While pregnancy is a wonderful thing, it is also a lot of work for your body. Many women experience hypothyroid postpartum which can make thing more difficult when you’re a new mom. I’ve worked with many clients through their pregnancy and postpartum and I’ve seen what helps, so I’m going to share my top tips with you today.
What is hypothyroidism?
Hypothyroidism happens when the thyroid gland doesn’t make enough thyroid hormone (ft4 or ft3). This condition also is called underactive thyroid.
It’s important to note that it’s very common for a doctor to diagnose a patient with hypothyroidism when TSH levels are high without actually testing thyroid hormones (ft4 and ft3).
Please note: TSH levels tell you what your pituitary is up to, but it’s not telling you what the thyroid is doing.
Everyone is biochemically individual, but according to functional practitioners, a TSH level between 0.5-2.0 is the range where people feel healthy and vibrant. Most labs have “normal” TSH ranges that span anywhere from 4.0-8.0, but most people with TSH levels this high don’t feel well and need to make some steps to reduce their TSH level.
What is TSH and what is an optimal level?
TSH is a hormone that the pituitary sends out to tell the thyroid how much or how little thyroid hormones to produce.
What is free T4 and what is an optimal level?
Free T4 is a hormone produced by the thyroid. You want free T4 levels to be in the middle of the lab range. So if the range is 1.0-3.0, you want your free T4 to be 2 (or close to it). Each lab has a different range, so you have to look at what the specific range is to know what number to look for.
What is free T3 and what is an optimal level?
Free T3 is a hormone that mostly comes from fT4. The thyroid makes fT4 and sends most of it to the liver to be converted to free T3.
You want free T3 to be in the middle of the lab range. So if the range is 1.0-3.0, you want your free T3 to be 2 or close to it. Each lab has a different range, so you have to look at what the specific range is to know what number to look for.
What causes hypothyroidism?
This really depends on which level is too high or too low, so let’s break this down.
If TSH is elevated:
TSH is a hormone that the pituitary sends out to tell the thyroid how much or how little thyroid hormones to produce.
The pituitary, hypothalamus and adrenals (also called the HPA axis) are all part of the endocrine system and communicate with one another throughout the day. When the body perceives stress – emotional, mental, physical, environmental, mental, stress from disease, etc. – the hypothalamus tells the adrenals to work harder to put out additional cortisol, and it tells the pituitary to produce more TSH so the thyroid will produce less fT4.
So, a high TSH level doesn’t always indicate a thyroid problem. Instead, there’s usually some sort of imbalance in the HPA axis. Your practitioner’s job is to now figure out why there is an imbalance.
Everyone is biochemically individual, but in our practice we’ve found that a TSH level between 0.5-2.0 is the range where people feel healthy and vibrant. Most labs have “normal” TSH ranges that span anywhere from 4.0-8.0, but most people with TSH levels this high don’t feel well and need to make some steps to reduce their TSH level.
One of the biggest drivers of elevated TSH are stressors. So, if your TSH is elevated, regardless of if you also have low or high fT4, you really want to take a good look at the stressors in your life.
Here are some of the stressors and other root causes that can cause elevated TSH:
Emotional stress
Mental stress
Physical stress
Not getting enough sleep
Chronic illness or disease
Living in a cold environment
A move
Surgery
Over exercising
Elevated cortisol
Not eating enough food
Fasting
Low cortisol
Adrenal imbalance
Not eating enough healthy carbohydrates
Dental work
A car accident, death in the family, or any other traumatic event
An issue with the pituitary
Low fT4
A change in your schedule – new job, night shifts, a new baby, etc.
Nutrient deficiencies such as low retinol, zinc, and vitamin D
Certain medications
Common root causes of low fT4:
1. Most often, free T4 is low because the thyroid doesn’t have the resources to produce the proper amount of T4. The thyroid needs iodine and tyrosine to produce thyroid hormones. Increasing the consumption of iodine-rich foods, reducing exposure to chlorine, fluoride and bromine (this is incredibly important!), and taking an iodine supplement can often help improve this imbalance.
