Breastfeeding and Antithyroid Drugs: A View from Within

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.

• Thus, you’ll have a normal range of thyroid levels, which is important for normal lactation and maintaining a sufficient supply of milk.
• One of the main ways thyroid hormones stimulate breast milk production is by stimulating the release of prolactin from the pituitary gland.
• Levels secreted into milk are too low to influence tests for neonatal hypothyroidism.
• For babies born with hypothyroidism due to the mother taking ATDs during pregnancy, the drugs typically clear the infant’s system quickly, with thyroid function being restored to normal.
• 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.

Drug Levels and Effects

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.

• There is also connection between thyroid disorders and autoimmune problems.
• Mothers may find their thyroid levels change with pregnancy and childbirth, which is why frequent testing of mother is recommended.
• It won’t influence tests for neonatal hypothyroidism (an underactive thyroid in babies).
• The postpartum period is also a high risk time for new development of Graves’ disease.
• To ensure timely treatment, the task force recommends TSH testing at the time pregnancy is confirmed and every four weeks until mid-pregnancy, when thyroid function tends to stabilize.

Is it safe for a mom with thyroid disease to breastfeed?

• The guidelines note that women who were diagnosed with hypothyroidism prior to pregnancy and increased their dose of thyroid hormone replacement should resume their pre-pregnancy dose following delivery, with follow-up testing recommended six weeks later.
• Many of these drugs (including Propranolol/Inderal) are considered to be acceptable for use in breastfeeding mothers.
• As I recall, I was really uncomfortable the day of the surgery, but it got better pretty quickly after that.
• This scan is done using radioactive iodine (I-131), and is usually done at the same time as a thyroid scan.
• Make sure to monitor your baby for any changes in behavior or development if you take levothyroxine while breastfeeding.

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.

Pharmacokinetics of ATD

However, this approach may be used in rare cases where the mother is hypothyroid after RAI or surgery, but maternal antibodies are causing hyperthyroidism in the fetus. The ATDs will pass through the placenta to calm the fetal hyperthyroidism, while the replacement hormone will keep the mother’s thyroid levels stable. Common causes of thyrotoxicosis during pregnancy are Graves’ disease, an autoimmune condition, gestational transient thyrotoxicosis, and overactive thyroid nodules. Receiving a correct diagnosis is critical, as this will affect treatment options. Findings that point to gestational transient thyrotoxicosis include no prior history of thyroid disease, and absence of goiter or eye findings, mild symptoms of thyrotoxicosis, and vomiting.

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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.

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.

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 GD or a newly diagnosed case with no apparent thyroid disease background.

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.

Anti-thyroid medications

And if you have low synthroid enjoo 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.