The body and immune system go through enormous changes post-delivery of a baby, and changes in how mothers feel is common. Post-partum thyroid dysfunction is very common, especially so in the following groups.

Very High Risk and should be routinely monitored:

• Previous episode of post-partum thyroiditis

• have thyroid disease such as Hashimoto's thyroiditis or take thyroid hormone replacement

High risk and monitoring recommended:

• type 1 diabetes mellitus

• chronic hepatitis C

• Positive thyroid peroxidase antibodies

• Previous autoimmune non-thyroid disease

Increased risk, consider monitoring:

• systemic lupus erythematosis (SLE)

• had gestational diabetes mellitus

• if there is a family member with thyroid disease, whether autoimmune or not

• if there is a family member with a non-thyroid autoimmune condition.

Post-partum thyroiditis can easily be missed, or mis-diagnosed, often as depression. It is essential to have a clinical assessment and blood test to diagnose it, and consider the differential diagnoses, such as Graves' thyrotoxicosis or toxic adenoma. It can cause problems caring for and bonding with the baby, difficulties in breast feeding and if undiagnosed can cause difficulties for subsequent pregnancies, especially if the mother was to conceive and carry with undiagnosed and untreated hypothyroidism.

If you, or a patient has any symptoms that could be attributable to thyroid dysfunction in the year after delivery it is important to be checked. If you or your patient are part of the higher right groups you might consider routine monitoring as above, and/ or arrange a review with an endocrinologist and London Swiss Medical would be happy to advise you.