If you’re concerned about taking iodine when you have thyroid disease, read this post and it should answer your questions.
2. Free T4 can also be low when thyroid antibody levels such as TPOab or Tgab are elevated. When antibodies attack the thyroid tissues, this can make it difficult for the thyroid to produce enough fT4.
3. Another common cause of low FT4 is anemia. The body needs iron to make TPO, which is then used to make a thyroid hormone (FT4). When the body is deficient in iron, FT4 levels can drop, putting the body in a hypothyroid state. To read more about this, and see what steps you can take to reverse the issue, click here.
4. Having your thyroid removed, radiated or ablated, or being born without a thyroid.
Common reasons of low fT3:
1. Free T3 can be low because there isn’t enough free T4 being produced by the thyroid to be converted into free T3.
2. If there are adequate levels of free T4, but there isn’t enough free T3, then this often indicates liver congestion.
Let me explain. . .
Your thyroid produces T4 and sends most of it to the liver to be converted into the active form, free T3. If you have enough free T4, but not enough free T3, then you don’t necessarily have a thyroid problem, instead, you may need to support your liver so it can efficiently convert T4 to T3 for you.
Liver congestion is pretty common nowadays, and can not only cause low T3 in the body, it also can cause estrogen dominance, severe headaches, blood sugar imbalance, chemical sensitivities, skin issues, and dark circles under the eyes, among other things. Here is an article I wrote with specific steps you can take to improve this issue.
3. Free T3 can also be low because there is excess cortisol (from adrenal imbalance) that is blocking the conversion of free T4 to free T3 and instead creating an excess of reverse T3.
4. Nutrient deficiencies such as zinc, selenium, or vitamin D.
What is the root cause of postpartum hypothyroidism?
One of the key reasons for hypothyroid postpartum is that the body has gone under a lot of stressors and this causes an imbalance in the adrenals which then can lead to lower thyroid hormones and possible autoimmunity.
What do the adrenals do?
The adrenal glands are the body’s emergency system. When the body is under chronic stress, the adrenals will send out cortisol into the bloodstream. Over time, chronic cortisol output can weaken the endocrine system, immune system, liver, digestive system, and brain. It can also cause the thyroid to slow down (aka hypothyroidism) and in some rare cases, it will speed up (aka hyperthyroidism).
Adrenal imbalance is often why you’ll see postpartum symptoms such as:
Low blood pressure
Clenching or grinding your teeth
Hair loss
Insomnia
Waking up in the middle of the night with difficulty going back to sleep (this is outside of your baby waking you)
Feeling keyed up and having trouble calming down
Craving salty foods
Chronic low or middle back pain
Chronic fatigue
Afternoon headaches or headaches after exercising
Anxiety
Panic attacks
Dizziness when you stand up
Difficulty losing weight (after a reasonable amount of time after the baby is born)
Stubborn weight around the midsection (after a reasonable amount of time after the baby is born)
Getting upset or angry easily
Nutrient deficiencies
Digestion issues
How do the Adrenals Effect the Thyroid?
When the adrenals become too taxed and cortisol levels are out of balance, this can create an imbalance in the HPA-axis which then can lead to low thyroid hormones.
Imbalanced adrenals can also create issues with digestion which often leads to lower stomach acid and then nutrient deficiencies.
An imbalance in the HPA-axis can also weaken the immune system which can result in Hashimoto’s or Graves’ disease.
It’s important to understand that the thyroid doesn’t work alone in the body. In simple terms, it’s reacting to the environment that it’s in. When the body is taxed and not nourished well, this alone can lead to postpartum hypothyroidism.
Should you get thyroid labs done postpartum?
Yes, I think it’s very important to get them done around the 6-8 week period so you can see how things are going.
