You're exhausted, but everyone's exhausted with a baby. You're anxious, but isn't that just new-mom worry? Your heart races at night, your hair is falling out in the shower, you can't remember why you walked into the kitchen, and you feel low in a way you can't quite explain.
You keep telling yourself it's normal. That you just need to try harder, sleep more, get more organized. That other moms seem to handle this, so you should too.
Here's something a lot of moms are never told: sometimes what feels like postpartum anxiety or depression has a physical piece, and one of the most common is a change in how your thyroid is working after birth. It's called postpartum thyroiditis, and it's worth knowing about. Not so you can diagnose yourself, but so you know what to ask.
This post isn't medical advice, and I'm a therapist, not a physician. What I can do is help you understand how your body and your mental health are connected, so you can walk into your next appointment with the right questions and stop blaming yourself for symptoms that might not be "just in your head."
For busy moms in San Francisco, San Jose, Los Angeles or San Diego who are back at work or running a household on very little sleep, it's easy to write these symptoms off as "just postpartum." Sometimes they deserve a closer look.
What Your Thyroid Has to Do With Your Mood
Your thyroid is a small, butterfly-shaped gland at the front of your neck. It makes hormones that help regulate your energy, your heart rate, your body temperature, your metabolism, and yes, your mood and ability to think clearly.
When the thyroid makes too much hormone, the body can feel like it's stuck in overdrive. When it makes too little, everything can feel slowed down and heavy. Either one can affect how you feel emotionally, which is why thyroid changes and mental health symptoms can look so similar.
What Is Postpartum Thyroiditis?
Postpartum thyroiditis is inflammation of the thyroid that can happen in the year after giving birth. It affects roughly 5 to 10 out of every 100 people after delivery, which makes it far more common than most moms realize. It can also happen after a miscarriage or other pregnancy loss.
It often unfolds in two phases, although not everyone goes through both, and the timing varies:
Phase one: the overactive (hyperthyroid) phase
This often shows up around 1 to 4 months after birth. As the inflamed thyroid releases stored hormone, you might notice:
Feeling anxious, jittery, irritable or "wired"
A racing or pounding heart
Trouble sleeping, even when the baby is asleep
Feeling hot or sweaty when others aren't
Shaky hands
Losing weight quickly without trying
Feeling restless or unable to sit still
This phase can be short and mild, and it's easy to miss. Many of these symptoms sound a lot like postpartum anxiety, or just life with a newborn.
Phase two: the underactive (hypothyroid) phase
This often shows up around 4 to 8 months after birth. As the thyroid runs low on hormone, you might notice:
Deep fatigue that rest doesn't seem to touch
Low mood, flatness, or losing interest in things you used to enjoy
Brain fog, trouble concentrating, or forgetfulness
Feeling cold all the time
Dry skin, more hair loss than you'd expect
Constipation
Weight gain or trouble losing weight
Aches and stiffness
Again, many of these overlap with postpartum depression and with plain sleep deprivation. That overlap is exactly why it's worth asking a medical provider to take a look.
For many people, thyroid levels return to normal within about 12 to 18 months of when symptoms start. Some develop a lasting underactive thyroid that needs ongoing medical care. Your medical provider can tell you what to keep an eye on going forward.
Why It's So Easy to Miss
Postpartum thyroid changes hide in plain sight. Think about it: tired, anxious, foggy, emotional, losing hair, can't sleep, body feels different. That's a description of almost every new mom. So the symptoms get waved off, by doctors, by partners, by friends, and often by moms themselves.
There's also timing. Your postpartum checkup may happen before thyroid changes start. By the time you're at four or six months and feeling off, the official "postpartum" appointments are behind you, and you might not think to connect the dots.
And then there's the voice a lot of high-achieving moms know well: Don't make a fuss. Everybody's tired. You're being dramatic. Just push through. That voice is one of the biggest reasons moms wait too long to ask for help, for their thyroid, their mental health, or both.
Taking martyrdom out of motherhood means trading "push through" for "check it out." Asking a question about your body is not being high-maintenance. It's being informed.
