I'd previously posted about a mother in my breastfeeding class who'd
had her thyroid removed early in her pregnancy. The Lactnet archives and
several kind correspondents came through with info that I could share
with her to discuss with her doctors.

Anyway, about one week post-partum, she's back in touch for a consult,
since BF had gotten off to a slow start (unrelated to her special
situation -- a c-section, slow recovery, a painful first BF attempt
followed by complete supplementation, with pumping delayed until day 4,
a beautiful, healthy, impatient baby with a strong nipple/flow preference).

She's also clarified her thyroid-related situation: she will be
undergoing ablation of the remaining thyroid tissue with isotope 131
radioactive iodine. Unlike many radioactive treatments, which can be
handled with a temporary weaning, the references on this treatment
usually call for a complete weaning before the treatment. She won't even
be able to hold the baby for some time because of the high dosage in her
body.  The rationale is that the iodine which is actively transported
into the remaining thyroid tissue will also be concentrated into the
milk and the actively producing breast tissue, creating an exposure that
could increase her chances for breast cancer.  This is somewhat
theoretical, but compelling to a this mother who's already had a
traumatic brush with cancer.

The current plan is that she will breastfeed for one month and then
dry-up as quickly and completely as possible.  I have already suggested
(until she must think I'm a bit dense) discussing with her doctors the
possibility of delaying the treatments, along the idea that thyroid
cancers are usually slow-growing and not prone to metastasizing, and
that perhaps ultrasound scans could carefully monitor the thyroid region
for any signs of growth.  But possibly because the original event was
many months back, no one is interested in any delay.

So, while we're currently trying to rev up the milk volume, about three
weeks from now, we're putting on the brakes.  Her question, and mine:
how long will it be before she can be considered "dried up" and no
longer accumulating milk within her breasts.  I have information and
strategies on rapid weaning (though I'd be happy to hear more) and of
course, women respond differently, so I've said that we'll just have to
monitor her individual response.

But in most weanings, the woman is simply aiming to be comfortable and
not obviously producing, but not looking for assurance that the process
is completely stopped.  Women can sometimes express milk for months
after weaning -- but are those women still "producing" and re-absorbing
milk on some level in an ongoing way, or just producing in response to
the particular stimulation of expressing?

Anyway, I'd love to hear of other cases like this, in terms of the
time-frame to complete cessation (especially so early on, when normally
the supply is still on the increase). And if the breast is not obviously
filling, is that about as much measure as we can have that lactation can
truly be considered "done."

With thanks sent in advance, and reaching backward, too, for all the
resources Lactnet provides.

Margaret Wills, LLLL, IBCLC

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