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From:
Angela White <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 1 Feb 2009 15:26:44 -0800
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I wish more were known about Graves Disease and lactation. I was 
diagnosed with postpartum Graves Disease in 2003. At that time I 
could not turn up any indication that prolactin or oxytocin from 
continued breastfeeding would disrupt thyroid function. I would love 
to hear if such a connection has been found. In this mother's case, 
while the breastfeeding itself -- putting baby to the breast with an 
SNS and/or pumping -- should not be a problem, the concern I would 
have is with the hormone protocol to induce lactation. Pregnancy can 
trigger postpartum Graves' Disease or postpartum thyroiditis from the 
hormone changes after the birth. Thus, when a woman follows a hormone 
protocol to mimic pregnancy and induce lactation, there is a 
possibility that that will affect her thyroid function. The mother 
would need to ask her endocrinologist about the effects of estrogen, 
progesterone and/or domperidone on the thyroid.  My endocrinologist 
said it would be alright to take birth control pills while I was 
being monitored for hyperthyroidism, although my slim understanding 
is that estrogen can bind with available thyroid hormone, and 
progesterone could stimulate further hormone production. It appears 
that domperidone affects TSH 
(http://www.ncbi.nlm.nih.gov/pubmed/4094840) although I don't have 
access to the full article to see exactly what it says about how it 
affects TSH in hyperthyroidism. All that being said, that doesn't 
mean the mother shouldn't attempt to induce lactation. If the 
endocrinologist approves the birth control pills and/or domperidone 
and is willing to monitor the mother's TSH, Free T4 and Free T3 
closely every four weeks during and after the protocol and adjust her 
antithyroid medication as needed, then I think breastfeeding would be 
a wonderful way to bond with the baby and reduce any anxiety that 
stems from hyperthyroidism. That would have to be weighed against any 
stress of inducing lactation and dealing with the fluctuation in 
thyroid levels if any. Personally I have been very glad to be 
breastfeeding, and I was even able to go into remission from Graves' 
while tandem nursing my first two daughters (treating the underlying 
thyroid problem also fixed the infertility and I now have three lovely girls!)

As to whether the hyperthyroidism would affect milk production, the 
jury is still out. I developed the hyperthyroidism postpartum and I 
struggled with oversupply. However, I just read in "The Breastfeeding 
Mother's Guide to Making More Milk" pp. 129-132 some suggestion from 
rat studies and anecdotally that active hyperthyroidism before/during 
pregnancy could hamper milk production. I suspect though that if the 
mother is already being treated for the hyperthyroidism and has 
normal hormone levels while on medication, her ability to make milk 
would be unaffected.

The mother should be prepared to share with her doctors information 
from "Medications and Mothers' Milk" and LactMed about the 
compatibility of antithyroid medication with breastfeeding. She 
should also be aware that she should not do any thyroid testing with 
radioactive iodine (it's totally unnecessary anyway, the same results 
can be achieved through blood testing), and certainly not ablate her 
thyroid with radioactive iodine (which would mean she could not hold 
the baby for a certain number of days, much less breastfeed).

Please let me know if you learn more about Graves' Disease and lactation.

Best wishes,
Angela White, LLLL, JD
http://www.breastfeeding123.com

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