Breastfeeding and Thyroid Problems: FAQ

When you have low thyroid levels in your body, it might be difficult for you to produce enough milk for your baby. Without enough milk supply, your baby might experience poor weight gain and low energy. ATD which are used today include propylthiouracil (PTU), carbimazole (CMZ) and methimazole (MMI) 6. PTU is about 80% protein bound, while MMI is non-protein bound and more lipid soluble 7.

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Treatment of overt hypothyroidism is always recommended during pregnancy, and therapy is also recommended for subclinical hypothyroidism in TPOAb-positive women. The guidelines note that the recommended treatment is oral levothyroxine; combination therapy using T3 or desiccated thyroid is not recommended during pregnancy. Based on the above experimental studies regarding ATD use during lactation, it was suggested that PTU should be preferred over MMI, due to its lower concentration in milk 14. In 1989, the American Academy of Paediatrics listed PTU as a lactation-compatible treatment 15. At that time, PTU had already been considered as the first-line treatment in postpartum GH.

Thyroid use while Breastfeeding

• A procedure called a fine needle aspiration may be recommended to assess potential malignancy.
• Your milk supply could go down a bit if you miss any nursings, so try to pump if you miss any feedings.
• In the case of drug transfer from maternal plasma to milk, the physiochemical properties and concentrations of a pharmaceutical agent are not always translated into clinically significant consequences affecting the newborn.
• You don’t want your body reacting to your growing baby as a foreign invader!
• To test postpartum thyroiditis, doctors may use radioactive iodine, which isn’t safe for pregnant and breastfeeding women.

A blood test can confirm the presence of antibodies (TRAb) that cause Graves’ disease, and an ultrasound can identify the presence of nodules. Although a radioactive iodine uptake & scan can distinguish between Graves’ disease and other causes of thyrotoxicosis, this procedure is not recommended during pregnancy. Thyroid dysfunction is a potential factor in infertility, possibly due to irregular menstrual cycles. The new guidelines recommend TSH testing for all women seeking treatment for infertility, with levothyroxine recommended for cases of overt hypothyroidism. Low-dose levothyroxine therapy “may be considered” in women who are using assisted reproductive techniques and test positive for thyroid peroxidase antibodies (TPOAbs), which are often present in Hashimoto’s thyroiditis. This treatment is done using radioactive iodine (I-131), but in much larger doses than used for a diagnostic scan.

Carbimazole (Neomercazole®) reaches sub-clinical levels in infants exposed to less than 30milligrammes a day through their mother’s breastmilk. If this drug is used monitoring of the infant’s thyroid function is recommended but not always essential. A mother with an overactive thyroid gland produces raised levels of levothyroxine and will experience symptoms which may include tachycardia (increased heart rate), sweating, heat intolerance and loss of body weight.

Related treatment guides

Hence, a compound that is considered minimally excreted in breast milk compared to another could be harmful in certain circumstances. These additional parameters are not easily incorporated into existing in vitro risk-predicting models. New models that offer a more holistic approach of these issues are under investigation, but further studies are still required for their validation in the general population 4. Previous experimental studies assessed the excretion of ATD into human milk 10,11. In most of these studies, the mean serum PTU concentration synthroid actonel after oral ingestion in thyrotoxic lactating women was compared with the mean total amount of PTU excreted in human milk.

• Technetium-99m has a very short half-life (6.02 hours, compared to 8.1 days for I-131).
• It provides multiple advantages for the mental and physical development of the infant and is also implicated in the reduction of the development of several diseases in adulthood 3.
• The guidelines were reviewed in advance and endorsed by a number of medical associations as well as patient groups, including the Graves’ Disease & Thyroid Foundation.
• For papillary thyroid cancer in a woman with stable disease or a diagnosis during the second half of pregnancy, surgery may be delayed until after delivery.
• If this drug is used monitoring of the infant’s thyroid function is recommended but not always essential.

The amount of time suggested for suspending breastfeeding varies depending on the dosage and form of the isotope (there are many forms of Tc-99m). For some tests, breastfeeding can be resumed immediately; for others it is recommended to suspend breastfeeding for amounts of time varying from 6 hours to 48 hours. The good news is that the vast majority of women with thyroid dysfunction give birth to healthy infants – and all newborns in the U.S.A. are automatically screened for thyroid dysfunction, so that any potential issues can be identified quickly. Moms who are hyperthyroid have elevated thyroid hormone (usually T4) levels. Symptoms include weight loss (despite an increased appetite), nervousness, heart palpitations, insomnia, and a rapid pulse at rest.

If the mother has hypothyroidism, will it affect the baby?

• It’s a bit scary to think of (at least it was for me!), but it doesn’t really hurt at all (about like having blood drawn from your arm) and it just takes a few minutes.
• A study out of Japan has indicated that low-dose ATD therapy following delivery might reduce the risk of relapse, although further studies are needed in this area.
• It is also recommended that iodine levels be monitored and treated, if they are not at appropriate levels.
• Thyroid disease is diagnosed through blood tests that measure the levels of thyroid stimulating hormone (TSH) triisdothyrine (T3)/tetra-iodothyronine (thyroxine or T4).
• Continuing to breastfeed will only benefit your baby, as babies who are artificially fed are at increased risk of developing autoimmune thyroid disease themselves.

For women with severe thyroid illness during pregnancy, the task force recommends establishing a relationship with a neonatologist or pediatrician prior to delivery to ensure seamless care for the newborn. The guidelines recommend that women with overt or subclinical hypothyroidism, as well as those at risk for hypothyroidism, undergo TSH testing every four weeks until mid-pregnancy and at least once near 30 weeks gestation. The new guidelines (updated from a prior edition from 2011) are available free on the website of Thyroid, the official peer-reviewed journal of the ATA, published by Mary Ann Liebert, Inc., publishers. The guidelines were reviewed in advance and endorsed by a number of medical associations as well as patient groups, including the Graves’ Disease & Thyroid Foundation.

Breastfeeding is considered the optimal way of newborn and infant feeding by clinicians and social workers 1,2. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

If antibodies are elevated, the test should be repeated at weeks 18-22. Dealing with overactive nodules during pregnancy is challenging, as treatment with ATDs in the mother can potentially cause hypothyroidism in the fetus. Therefore, the task force recommends using a low dose of ATDs, with the goal of keeping the mother’s Free T4 at or slightly above the reference range.

Thyroid medications

When the thyroid is not functioning correctly, it can impact milk production. There is also connection between thyroid disorders and autoimmune problems. You don’t want your body reacting to your growing baby as a foreign invader! Problems with the thyroid can begin before or during pregnancy, in the postpartum period, or later in life. They can also occur along with other medical conditions, which can make diagnosis and treatment more challenging. Thyroid hormones are important for your milk supply, so having a thyroid disease may interfere with its production.