible in less than 30 days (that is why we always are told 4-6 weeks after a change in dosage for a check).  With that in mind, I am going to push for a 12% decrease (one dosage level) immediately after delivery to split the difference between prepregnancy and final pregnancy dose with testing 4 weeks out, adjustment if needed, and testing another 6 weeks after that.  I also know that too high of a dose makes *me* feel very anxious and amplifies PPD and would call for an earlier lab if I felt that way.

Your mileage may vary.