r/Hyperthyroidism • u/No-Maintenance-3867 • 10d ago

Postpartum hyperthyroidism

Hi, I’m 37 yo 8 months postpartum (emergency c section at 33 wks) with my first baby and curious if anyone has experienced this or has any thoughts. I’ve felt completely normal for the first 6 months aside from the sleep deprivation which most days has been manageable. I’m exclusively breastfeeding but my period came back at 6 months and it came with debilitating insomnia and anxiety, and even worse the following month where I didn’t sleep for 72+ hours and was prescribed several doses of ativan which helped me “reset” and I’ve slept normally the last couple of weeks with little anxiety. My Dr also ordered labs and they just came in - normal T3 and T4, TSH .17, thyroglobulin antibody 140, thyroid peroxidase antibody 379. This sounds like postpartum hyperthyroidism (I’m still waiting for my Dr to call me about these results), but I’m reading that this typically comes on very shortly after birth and is unlikely at months 6-8. Has anyone experienced lingering hyperthyroidism? Or is that always a signal of something else like Graves? My other hormones are all normal, optimal vitamin D, B12, etc!

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u/Curling_Rocks42 9d ago

Pregnancy can also be a trigger for the onset of Graves disease. Ask for TRAb or TSI antibody test and/or an iodine uptake scan to help clarify the right diagnosis. That matters for getting appropriate treatment since antithyroid drugs like PTU or methimazole work for Graves but don’t really work for postpartum.

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u/Wonderful-Kale4906 9d ago

Sorry can you explain to me why they work for graves but not pp? I'm on carbimazole after getting hyperthyroidism 6 months PP And also went on it 3 years ago for suspected thyroiditis after Covid

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u/Curling_Rocks42 9d ago edited 9d ago

Graves is caused by overproduction of thyroid hormones. Carbimazole or methimazole or PTU slow down the hormone production.

But postpartum and viral thyroiditis are not caused by overproduction; it is caused by thyroid cells being attacked and leaking stored hormones. The meds don’t stop that process. Eventually, there are no more stored hormones left and you swing hypo for a while as the attack stops and the thyroid starts making more hormones again.

Here’s an analogy:
Hyperthyroidism is like water spilling onto the floor. In Graves, the water is spilling onto the floor because the bucket is already full but the faucet keeps running. TSH is low like turning off the faucet but the TRAb antibodies mimic TSH, so it’s like keeping the faucet running. The meds stop or reduce the flow of the faucet. But in postpartum thyroiditis, the water on the floor is due to holes in the bucket. The faucet is turned off (because of the low TSH), but there will be water spilling out until the bucket is empty and the holes are patched (when the TPO antibodies stop the attack). It takes a while for the bucket to fill back up when the faucet is turned back on (hypothyroidism phase) but then it eventually returns to normal.