As the Mother of two hypothyroid daughters one discovered prepregnancy with Hashimoto's Disease and the other was discovered post delivery while breastfeeding 4 years ago. 
The later daughter delivered twins at 37  2/7 weeks after invitro. As I previously posted when celebrating their birth she began breastfeeding at 6.5 hrs after delivery (she was cold and BP were up and they were ruling out using Magnesium which they didn't) As I love to say Lyra the girl was going to breastfeed off anything she could snag. Jonah the smaller twin caught on and never missed a meal once he figure his greedy sister was going to hog up Mom. Mom is now going on 15 weeks of exclusively breastfeeding. She pumped only 3  times and last got 6.5 ounces which Jonah took from me on Monday when Mommy had to go to a teachers' meeting and it was rainy and chilly.
I really am impressed but I attribute it to Mom being very accepting of being totally at the beck and call of the two little ones. There a moments when I know the prolactin is so thick it hangs like a cloud in the air around them as the 3 of them repose in the recliner. 
She has let her housekeeping slip and Dad doesn't seem to have an issue with it. They have gone to Jacksonville for the holidays and did great. Tomorrow Mommy turns 35 and they will go to the Florida Keys for the weekend. Other Nana is going (old LLLL) and she will baby sit when they go snorkling with the Dolphin and off John Pennekamp Park. Carrie realizes she is fortunate to be surrounded with family who will help pickup (this MeMe and Choo Choo travel over 30 miles to pickup from nursery school when its' cold and rainy or she hasn't slept all nite). Mid January they were weighed and Lyra who started at 6-9 weighed 12-7, Jonah who started at 5-8 was at 12-0 and both were 24 inches. 
Her Endocrinologist has run her levels and adjusts throughout pregnancy and now postpartum. This one didn't want to take Synthroid but takes 150 mcg. He demands no generics as so many Endos do. 
The daughter with Hashimoto's had levels that fluctuated radically and the Endos had it on weird alternating doses, but she made milk and did nicely.
Your client needs to look how often these twins are feeding. Have her levels tested and adjust her meds if needed. Usually your needs drop after delivery.
There are moments when Carrie thinks her supply has dropped but then she remembers they have been snacking all day and night. They have had moments of nearly 6 hrs of sleep and Carrie says that is "heavenly".
Hope this offers encouragement and hope.
Leanne Jewell RN-BC, I:BCLC, LCCE, FACCE
South Florida 




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