Hi all:  I am usually a lurker, but feel our work with a recent client
needs to be shared.  I'll try to keep it as short as possible, and
hopefully not leave out important info.  Please feel free to ask
questions if anything seems unclear.  I have mom's permission to share.
In our busy hospital breastfeeding clinic we had started to see a mother
and her 4 day old daughter as outpatients.  Presenting problems were
sore, damaged nipples, milk stasis, and breast edema(not saying engorged
anymore after one of Linda Smith's presentations).  We were able to come
up with a feeding/pumping plan, as well as strategies for decreasing
breast/nipple discomfort.  We continued to F/U with this dyad every few
days.  Mom continued to experience uncomfortable fullness and oversupply
despite baby moving milk well and occ pc pumping to comfort.  We started
to question if mom's  being hyperthyroid was contributing to oversupply
(since hypothyroid may be a cause of undersupply) We weren't able to
find anything to support this in the lactnet archives, though.(does
anyone know if this could be possible?)   After a few more visits to the
clinic our concern began to shift to the baby, who despite huge
transfers of milk during visits to the clinic(at 11 days she took 180ml,
6oz. directly at breast) , was not gaining weight.  Mom was feeding on
cue, at least 8x/24 hrs. Baby's bw was 9-6, dropped down to 8-14 on day
3, on day 4 was 4000 gm, 8-13.  Wt continued to fluctuate between 4000
gm. and 4130 gm.,9-1.  Finally, on day 14, babe's wt was again down to
4060 gm, 8-15.   At that visit she took 130ml at breast.  Mom described
babe as starving, wanting to eat all the time, and irritable.  We
wondered if we were seeing an effect of the PTU(propylthiouracil) that
mom was taking for her hyperthyroid, as she had been taking high doses,
200-300mg/day throughout pregnancy and postpartum.  That same day mom
stated her diagnosis as Graves disease, not just hyperthyroid.  We were
able to arrange an appointment with a paediatrician , as well as some
blood work incl. CBC, TSH, and FT4.  Throughout, baby appeared well,
alert, responsive, settled after feeds.  At the drs. app't, baby was
more irritable, and paed. found that she was tachycardic.  FT4 was
elevated, all other blood work normal.  Final diagnosis was that baby
had transient maternal-derived Grave's disease, and was started on PTU
as well as propranalol for the tachycardia.  The Graves disease was
apparently the reason for her voracious appetite, and failure to gain
weight.  Biweekly bloodwork continued, and she is finally off the
propranolol, on a very small dose of PTU and gaining like crazy.  The
weight gain started as soon as the meds started, and now at 1 1/2 months
she weighs 5130 gm, 11-4.  Mom continues to experience oversupply, but
it is manageable.  I hope I have described this well enough, from what I
understand this is extremely rare, so we thought it needed to be shared.
Hope it is helpful, Doreen Vanderstoep RN. IBCLC 

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