Friday 27 April 2018

Underactive thyroid and avoiding mastitis when breastfeeding

Ask the GP

Breastfeeding mother
Breastfeeding mother

Nina Byrne

Our GP answers medical queries on an underactive thyroid and mastitis during breastfeeding.

Question: I had blood tests done recently with my GP and she has told me that I have an underactive thyroid. I have been informed that I need to start medication for this. I feel fine.

Do I really need to take medication and how long will I need to take it for? Will this be for the rest of my life?

Dr Nina replies: Your thyroid gland is a butterfly-shaped gland that sits just below your Adam's apple in your neck. This small gland plays an important role in body function. It produces thyroid hormone which helps regulate our metabolism. Problems can arise when the gland produces too much (hyperthyroidism) or too little (hypothyroidism) thyroid hormone.

As you have found out, an underactive thyroid may not cause any symptoms or they may be very non-specific. Symptoms may include feeling tired or feeling cold. You may notice weight gain, constipation, dry skin and brittle hair and nails. An underactive thyroid may also cause depression, memory changes, muscle weakness and muscle aches and pains. Periods may become heavier or more erratic.

In extreme severe cases, a severely underactive thyroid may cause heart problems and even a coma. All of these symptoms can occur in other conditions or may not be associated with disease at all, so a thyroid condition doesn't always come to mind.

Hypothyroidism has a number of causes. The most common is autoimmune or Hashimoto's thyroid disease. This is an autoimmune condition where the body produces antibodies that attack the thyroid's ability to produce enough thyroid hormone. This condition can run in families. It is more common in women than men, occurring in one in 50 versus one in 1000 respectively.

Those who have had surgery or radiation to their thyroid gland or have undergone treatment for an overactive thyroid are also at risk of an underactive gland.

More rarely, a child may be born with an underactive gland (all babies are screened for this as part of the heel prick test).

It can also occur due to iodine deficiency. This used to be a more common cause, but most supplements now contain iodine and eating seafood will also provide adequate levels. In the US, salt is iodised to prevent this.

The pituitary gland in the brain produces a hormone called thyroid stimulating hormone (TSH) which helps regulate thyroid hormone levels, so problems here may also cause an underactive gland. Women are also at risk of an underactive gland after pregnancy.

An underactive thyroid can be easily diagnosed with blood tests in your doctor's office. In an underactive thyroid, the TSH levels are normally high and T4 (thyroid hormone) levels are low. It is also possible to check for thyroid antibodies in the blood. Cholesterol levels may also appear high in those with an underactive thyroid. These may improve once the condition is treated.

Treatment involves taking synthetic thyroid hormone. Once you start this, it is normally continued for life. This may seem quite daunting, but there are virtually no side effects to thyroid medicine and most people feel better within a number of weeks of taking it. It is important to have follow-up blood tests to ensure you are taking the correct dose.

Thyroid medicine absorption may be reduced by calcium and iron tablets and these should not be taken at the same time. Many patients are advised to take the medicine on an empty stomach.

It has also been suggested that taking the medicine at night may result in better absorption and high levels of the drug in the body.

Question: I'm due my second baby any day now. I really want to breastfeed again, but I'm worried as I had really painful bouts of mastitis the last time, which cut my feeding short. Have you any advice to help me this time around?

Dr Nina replies: Mastitis occurs when the glands of the breast become inflamed and painful. This condition occurs most commonly in breastfeeding women usually in the first few months of childbirth.

The breast becomes painful, swollen and tender. There may be redness of the skin. A firm lump may also be felt within the breast. When infection occurs there may also be fever or flu like symptoms. Mastitis usually only occurs in one breast.

Anything that allows the breast to become engorged can lead to mastitis. This can occur if you stop breastfeeding suddenly or skip or drop feeds. The baby not latching on properly, or having feeding problems such as tongue tie, may contribute. Cracked or sore nipples will make mastitis more likely.

Mastitis occurs in up to three in 10 breastfeeding women. Antibiotics and simple painkillers such as paracetamol and ibuprofen can provide relief.

It is important to continue breastfeeding when you have mastitis. Massage the affected area while feeding to encourage the blocked gland to clear. If it is too painful to feed, then try expressing from that side.

To reduce the risk of mastitis, ensure that the breasts are filling before each feed and emptying after them. Feed the baby in different positions. Ensure that one breast is empty before starting to feed on the other side. Alternate the breast you offer first at each feed. Don't allow the baby to use the breast for soothing rather than feeding.

Pay attention to latching on - this will make a difference. Lastly, wear bras that fit properly, too tight increases the risk of mastitis.

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