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Dr. David Derry Answers Reader Questions
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Index of Q&As with Dr. David Derry



Topic: Low Milk Supply & Breastfeeding With Thyroid Problems

A Reader Writes:

Any thoughts on why some thyroid patients seem to have such tremendous difficulty with low milk supply when attempting to breastfeed?

David Derry Responds:

Dear Patient

Post partum thyroid dysfunction is common especially in women with Hashimoto's thyroid inflammation. This can express itself as mild depressions through to full paranoid delusions and psychotic behavior. With the help of anti-depressants and thyroid most people can be brought out of this quite quickly. One of my most serious cases of mine involved frightening thoughts by the mother about harming her baby. She buried all of her kitchen utensils in the back yard. Fortunately she responded rapidly within a week to thyroid hormone and anti-depressants. From there she went on to do well.

During the pregnancy the demands for thyroid hormone and iodine are more than normal. The placenta also puts out a hormone to make the thyroid work more. So when the stress of the pregnancy is removed the thyroid may end up partially burned out. So just when the mother needs to cope well (needs thyroid hormone) she is left with a worn out thyroid.

Adequate thyroid hormone is essential for initiating breast feeding and this is where that problem comes from. All mammals need thyroid to initiate breast feeding and it is most extreme in the cat. During the immediate post partum period the cat totally empties its thyroid in order to start breast feeding. (1) As well thyroid hormone initiates and controls the last enzymatic process in the breast to make milk.

The thyroid hormone and thyroid gland together with iodine are the most important factors by far for completion of a normal pregnancy and normal baby. Iodine is put into the mother's milk by the lactating breast to levels that are 30 times the levels in the mother's blood. Iodine still has important functions in the child's brain development after birth. Most likely the iodine in the mother's milk is the same function as the iodine in pregnancy which is ensure that the natural death of cells occurs (apoptois). The death of many cells in the brain and elsewhere during development is an important function. Newer evolutionary parts of the brain replace older ones. Because there is limited space in the skull some cells have to die off to make room for the more evolutionary modern cells. It has been estimated that about 80 percent of the brain tissue is replaced during development in this manner.

There is an increased need for thyroid hormone and iodine during pregnancy. Thus each pregnancy is a load on the thyroid function which not every women's thyroid gland carries out adequately. As thyroid is important for adolescence, normal menstruation, pregnancies and menopause it is not surprising the females have a much higher incidence of thyroid dysfunction.

So I feel poor milk production in women with a history of thyroid dysfunction is likely related to low blood levels of thyroid hormone. As breast feeding is so important to the child and mother it seems important to check this out at the time.

It is likely that if thyroid hormone is given to a mother with breast feeding problems the problems would disappear quickly within a week.

Hope this helps answer your question.

David

(1) Pitt-Rivers R, Tata JR. Thyroid hormones. 1st ed. London: Pergamon, 1959. page 86-88.

(2) Moon RC. Influence of graded thyroxine levels on mammary gland growth. Amer J Physiol 1962; 203:942-946.

For More Information

See The Thyroid Guide to Fertility, Pregnancy & Breastfeeding Success




About Dr. Derry:

Dr. Derry is no longer practicing medicine.

These answers are personal opinions. Please discuss any ideas you get with your physician.

Born in 1937, I am at the cutting edge of the war baby boom. With one exception the baby boomers tend to do what I do in large numbers about ten years later. The exception was that after finishing my internship at the Toronto General Hospital in 1963, as I had planned, I started a PhD in biochemistry at the Montreal Neurological Institute at McGill University in Montreal. After completing my PhD, I was hired by the Department of Pharmacology at the University of Toronto to teach and do research. Within a short time I became a Medical Research Council Scholar, which meant the Medical Research Council of Canada paid my salary to do research. Domestic rearrangements suddenly placed five children between the ages of 5 and 9 under my care. I abandoned my research career and took all five children, a new wife and dog out west to Victoria British Columbia.

My aim in 30 years of General Practice (an honor and a privilege) was to learn carefully and persistently how to listen to the patient. This is the one area of medical research that has gone almost totally un-examined. Sir William Osler, who I feel was the greatest physician of all time, said: if you listen to the patient they will usually give you the diagnosis and if you listen even more carefully they will likely indicate the best treatment for them. Gradually with the help of multiple self-development courses over the years I learned to listen by just getting my ego out of the way. From my patients I learned everything. Because of the arrival of effective treatments with potential side-effects, in 1945 the out-dated Hippocratic oath of “do no harm” was replaced with a new principle of ethical patient care namely “Consider first the well-being of the patient.” Combining extensive medical-literature reading with what I learned daily from patients clarified which approaches and treatments assured the “well-being of the patient.”

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