> Theresa Johnson  writes:
>
> <She is on elevated thyroid replacement therapy to keep her thyroid  
> suppressed and has frequent levels drawn.  This is to keep down any  
> growth and stimulation of thyroid cells or potentially new cancer  
> cells, so nearly in a hyperthyroid state throughout her entire  
> pregnancy >>

Am I understanding you correctly:  her thyroid gland was NOT removed,  
so the endocrinologist is giving thyroid replacement therapy at HIGH  
levels to prevent growth of new thyroid tissue? and Her physiological  
state is hyperthyroid not euthyroid?

> a plan of care that included  a great pump, herbs, breast  
> compression etc.


Sounds like she's on the right track for increasing milk supply.  
However, dId mom have weight gain in pregnancy? Does she still have a  
few extra pounds or has she returned to her pre-pregnancy weight?  I  
would suspect someone in a constant hyperthyroid state to have very  
little in the way of body fat and energy stores. (the hyperthyroid  
state would "burn up" most of what she has)  Would you consider her  
diet sufficient in caloric intake to compensate for both the  
hyperthyroid and lactation?
We have been told that diet is not as "important of a factor" as once  
was believed-- they only need about 500 extra calories above their pre- 
pregnancy diet, etc.. that has not been my experience with some  
mothers. Those who are very thin, returned to their pre-pregnancy  
weight  before 6-8 weeks (thin to begin with) often need to increase  
their intake of good calories and high quality fat before they see an  
increase in milk production. We know that milk production is not  
"expensive" for the body calorie for calorie but some of these women  
have poor diets especially when it comes to good fats. Or they aren't  
eating very much at all because of new baby concerns and they need t  
be reminded to eat. I usually put the family to work on creating  
nutritious snacks to leave for mom to graze on durning the day.
It doesn't need to be much but  they feel better and milk supply  
increases.

One more thing:
> hyperthyroidism and milk ejection difficulty and suggests that  
> oxytocin spray

I had someone recently who looked into oxytocin nasal spray and it was  
$90.00 for the Rx of an ounce 30 ml (about a week's worth?). Insurance  
would not cover it.  Something that a young mother might not be able  
to afford. I have not had any moms use this recently but I remember  
something  a "rebound effect" with oxytocin nasal spray.  It is only a  
short term solution and only if the milk is there.

Hope this helps,
Marie Davis RN IBCLC



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