Thyroid Changes vs. Postpartum Anxiety and Depression
Here's the honest answer: you can't tell the difference from symptoms alone, and you shouldn't have to try. A blood test your medical provider can order is what tells you how your thyroid is working.
What's helpful to know:
Thyroid changes can look like anxiety. The overactive phase can bring a racing heart, restlessness, irritability and trouble sleeping, much like postpartum anxiety.
Thyroid changes can look like depression. The underactive phase can bring fatigue, low mood, brain fog and loss of interest, much like postpartum depression.
They can happen together. Having a thyroid issue doesn't rule out postpartum depression or anxiety, and having depression or anxiety doesn't rule out a thyroid issue.
Treating one doesn't always resolve the other. Some moms find that once their thyroid is managed, they feel much more like themselves. Others still have anxiety or low mood that deserves its own care. Both are normal.
This is why "body and mind" care tends to work best together. The American Thyroid Association recommends screening for thyroid problems in anyone with depression, including postpartum depression. If you're struggling emotionally after having a baby, it's reasonable to ask whether thyroid testing makes sense for you.
Who May Be at Higher Risk
Anyone can develop postpartum thyroid changes, but your chances may be higher if you:
Have tested positive for thyroid antibodies before or during pregnancy
Have type 1 diabetes or another autoimmune condition
Have a personal or family history of thyroid conditions
Had postpartum thyroiditis after an earlier pregnancy
If any of these apply to you, mention it to your OB, midwife or primary care provider, even if you feel fine right now.
How to Bring It Up With Your Doctor
It can be hard to know how to start this conversation, especially if you're worried about being brushed off. Here's a simple way to do it.
Write down what you've noticed before the appointment. Brain fog makes it hard to remember details in the moment. A quick list on your phone helps: what symptoms, when they started, whether they're getting better or worse, and how they're affecting your days.
Use clear, specific language. For example: "I'm X months postpartum. I've been having a racing heart, trouble sleeping and feeling anxious most days. I've read about postpartum thyroiditis. Could we check my thyroid?"
Mention your mental health too. If you're feeling low, anxious or not like yourself, say so. Your provider can look at the whole picture and talk with you about next steps for both.
Bring backup if it helps. A partner or friend can come along or join by phone to help you remember what was said.
It's okay to follow up. If your results come back normal and you still feel off, that's important information too. It may point toward postpartum depression or anxiety, which can be treated with the right support. Keep the conversation going.
If you're breastfeeding or taking any medications, your provider can factor that into any testing or treatment decisions. Please don't start, stop or change any medication without talking to your prescriber first.
Taking Care of Yourself While You Get Answers
Waiting for appointments and results can be stressful, especially for moms who like having a plan. A few things that can help in the meantime:
Lower the bar on purpose. If you're running on empty, this is not the season for perfect meals or a spotless house. Decide what truly matters this week and let the rest go.
Protect sleep where you can. Trade night shifts with your partner, ask a family member to take a morning, or nap when it's possible. Sleep won't fix a thyroid issue, but it helps everything feel a little more manageable.
Eat regular meals. Not perfectly, just regularly. Skipping meals can make shakiness, irritability and fatigue feel worse.
Tell someone what's going on. "I'm getting my thyroid checked because I've been feeling really off" is a complete sentence. You don't owe anyone a full explanation to ask for help.
Be kind to your brain. Use lists, reminders and calendar alerts. Forgetting things right now doesn't mean you're failing. It may mean your body needs attention.
When to Seek Help
Feeling tired and emotional with a new baby is common. But please reach out to your OB, midwife, primary care provider or a perinatal therapist if:
Anxiety, low mood, irritability or exhaustion last more than about two weeks, or keep getting heavier
You notice a racing heart, shakiness, feeling unusually hot or cold, or big unexplained weight changes
You can't sleep even when you have the chance to
Brain fog or fatigue is making it hard to get through your day
You're having intrusive or scary thoughts you can't shake
You feel hopeless, numb, or like your family would be better off without you
You've had depression, anxiety or a thyroid condition before and notice familiar signs
If you have chest pain, a very fast or irregular heartbeat, trouble breathing, or feel faint, seek medical care right away.
