Yes, thyroid problems can be related to both supply and let-down, sometimes
in opposite ways.
Hypothyroidism, or low thyroid status (mom usually on meds called
Synthroid, Levothroid, or Levoxyl), can cause a decrease in milk supply. I
don't take mom's word that there's no history of thyroid problems --- I
check levels. I've diagnosed several new cases of hypothyroidism this
way. There are other symptoms, of course, but sometimes the decrease in
milk supply is the first to manifest.
Low milk supply itself can cause "perceived lack of let-down", because if
supply is down, then the ducts and sinuses don't get distended when one has
a let-down, so the sensation of let-down, ie, the tingling, etc. doesn't
happen. Then this gets into the psychological cycle.
Hyperthyroidism, or high thyroid status (mom usually on meds like Tapazole,
Cytomel, PTU, and/or Inderal/propranolol for symptom control) has been
shown in rodents to inhibit let-down. Not sure the exact mechanism, as I
don't have the article with me at home, just remember that the poor little
things got engorged because they had good supply but couldn't let-down for
their pups.
Have this mom's levels been rechecked since birth? Thyroid levels that
have been maintained with meds during pregnancy may have changed after
birth, if med doses not adjusted accordingly. There's also a condition
known as Post-partum Thyroiditis that could be contributing to all this -
thyroid levels fluctuate depending on the phase of the thyroiditis.
Part of this mom's problem may also be that she's returned to carpool,
soccer games, etc. so soon. Not enough time to recover from childbirth is
a major contributor to both low supply and inhibited let-down . . .
"Super-Woman Syndrome".
Hope this mini-lecture helps!
Becky Saenz, MD, IBCLC
At 03:49 PM 09/22/2000 -0700, you wrote:
>i am working with a first time mom of a 4 week old baby. she has a history
>of thyroid problems (unclear exactly what, but she is on several meds).
>after birth of baby, no problems with weight gain or breastfeeding for a
>bout a week, then a sudden "dissapearance" of her let-down. she consulted
>an ibclc (miriam - you out there?) and ibclc confirmed latch, suck good,
>but milk not letting down - no apparent reason why. she began pumping and
>easily pumped enough milk for her baby to gain 11 ounces that week and 8
>the following 4-5 days - so no apparent problem with milk supply, even
>thought the thyroid meds may not have completely leveled her hormones to
>the right point yet. her obgyn prescribed reglan at recommendation of
>hopsital based ibclc, and she took it for a week - after a couple days of
>this, the let-down problem seemed to have subsided and baby exclusively
>nurisng at breast - no pumping, no supplementing. mom and baby are also
>battling thrush - mom given 1 single dose of diflucan (not sure of mgs.)
>and nystatin for baby. after i gave her info on gentian violet seh started
>that, (day 3 now) and is considering asking the pediatrician who prescribed
>the diflucan for the full 2 week course with loading dose per jack newman
>info.
>
>after a week on the reglan, she was noticing deppresive effects, and
>feeling more confident with her supply, and chose to discontinue it. it
>seemed fine for a day, but seh woke up this morning with same problem - no
>let-down to baby, but pumped 4 ounces off one side in jsut a short time.
>she will probably re-start the reglan, but she is panicking about her
>ability to feed this baby.
>
>i could use input on a couple points:
>
>1) is there a relationship between reglan and let-down reflex, when supply
>seems fine without reglan?
>2) is there a relationship between thyroid disorders nad let-down reflex
>when the milk supply seems fine?
>3) if her let-down is inhibited - why could that be, and what could help -
>i have seen refernece to rescue remedy before each nursing - anyone have
>the doseage? might this be a permanent problem for her? could it just be
>anxiety over her supply related to her thyroid function, when no supply
>problem really exists? does thyroid regulate oxytocin as well as prolactin?
>4) in your opinions, should she continue with the reglan for two weeks (the
>duration of hte prescription) then stop, taper off slowly starting now, or
>discontinue altogether and pursue some other remedy?
>5) how superior is domperidone for this situation?
>6) could this mom call jack newman for a consult? do you do phone or email
>consults?
>
>thanks in advance!
>
>any and all bits of advice more than welcome.
>Lyla Wolfenstein
>[log in to unmask]
>
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