Dear friends at Lactnet-

It has been a long time since my last post, but I constantly lurk and learn so much.  I have a stubborn case and have permission to post.

My client has had her thyroid removed approx 3 years ago due to cancer.  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 until now which is 3.5 weeks postpartum.  She carried the baby full term 39 weeks.  Recent level last week showed her in near 0.3 TSH which is almost hyperthyroid state, but normal levels, exactly where her endocrinologist wants the levels to be.

By her history (I did not see her) she had lots of colostrum, slight delayed milk production (not until the 6th day), and breast changes throughout pregnancy and 1st week postpartum.  Some feelings of fullness and some tingling after day 6 with feedings.  Did listen for swallows and watched milk transfer and wet and BM diapers.  Was noted by LC colleagues that baby's weight was the same as discharge weight at 2 weeks (6# 14 oz).  On oral exam, baby was noted to have left sided jaw weakness and the couplet was sent to therapy here in Orlando for jaw strengthening exercises and a plan of care that included  a great pump, herbs, breast compression etc.  

Recent diary kept and  still only pumping 1 ounce every 3 hours after 1 week of the pumping plan and supplementing and feeding baby while working on jaw strength.  Has tried to pump more often but is difficult as you can imagine with taking care of newborn.   

My question is, is there any more thoughts to recommend? On the LLL website it talks about there being a correlation of hyperthyroidism and milk ejection difficulty and suggests that oxytocin spray might be beneficial.  Any other thoughts? There is so little information out about hyperthyroidism and breastmilk production.   I dont think decreasing her medication is an option because she remains cancer free and her TSH levels are exactly where her endocrinologist would like them to be to prevent recurrent cancer cells.

Any suggestions would be appreciated, she really wants only human milk for her baby and is dedicated to following a plan to get to that point.  Right now she is keeping a diary so she can see, possibly, small incremental 24 hour improvement over time.


Thank you for your help,

Theresa Johnson RNC, BSN, IBCLC
Orlando Florida  



















      

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