You don't have to be "bad enough" to deserve care. Reaching out early is not overreacting.
If you're in crisis or worried about your safety, please reach out right now:
Call or text 988, the Suicide & Crisis Lifeline, available 24/7
Call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262), free, confidential and available 24/7
Call the Postpartum Support International HelpLine at 1-800-944-4773, or text "HELP" to 800-944-4773 (Spanish: text 971-203-7773), for support and resources (not a crisis line), or visit postpartum.net
If you're in immediate danger, call 911 or go to your nearest emergency room
How Therapy Fits In
Therapy doesn't diagnose or treat thyroid conditions. That's your medical team's job. But therapy can be a big part of feeling like yourself again, whether your thyroid turns out to be involved or not.
In our work together, we can:
Help you sort out what you're feeling and prepare for conversations with your medical providers
Support you with postpartum anxiety or depression, whether it shows up alongside a thyroid issue or on its own
Ease the stress of waiting for answers, and the frustration of feeling dismissed
Work through the "I should be handling this better" story so you can ask for what you need
Build practical tools for calming anxiety, managing low energy days, and protecting your relationships
Help you adjust if you're facing an ongoing health condition on top of new motherhood
I'm Alexa Levine, LMFT, a licensed marriage and family therapist who works only with pregnant and postpartum moms. My practice is 100% virtual, so I see moms throughout California, including Bay Area moms looking for pregnancy and postpartum therapy in San Francisco and San Jose, as well as Los Angeles, Orange County and San Diego.
Many of the moms I work with are high-achieving professionals: attorneys, physicians, tech and creative leaders, founders, and moms carrying the mental load for the whole household while heading back to work. Sessions are 100% virtual and fit around a full calendar. My practice is private pay at $275 per session, and you book directly with me. The easiest first step is a free 10-minute consult call.
Your Symptoms Deserve to Be Taken Seriously
If you've been telling yourself that feeling this off is just part of having a baby, consider this your permission to ask more questions. Your body went through something enormous. Checking in on it is not complaining. It's taking care of the person your family depends on.
If you'd like support while you figure it out, book your free 10-minute consult call. It's a quick, no-pressure call to see if we're a good fit. You can also reach me through my contact page.
Frequently Asked Questions
Can postpartum thyroid problems cause anxiety or depression?
Thyroid changes after birth can cause symptoms that look a lot like anxiety or depression. An overactive thyroid can bring a racing heart, irritability and trouble sleeping, while an underactive thyroid can bring fatigue, low mood and brain fog. Thyroid issues and postpartum depression or anxiety can also happen at the same time, so it helps to talk with your medical provider and a perinatal therapist.
What are the signs of postpartum thyroiditis?
Postpartum thyroiditis often has two phases. The overactive phase, often around 1 to 4 months after birth, can bring anxiety, a racing heart, heat intolerance, shakiness and weight loss. The underactive phase, often around 4 to 8 months, can bring fatigue, low mood, feeling cold, dry skin, hair loss and weight gain. Not everyone has both phases, and only a blood test can confirm it.
How common is postpartum thyroiditis?
Postpartum thyroiditis affects roughly 5 to 10 out of every 100 people in the year after giving birth. It is more likely if you have thyroid antibodies, type 1 diabetes, a personal or family history of thyroid conditions, or had postpartum thyroiditis after an earlier pregnancy.
Should I ask my doctor to check my thyroid if I have postpartum depression?
It's a reasonable question to ask. The American Thyroid Association recommends screening for thyroid problems in anyone with depression, including postpartum depression, since thyroid changes can cause similar symptoms. Your OB, midwife or primary care provider can decide whether a blood test makes sense for you.
Can therapy help if my symptoms are caused by my thyroid?
Therapy does not treat thyroid conditions, which need medical care. But therapy can help with postpartum anxiety or depression that shows up alongside a thyroid issue, the stress of waiting for answers, and adjusting to a health condition as a new mom. Alexa Levine, LMFT offers virtual therapy for pregnant and postpartum moms throughout California, with a free 10-minute consult call.
