Elise,

       It could be hypothyroidism.  Your main question was:  "So, the
question: supposing it is hypothyroidism, can her milk be brought in, and if
so, how?"  The biggest problem that we run into is that it will be difficult
for her doctor to automatically get her on the right dosage.  When I was
diagnosed with hypothyroidism, specifically Hashimoto's disease (and I was
not lactating), it took an endocrinologist (the "best" specialist in town)
about one and a half years to get my synthroid dosage "just right" -- and
issues like weight and breastfeeding do affect the outcome.

       Providing too high a dosage of synthroid can cause someone to be
hyperthyroid, which increases the possiblity of high blood pressure and heart
attack.  So even the specialist is placed in "educated guess" mode to
determine the appropriate dosage.  However, if the mother is hypothyroid, she
"definitely" needs treatment.  I would recommend that she get an appointment
with an endocrinologist ASAP.  Once my regular doctor found my elevated TSH
21.55 (normal range is usually 1-3!), she immediately referred me to the
endocrinologist.  I ended up waiting six weeks for an appointment.  In this
day and age of HMO, some general practitioners try to handle the intricacies
of synthroid dosage themselves.  Please HIGHLY recommend an endocrinologist
for this.  Their main focus is thyroid and diabetic diseases.  Sadly, it may
take a couple of months before your mother can even get in to see a
specialist, so if her GP is willing to start treatment earlier, it couldn't
hurt milk production now.

       Often women with hypothyroidism are sluggish, so it would not surprise
me if she is very tired and not pumping or feeding as often as she should
(assuming she does have hypothyroid...).  Basic breastfeeding strategies
still apply.  Mom will have to increase feedings and pumpings if baby is not
interested.  She needs to maintain appropriate water and food intake.  Of
course, proper latch is imperative.  Don't let mom think that the answer is a
little pill she needs to take every day.  She still needs to get things
moving milk supply-wise.

Debbie Albert, Ph.D.,IBCLC
Tampa Lactation Counseling
Tampa, FL

P.S. -- Are you related to a Betsy Gagni in Tampa, FL?


In a message dated 6/18/02 10:42:36 PM Eastern Daylight Time,
[log in to unmask] writes:


> Date:    Tue, 18 Jun 2002 22:17:48 -0400
> From:    Rick Gagne & Elise Morse-Gagne <[log in to unmask]>
> Subject: milk not coming in; thyroid?
>
> I've looked in the archives and seen quite a few posts on the topic but saw
> nothing addressing my specific question.
>
> Mom whose milk has not come in at 1 week postpartum--zilch--no breast
> changes.  Being seen by LC.  Does not appear to be retained placenta, no
> other obvious reasons.  Some years ago there was some question about her
> thyroid function.  So, the question: supposing it is hypothyroidism, can
> her milk be brought in, and if so, how?
>
> I saw several posts in the archives saying "low milk, but thyroid function
> normal/low normal".  I have talked with three mothers whose thyroid
> function was either being treated and was considered "under control" or was
> "within normal range" (but they were being tested for some reason, other
> than milk supply, in the first place) whose milk was definitely low.  I see
> that Dr Hale in _Clinical Therapy_ says that "the nuances in discerning
> hypothyroid states are enormous and careful ... study...by accomplished
> clinicians or endocrinologists is important."  I have certainly gotten the
> impression from my vast experience :-) that milk supply may be a more
> sensitive indicator for thyroid problems than the tests, or perhaps the
> people interpreting the tests.  Or could the thyroid levels fluctuate
> rapidly enough (especially in and after pregnancy) that test results from
> August might not be applicable in October?
> Comments from more medically knowledgeable types solicited!



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