Tuesday 20 August 2019

'Overactive thyroid mimicked symptoms of baby blues'

Life should have been wonderful after the birth of her son but instead out-of-control hormones took a major toll, writes Siobhan English

Siobhan English with son Robert (then six months) at their Dunlavin home. Pic: Steve Humphreys
Siobhan English with son Robert (then six months) at their Dunlavin home. Pic: Steve Humphreys
'I was suffering from an overactive thyroid and my hormones were in complete disarray.'
Siobhan English

Siobhan English

The first few weeks and months after the birth of my son last September should have been such a wonderful time in my life, but instead I almost drowned in my own tears.

Looking back now, I know it was much more than just sleep deprivation that caused such turmoil.

I was suffering from an overactive thyroid and my hormones were in complete disarray. I had never before heard of it being associated with pregnancy and was later surprised to discover how common it is.

The thyroid is a butterfly-shaped gland at the front of the neck. Its job is to produce hormones which regulate our metabolism, that is, the speed at which energy is used by our bodies.

"International studies suggest that one in four women will develop biochemical changes in thyroid function post-partum," says consultant endocrinologist Dr Margaret Griffin. "Many will have no symptoms but about one in three of those affected will go on to get symptoms."

It can result in either hyperthyroidism (high thyroid hormone levels in the blood) or hypothyroidism (low thyroid hormone levels in the blood).

When a woman who has recently given birth feels she has a problem with her mood and seeks help, doctors will first look at the obvious reasons for her feeling low. Post-natal depression is often the first port of call. However, when you delve deeper, it may not be the case.

Certain symptoms of thyroid disease, such as anxiety, are similar to those associated with post-natal depression, and sometimes women are misdiagnosed, often through no fault of their doctor.

In order to confirm whether or not there is a thyroid issue, a patient's medical history must be fully investigated and they need to undergo thyroid function blood tests. These are then reviewed by an endocrinologist who specialises in hormone-related disorders.

Initially patients will undergo a test to measure the levels of TSH (thyroid stimulating hormone) but this alone may not provide a complete picture. Sometimes running a full blood panel that includes Total T4, Free T4, Total T3, Free T3, Reverse T3, and thyroid antibodies may provide more insight into the most appropriate course of treatment.

In my case, after a second series of tests, I was informed by my endocrinologist that my symptoms were unlikely to be the result of post-natal depression. Rather, it looked more like thyroiditis that had flared up post-partum and caused an overactive thyroid.

Throughout my life I had often suffered from goitre, which is a swelling of the thyroid gland, but it never gave me cause for concern. There was also a history of thyroid disease in my family, but it was only when I had my baby that it became an issue.

As well as feeling depressed, lack of concentration, severe pains in my legs, and fatigue were some of the other tell-tale signs.

For several weeks I suffered from severe stomach pains, diarrhoea and nausea, but as I later concluded, this may have been a reaction to the medication I took to treat what I believed was post-natal depression. Coincidentally, once I stopped that medication, all my stomach issues vanished.

It had taken nine months to get fully diagnosed and start treatment for my overactive thyroid, after which my health and well-being started to improve, but we had to endure a rough few months in the meantime.

Looking back, over the years I was always prone to the odd mood swing, but a few weeks after the baby was born I felt awful. There were days I could not leave the house. I even cried at the very thought of it. I was a new mother but I felt pretty hopeless and inadequate.

Initially we put it down to tiredness - my partner and I were both exhausted - but as time went on I was suffering from both insomnia and serious aversion to heat and it was affecting the few hours' sleep I did get with a newborn. I would nap at every opportunity but I was barely in survival mode.

It was only when I saw my local public health nurse that we accepted something was wrong. I cried for the entire session. I subsequently made an appointment to see my doctor and they too believed it was post-natal depression.

In one way I was relieved, but the thought of taking antidepressants to alleviate the symptoms made me shiver. I agreed to take one course, but within a few weeks I was feeling worse than ever.

Not only was my mood not improving significantly, but now my hair was falling out in clumps. I then began to suffer from terrible stomach pains. The cramps were akin to those you'd get from food poisoning, and as a result my appetite would be up and down.

An overactive thyroid can often cause weight loss due to increased metabolism, but in my case my weight was not affected. I'd always struggled with it, so in fact not being able to face food for a while felt like a blessing.

It did affect my day-to-day living though, and looking after my son was proving difficult. I would often be bowled over in pain, while at the same time suffering from the worst nausea and diarrhoea.

After a few weeks I could take it no longer and stopped all medication of my own accord.

In the meantime I had returned to my doctor, who then ran a full set of tests for thyroid function.

These showed that I was overactive, whereby my thyroid gland was producing too much of the hormone thyroxine.

I was deemed atypical, whereby I presented a little later than usual and also had some nodules on the thyroid.

"Normally, at this point typical post-partum thyroiditis would usually have progressed to underactive," Dr Griffin says.

I was immediately put on a drug called Neomercazole which contains the active substance carbimazole and is used to reduce the formation of thyroid hormones with an overactive thyroid gland.

Patients with underactive thyroid are often prescribed Eltroxin (Levothyroxine) which replaces or provides more thyroid hormone.

"Of those affected, between 20pc and 30pc will go through a hyperthyroid phase (overactive) usually between one and four months post delivery and lasting two to eight weeks," Dr Griffin says.

"This usually progresses to hypothyroidism [underactive] lasting anything from two weeks to six months and then returning to normal thyroid function for most. Approximately one-third of all affected will go on to develop permanent underactive thyroid function," she adds.

Symptoms of hypothyroidism include lack of energy, cold intolerance, weight gain, constipation and dry skin.

Ten months have passed since my son was born and I am finally starting to feel human again. The blood results show that my medication has kicked in and some of the symptoms that debilitated me for so long are slowly starting to dissipate.

It is no quick fix, though, and I will remain on Neomercazole for another while to ensure my levels return to normal. In the meantime, though, I can fully concentrate on my role as a mum and get back to enjoying life again.

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