Levothyroxine use while Breastfeeding
If the supplementation is too low, prolactin levels will be affected resulting in a poor milk supply. The correct dose gives a mother the level of levothyroxine of a normal breastfeeding mother. Symptoms of an under active thyroid include gain in body weight, dry skin and hair and tiredness. Follow-up testing will determine if the dose needs to be further adjusted as pregnancy progresses.
THYROID NEWS
Depending on the medication, your baby’s levels may also need to be checked regularly postpartum. I-131 concentrates in breastmilk and high levels in breastmilk can suppress baby’s thyroid function (or even destroy the thyroid) and increase risk of thyroid cancer. Therefore it is important that breastfeeding be discontinued until breastmilk levels are safe (this depends upon the dose and ranges from 8 days to 106+ days). Hale recommends that when I-131 is used, breastmilk samples should be tested with a gamma (radiation) counter before breastfeeding is resumed to ensure that radiation in the milk has returned to safe levels.
- 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.
- (One exception is that women currently being treated with thyroid hormone replacement do not require supplemental iodine).
- This treatment is done using radioactive iodine (I-131), but in much larger doses than used for a diagnostic scan.
- In most of these studies, the mean serum PTU concentration after oral ingestion in thyrotoxic lactating women was compared with the mean total amount of PTU excreted in human milk.
I recall feeling really rotten the first day, but I think I could have nursed just fine as long as someone brought the baby to me. Your milk supply could go down a bit if you miss any nursings, so try to pump if you miss any feedings. The task force also states that administration of micrograms of levothyroxine “may be considered” in women who are TPOAb-positive, but euthyroid, and who have a prior history of pregnancy loss. Make sure to monitor your baby for any changes in behavior or development if you take levothyroxine while breastfeeding.
Under-active thyroid
It is recommended that the mother discontinue breastfeeding several days to weeks before this therapy, and pump and dump milk for several weeks after therapy to reduce exposure of the breast tissue to radiation. The US Nuclear Regulatory Commission recommends complete weaning after I-131 is used therapeutically. The vast majority of thyroid abnormalities are chronic autoimmune diseases, which are found in approximately 5% of new mothers in the general population 5. Hyperthyroidism due to Graves’ disease (GD) can occur during the postpartum period, as a relapse of previous synthroid panic GD or a newly diagnosed case with no apparent thyroid disease background.
The type of thyroid scan I had was a radioactive iodine uptake & thyroid scan. I had to drink some radioactive iodine, then come back later in the day to have the scan (like a x-ray). I had thyroid surgery (a partial thyroidectomy for what turned out to be a benign cold nodule) about a year before my daughter was born, so I was not breastfeeding at the time. As I recall, I was really uncomfortable the day of the surgery, but it got better pretty quickly after that. My neck muscles were sore for weeks – it might take a little creative positioning to help you to breastfeed comfortably. You might want to take a nursing pillow to the hospital to raise baby up so you can see her without moving your head as much, etc.
The thyroid autoantibodies are IgG immunoglobulins, which are too large to pass into breastmilk. Continuing to breastfeed will only benefit your baby, as babies who are artificially fed are at increased risk of developing autoimmune thyroid disease themselves. In conclusion, in our opinion and in the light of these new data regarding PTU hepatoxicity, PTU should not be prescribed for thyrotoxicosis in breastfeeding women.
For women who are currently taking ATDs, antibody testing is recommended at the time pregnancy is confirmed, with a second test at weeks 18-22, and then a third test in weeks if the second test was elevated. Within the first days of an absent or weak menstrual period, women who are taking ATDs are advised to contact their provider to discuss thyroid function testing and potential dose adjustments. Antithyroid medications come with an increased risk of birth defects, although PTU generally has a lower risk than methimazole, and is the recommended medication during the first trimester. Mothers with Graves’ disease who are not taking antithyroid drugs can safely breastfeed.
And if you have low thyroid hormone levels while breastfeeding, you may find that your milk production is either delayed or insufficient. A small percentage of pregnant women experience postpartum thyroiditis, which is a condition when your thyroid gland becomes inflamed after you have a baby. This condition may first cause hyperthyroidism, but over time, it can lead to hypothyroidism.
Steroid injections and Breastfeeding Mothers
Levels secreted into milk are too low to influence tests for neonatal hypothyroidism. If a thyroid nodule in the mother is detected during pregnancy, follow-up will include a detailed family history, ultrasound, and thyroid function testing. A procedure called a fine needle aspiration may be recommended to assess potential malignancy.
Levothyroxine use while Breastfeeding
If a malignancy is identified, surgery will be recommended, although the timing can be affected by the type of cancer. 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. For women with more aggressive forms of cancer, such as medullary carcinoma or anaplastic cancer, the task force notes that surgery should be “strongly considered” during pregnancy. For women with a history of Graves’ who were treated with surgery or RAI, antibody testing is recommended at the time pregnancy is confirmed.