Thyroid replacement was begun, the mothers energy returned quickly, her milk production increased, and formula supplementation was no longer necessary. Despite a general awareness that hypothyroidism can interfere with successful lactation, there has been little research into the mechanisms of that interference until recently.
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19 The hypothyroid state is usually more obvious clinically, leading to diagnosis. In some cases onset may be days after delivery, accompanied not only by signs of hyperthyroidism but also by severe hypertension.
Two recent human cases have involved multigravid women who delivered prematurely secondary to poorly controlled hyperthyroidism. In each case, lactation was severely suppressed with neither woman able to express colostrum. Standard lactation management strategies were tried without success.
Recent studies may provide some new insights. A decade ago, Joshi et al. (1993) noted that lactation failure preceded the clinical evidence of thyroid problems in a number of their study subjects.
In an acute suckling test at 21 days postpartum, significantly smaller increases in serum prolactin and oxytocin concentration were found in treated rats compared to controls after 30 minutes of suckling.
The rats were able to lactate, but impairment of milk ejection led to apoptosis, involution, and litter death over time. Histological studies again showed functional mammary tissue with distended alveoli but almost total absence of adipose tissue.
Thus, improving milk release may improve lactation when thyroid hormones are dysfunctional. Exogenous pitocin (i.e., pitocin nasal spray) might provide the oxytocin necessary to eject milk. Massaging the breast from the chest toward the nipple prior to feeding may make more milk available to baby.
5 Tighter standards might also be applied to pre-conception and later pregnancy, and if extended through lactation might allow some struggling breastfeeding mothers to obtain help sooner. When hypothyroidism is diagnosed, thyroid hormone replacement is the first-line treatment.
In 2003, Hapon et al. induced hypothyroidism in rats before mating and compared these rats to controls during lactation. They discovered no differences in sucklinginduced prolactin release but did find a reduction in circulating oxytocin after suckling.
They should be considered supportive, not first-line therapy, but may be useful adjunct therapy when milk production has suffered. Greater recognition of the impact of thyroid dysfunction on lactation and timely, accurate diagnosis with appropriate treatment of affected mothers will en.
No correlation was observed between the T3 concentration or daily T3 excretion in milk and the T3 concentration in serum. The total amount of T3 excreted in milk was estimated as only 5-1000 ng/day.
The treated mothers released less milk than did control mothers, resulting in poor milk transfer and poor litter growth. 11. Hyperthyroidism. Hyperthyroidism is evidenced by a reduction in TSH and an increase in T3/T4.