Postpartum Thyroiditis



Postpartum thyroiditis refer to thyroiditis that develops in women after they have delivered a baby.



Symptoms of Postpartum Thyroiditis



Symptoms occur in two phases:


Symptoms of Hyperthyroidism develop a few weeks after delivery. These symptoms include:



1. Fatigue.


2. Restlessness.


3. Palpitations.


4. Insomnia.


5. Excessive perspiration.


6. Intolerance to heat.


7. Excessive weight loss.




A few weeks later, these symptoms subside on their own and Symptoms of Hypothyroidism develop, which include:


1. Fatigue, sluggishness.


2. Weight gain.


3. Intolerance to cold.


4. Depressed mood.


5. Excessive weight gain.



Some patients may not experience the phase of hyperthyroidism and go straight into the phase of hypothyroidism.




Cause of Postpartum thyroiditis



The cause of postpartum thyroiditis is an inflammation of the thyroid gland which destroys the architecture of the thyroid gland.


Normally, the thyroid gland stores a large amount of thyroid hormones to be released in small quantiies over a period of time.


With the destruction of the gland caused by the storm of the postpartum thyroiditis, the large quantities of the stored thyroid hormones gets released into the blood circulation. This causes the phase of hyperthyroidism.


The thyroid hormones remain in circulation for a few weeks (6-12 weeks) and so does the phase of hyperthyroidism.


After the storm clears up, the thyroid gland starts to repair itself, but it takes a while.


During this period, there is shortage of thyroid hormones, which gives rise to the phase of hypothyroidism.


This phase typically last a few weeks (6-12 weeks) and so does the phase of hypothyroidism.


Eventually, in most cases, the thyroid gland restores back to normal, although some patients may become hypothyroid permanently.




Diagnosis of Postpartum Thyroiditis



Diagnosis of postpartum thyroiditis is a tricky one. Patients usually consult their obstetrician or family physician who often does not think about the possibility of postpartum thyroiditis.


Patients get placed on a variety of medicines to control their symptoms which do not get better and they feel quite frustrated.


It takes an endocrinologist to diagnose postpartum thyroiditis.



Tests include:


1. TSH, Free T4, FreeT3


2. Thyroid Antibodies


3. A thyroid scan using I-123



The I-123 thyroid scan is the most useful tool in deciding whether hyperthyroidism is due to postpartum thyroiditis or Graves' disease.


However, the I-123 thyroid scan should not be done if a patient is breast-feeding.



Treatment of Postpartum Thyroiditis



In the majority of cases, postpartum thyroiditis is a self-limiting disease. Therefore, no specific treatment is required. However, close monitoring is essential.


Symptoms of hyperthyroidism can be managed with a BetaBlocker such as atenolol or propranolol.


Symptoms of hypothyroidism may requires a short course of thyroid hormone replacement with T4 and T3.


Patient education and close monitoring of the thyroid functions are the most important components of treatment.




This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, photoEndocrinology and Metabolism.



Dr. Zaidi is a former assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.



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