Here’s the list of labs to ask for (if your doctor won’t order labs for you, you can order them here:
TSH
TPOab
TgAB
Free T3
Free T4
Reverse T3
I also recommend getting a CBC, CMP with phosphorus, iron panel, fasting insulin, HA1C, saliva cortisol test and Vitamin D. Various nutrient deficiencies or other imbalances in the body can cause thyroid numbers to be too high or too low, so it’s important to look at the values in these tests.
Can Hypothyroid Postpartum be reversed?
Yes! It’s often just a matter of slowing down and nourishing the body. When the body is given the proper tools, it can often come back into balance.
How to Reverse Hypothyroid Postpartum Naturally
1. As soon as you wake up, drink a glass of water along with 1/4 teaspoon of Celtic sea salt. Then, throughout the dayhave a pinch of sea salt with each glass of water and also use it to season your food. The 80+ minerals in the salt will help nourish the adrenals and endocrine system.
If you take medications in the morning, talk to your practitioner about taking this step. If you need to delay the water and sea salt until later in the morning, that is fine.
2. Eat breakfast within one hour of waking. It’s important to nourish the body on a regular basis throughout the day. While intermittent fasting has its place, now is not the time for that. It’s best to nourish the body right now and not restrict.
Waiting too long to eat in the morning can cause your blood sugar levels to decrease too much and your adrenals can start producing excess cortisol. This can create a cycle of adrenal and blood sugar imbalance.
3. Eat regular meals throughout the day and include some protein, complex carbohydrates and healthy fat in each meal. I know this is a simple step, but skipping meals can put a strain on the adrenals and can create blood sugar imbalance, so it’s really important.
4. Remove all processed foods from your diet. Processed foods are a stressor on the body, and the goal is to remove stressors as much as possible to help support the adrenals.
Here is a quick list of foods to eat (choose organic as much as possible):
Pastured meats
Wild seafood
Pastured eggs
Raw or cultured dairy (raw milk, whole yogurt, kefir, sour cream, etc.)
Vegetables
Fruit
Spices and herbs
Soaked grains (if you can tolerate grains)
Soaked nuts, seeds, legumes and lentils
Fermented vegetables (like raw sauerkraut)
Lots of water!
Here are some recipe ideas.
5. Only do low-impact exercise like walking, pilates, gentle yoga or stretching. High impact exercise puts strain on the adrenals, especially when the body is already fatigued. If you’re having trouble losing weight, I know this can seem counter-productive, but I’ve seen clients lose weight by resting and following the steps I’m listing here.
If you’d like to learn specifically more about how to best exercise for your thyroid and adrenals, I highly recommend this class I teach alongside my brother, Dr. Erik Korem.
6. Sit down to eat each meal and eat slowly. Don’t eat on-the-go, when you’re stressed, driving, etc. I know that can be tough when you’re a new mama! Eating in a slow and relaxed state will help increase stomach acid production that you need so your body can break down and use the nutrients in your food.
Here’s an entire article to help you understand the importance of eating in a slow and relaxed state.
7. Diffuse essential oils throughout the day to help you feel more relaxed. If you can’t diffuse the oils, put a drop or two on the bottoms of your feet or on the spine twice a day to help lower stress levels. In fact, this study found that inhaling lavender essential oil can decrease cortisol levels. That’s good news for the adrenals! Here is a list of oils to avoid when pregnant or nursing.
If you’d like to learn specifically what oils to use to support the thyroid click here.
8. Spend more time outdoors. Getting fresh air and being in nature helps reduce the stress response in the body.
9. Avoid a super low-carb diet right now. While a low carbohydrate diet can be very helpful for many health issues, I don’t recommend it postpartum because your body needs the healthy carbs to replenish and heal the body. You also need those carbs so the liver can convert fT4 to fT3 (fT3 is the thyroid hormone that goes to every cell of the body, so it’s pretty important!).
Here’s a short list of carbs that are good choices:
Potatoes, all kinds (make sure to eat with plenty of butter)
Root vegetables
Fruit – apples, pears, berries, etc.
Soaked beans (kidney, navy, white, etc.)
