I became pregnant in late 2002, a couple of months after running the 2002 Chicago marathon (12th place finish, 2:39). A sports physician suggested that I get full blood work done at about 4 months post-partum (pp) as I was starting to aggressively ramp up my training for my first pp marathon in the spring of 2004. As I had gone slightly hypothyroid during the pregnancy, we included the thyroid parameters. The shocking results were that I was off-the-scale hyperthyroid, with t4 levels at 42.6 and TSH at undetectable levels below 0.3.
To determine the root cause, my endocrinologist correctly ordered tests for Graves' disease, which measures 24-hour radioactive iodine thyroidal uptake. Fortunately, my own investigation had uncovered the post partum thyroiditis. I questioned the value of the testing which would have meant that I would have to discontinue breastfeeding. The endocrinologist agreed to an interim diagnosis of post partum thyroiditis. If I did not respond to treatment as dictated for post partum thyroiditis, then clearly the testing would be required as a different diagnosis was likely. I did respond and my thyroid condition followed the peak and valley as expected for post partum thyroiditis. Within one month, my system had flip-flopped to a serious hypothyroid state (T4 <5 and TSH 87.36).
Needless to say, with these types of values, my endocrinologist and her assistant were shocked that I had enough energy to walk into the office – with a 5 month old baby in tow and then was even more flabbergasted when I told her that I was still running 50+ miles per week with two workouts and a longer run! But, I’ll admit I was feeling a bit tired!!
I had an excellent plan for my post partum comeback with challenging goals – assuming everything went right. Clearly, it was time to reassess. The goals needed to be re-evaluated based on the impact of this condition.
In the immediate future, I had to focus on recovering to a metabolic equilibrium. Thyroxine and decreased physical activity were required. Despite the recommendation from the endocrinologist to stop training, I consulted with my sport physician, other athletically minded physicians and physiologists to determine what would be appropriate activity in a serious hypothyroid state. As thyroid metabolism feeds into lactate buffering capacity, it was clear that all anaerobic or lactic developing activities must be curtailed. So, I focused on gentle, easy running and eliminated any faster running near or above my anaerobic threshold and all strength training. After about 4 weeks (Feb. 10, 2004), when my blood work showed that I was starting to respond to treatment, I slowly reintroduced faster paced running and strength training. By the end of May 2004, I ran a 34 minute 10k!
I did not reach normal TSH levels until July 2004 as I gradually increased my drug levels. Based on discussions with my endocrinologist, it is my understanding that post partum thyroiditis resolves in about 80% of women. In my case, I have remained in a hypothyroid state and expect to remain this way for the rest of my life. Those of us with a family history of thyroid conditions are more likely to remain affected.
The condition is manageable with ongoing assessment and care. It has driven me to take more care with my lifestyle as a whole which helps support my metabolic system.
Tania Jones, BSc MSc, is one of Canada’s top-ranked marathon runners (3rd, 2005) and a motivational speaker. Tania manages to balance elite athletic achievement in tandem with a successful corporate career as scientific professional with Procter & Gamble Pharmaceuticals and motherhood. Read more about Tania - www.taniajones.com
“I want to have a healthy and dynamic lifestyle. A positive, high-energy lifestyle will help me age in good health and raise a happy family. Competitive running is a vehicle that I use to keep me focused on the elements of this lifestyle”.
- Tania Jones, Feb. ‘05, SheRuns magazine