Postpartum Thyroiditis: Not Just a Worn Out Mom
Postpartum thyroiditis (PPT) is a common condition that can occur in the first 12 months after delivery, affecting 5% to 7% of all postpartum women. This article provides a case illustration of this disorder. The typical clinical course for PPT is that of initial thyrotoxicosis (hyperthyroidism), followed by a hypothyroid state, and eventual return to normal thyroid function. Symptoms of thyroid dysfunction can be mistaken for normal postpartum adjustment and fatigue by the patient. PPT must be distinguished from other causes of abnormal thyroid function. