Postpartum mood abnormalities may be a problem with the thyroid gland

  Because she was busy with her career, Ms. Zhang didn’t have a lovely daughter until she was not confused. In the first days after childbirth, Ms. Zhang had a happy and content smile on her face every day, but not long after that, her family found that Ms. Zhang’s mood was a little abnormal, and she was inexplicably angry at every turn, often flustered, irritable, and insomnia. At first, the family thought she was not tired of taking the children to rest at night, so she didn’t take it too seriously. After another few months, Ms. Zhang’s emotions turned like a roller coaster, turning from the previous excitement and anxiety to depression, reluctance, sentimentality, and crying secretly at every turn. The family took Ms. Zhang to the Provincial Mental Health Center for medical treatment. She was diagnosed with “postpartum depression” and prescribed some antidepressant drugs. After taking it for a period of time, her condition did not improve significantly. The family took Ms. Zhang to the endocrinology department for treatment. The doctor asked her about her onset in detail, and noticed that Ms. Zhang’s neck was obviously thickened, so she had her thyroid function and thyroid autoantibodies checked, and she was finally diagnosed as “postpartum thyroiditis (hypothyroidism).” It turned out that her violent temper at the beginning was due to the hyperthyroidism stage of postpartum thyroiditis, while the recent depression was due to postpartum thyroiditis turning into hypothyroidism. After a period of thyroid hormone replacement therapy, Ms. Zhang’s mood finally returned to normal.
   Postpartum thyroiditis is a syndrome of abnormal thyroid function that occurs within one year after delivery. It belongs to a special type of autoimmune thyroiditis and is not uncommon in clinical practice. According to statistics, the incidence of postpartum thyroiditis is 5% to 10%.
   Postpartum thyroiditis clinical manifestations of
   typical cases three clinical experience, that of thyrotoxicosis, hypothyroidism and recovery. Atypical cases can only manifest as thyrotoxicosis or hypothyroidism.
   The thyrotoxic phase occurs 1 to 6 months after delivery (usually 3 months after delivery) and lasts for 1 to 2 months. Maternal manifestations are symptoms such as palpitations, fatigue, fear of heat, and emotional agitation. The cause is that after the thyroid tissue is destroyed by inflammation, thyroid hormone overflows, leading to hyperthyroidism. Examination of the patient at this stage will find that the patient’s serum thyroid hormone (T3, T4) levels increase, and the thyroid iodine uptake rate is significantly reduced. The patient’s thyroid was slightly to moderately enlarged but not tender.
   Hypothyroidism occurs 3 to 8 months after delivery (usually around 6 months after delivery) and lasts for 4 to 6 months. The patient showed symptoms such as fatigue, weakness, moodiness, lethargy, chills, lack of appetite, constipation, and dry skin. The cause is that thyroid hormone synthesis decreases after thyroid follicular epithelial cells are damaged by inflammation. At this stage, the serum thyroid hormone (T3, T4) level of patients decreases, and the level of thyroid-stimulating hormone (TSH) gradually increases.
  The recovery period occurs 6 to 12 months after delivery. Thyroid hormone levels and thyroid iodine uptake rate gradually returned to normal, but nearly 20% of patients showed permanent hypothyroidism.
   Of course, there are also a small number of patients who do not have the typical “three-stage” process described above, but simply manifested as hyperthyroidism or hypothyroidism.
   How to diagnose postpartum thyroiditis?
   Due to people’s insufficient understanding of this disease, it is often missed or misdiagnosed. Clinically, all people who have no history of thyroid disease before pregnancy, have mood disorders, goiter enlargement (but no pain) and other changes within one year after delivery, and laboratory tests show abnormal thyroid function. Thyroid autoantibody test: thyroid peroxidase antibody (TPOAb), Thyroglobulin antibody (TGAb) is positive, and thyroid stimulating receptor antibody (TRAb) is negative, it can be diagnosed as postpartum thyroiditis.
   Why is postpartum thyroiditis easily misdiagnosed?
   Under normal circumstances, after a month of recuperation after delivery, all aspects of the body can basically return to the state before pregnancy. Even if some parturients have symptoms such as tantrums, palpitation, hyperhidrosis, weight loss or drowsiness, depression, cold fear, edema, constipation, etc., they are often regarded by themselves or their family members as poor rest, weakness, malnutrition, and anemia. As a result, some mothers showed obvious depression and were misdiagnosed as postpartum depression. Few people thought that these symptoms would be related to postpartum thyroiditis. Many patients with postpartum thyroiditis in the clinic are diagnosed only when they find that their neck is thickened and come to the doctor for examination. In short, the lack of knowledge and understanding of postpartum thyroiditis is the main reason for the misdiagnosis and missed diagnosis of this disease.
   How to treat postpartum thyroiditis?
   Once diagnosed with postpartum thyroiditis, it is necessary to give different drugs for treatment according to the patient’s disease stage and the severity of symptoms.
   Patients with postpartum thyroiditis during the hyperthyroidism stage have transient hyperthyroidism and mild symptoms, and antithyroid drugs are generally not recommended. If the patient feels that the heart rate is fast and palpitations are obvious, beta blockers (such as propranolol) can be taken as appropriate to relieve symptoms of high metabolism.
   During the period of hypothyroidism, appropriate supplementation of thyroid hormone (youjiale) can be performed for replacement therapy, during which attention should be paid to regular (2 to 4 weeks) monitoring of thyroid function to maintain a normal level. There is no need to stop the drug during lactation, and it will not cause adverse effects on the baby.
   After the recovery period enters the recovery period, the patient can gradually reduce the dose until the drug is stopped. A small number of patients with hypothyroidism can not recover, and thus become permanent hypothyroidism. This part of patients needs to undergo thyroid hormone replacement therapy for life.
   Postpartum thyroiditis prognosis of
   thyroid function in most patients can return to normal on their own, but easy to relapse into a “permanent hypothyroidism.” Within a year, 10% to 20% of women whose thyroid function has returned to normal develop “permanent hypothyroidism.” In 5-8 years, about 50% of women develop “permanent hypothyroidism.” Therefore, women with a history of postpartum thyroiditis are best to monitor their thyroid function once or twice a year. Once hypothyroidism is found, active treatment is required.
   How to screen and prevent?
   Thyroid peroxidase antibody is an important indicator to predict the occurrence of postpartum thyroiditis in pregnant women. Regular determination of thyroid peroxidase antibody before delivery is of great significance to predict the occurrence of this disease. In addition, patients with positive antibodies should also be closely followed up for postpartum thyroid function. Current studies have found that postpartum thyroiditis is related to excessive iodine intake, so women with a history of this disease should avoid using iodine-containing drugs to avoid inducing hypothyroidism.