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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