Fermented sourdough (if you can tolerate grains)
Beets
Peas
Soaked quinoa and oats
Organic, whole yogurt
10. Go for a walk outside daily. Walking is a great way to balance cortisol levels and calm the body. It’s also great for movement and lymphatic flow, sunlight, etc. which are all great for the body!
11. Take an epsom salt bath a few times a week: When you’re stressed, the first mineral your body burns through is magnesium (this is why so many people are magnesium deficient!). Soaking in a bath with 1 cup of epsom salts can help replenish your magnesium stores.
12. Get as much sleep as you can. Ok, now I know this is a difficult one, but I felt like I at least needed to point out that sleep is so important to support your health. I know this will be very difficult in the early days, but eventually, as your baby gets older, a regular sleep schedule that you create for yourself is very helpful.
13. Talk to your practitioner about supplementation that you might need. Here are some that I often use in my practice for women who are struggling with hypothyroid postpartum.
Cataplex B is an excellent source of thiamin, niacin, and vitamin B6.
Catalyn is a fantastic whole food multi-vitamin. Often hair loss is due to adrenal imbalance and stressors which then lead to nutrient deficiencies. Taking a multi-vitamin postpartum can be helpful to support the body foundationally.
Drenamin is one of my favorite supplements for adrenal support.
14. Don’t try and do everything by yourself. Trying to do everything on your own is very stressful and can make things difficult for your overall health and can lead to an imbalanced HPA-axis which can lead to low thyroid hormones. I recommend asking friends and family for help. Maybe they can bring freezer meals for you, come stay with you after the baby is born, or come over a few times a week so you can simply lay down and rest. This will look different for each person, but I can’t stress how important it is to ask for help.
15. Drink plenty of filtered water each day. Drinking 1/2 your weight in ounces is a good goal — a 160-pound person should drink about 80 ounces of water per day. Hydration is really important for the endocrine system. Without the right amount of water, the body can’t transport the necessary nutrients and hormones to the cells properly. So make sure you’re getting enough water.
16. Eat as many fresh organic vegetables as possible at all three meals with some healthy fats. There is no limit on vegetable intake. Often, cooked vegetables, as opposed to raw, can be helpful if you’re experiencing digestive issues. Cooking them in some healthy fats, adding them to soups, stews, roasting, etc. are all good choices.
17. Include protein at each meal. Get these proteins from meat, poultry, wild seafood, eggs, etc.
18. Eat magnesium-rich foods. Magnesium-rich foods help support the adrenal glands. Foods such as dark leafy greens, fatty fish, avocado, and soaked nuts, seeds and legumes are all good sources of magnesium to include in your diet throughout the week.
19. Eliminate all caffeine. I know this is a hard one, but your adrenals will thank you! Here’s a post about how I kicked the coffee habit — with step-by-step instructions for you.
20. Take one day of rest each week. While it’s popular to “hustle”, that kind of daily mentality can lead to all sorts of health issues and will strain the adrenals. Taking a day off each week is very important for your health. While taking care of a baby is a 7-day a week job, there are various things you can do to help create a more restful day once a week.
Here are some examples:
Don’t schedule anything or anywhere you need to be on that particular day
Turn off your phone for the day (this can have a huge impact on cortisol levels!)
Spend time outdoors
Make meals in the slow cooker or pick up food to reduce the amount of time working in the kitchen
Read a fun book when the baby naps
Take an epsom salt bath
Light a candle or a fire and create a cozy environment for the day
It’s ok. God set the example by taking a day to rest, so I order my week that way, too!
Some other resources for you:
If you’re looking for a good holistic resource for pregnancy, childbirth and postpartum, my two favorite books are The Mama Natural’s Week-by-Week Guide to Pregnancy and Childbirth, and The Nourishing Traditions Book of Baby and Childcare.
Disclaimer: The purpose of this post is to give an overview of how to support the body postpartum from a holistic perspective. This information is not intended to take the place of your doctor’s advice.
