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From:
Theresa Johnson <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 19 Jul 2009 18:56:44 -0700
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Marie,

Just to clarify,

She did have her thyroid removed, it was cancerous, but to prevent any free roaming thyroid cells left after surgery, the doctor keeps her on the high side of a euthyroid state but not too much so.  She has levels drawn often, is  definitely not thin, she did put on weight with pregnancy and pretty much appears an average size  5-9 or 10, 205 pounds with preg and 185 pounds post preg,  nothing drastic. Excellent nutrition, vegetarian, and is conscious to eat healthy.  Money is not a factor for her. 28 years old.  Her levels are euthyroid, but definitely with very low-normal TSH levels. Which means she is on the higher side of medication,  but still within normal range.

I appreciate all the suggestions, she is also an RN and very knowledgeable about breastfeeding and human milk in general.  She is not a Lactation Consultant.  Really wants to human milk feed her baby and eventually breastfeed her when the jaw strengthens.  I have suggested the SNS to her as an option.  Has not tried it yet.  I think the oral motor therapist suggested she use a bottle and then move to the breast in a few weeks.

Thank you again,
Theresa Johnson RNC BSN, IBCLC
Theresa

--- On Sun, 7/19/09, Marie Davis <[log in to unmask]> wrote:

From: Marie Davis <[log in to unmask]>
Subject: Re: Hyperthyroid and lactogenesis another thought
To: [log in to unmask]
Date: Sunday, July 19, 2009, 10:00 PM

> 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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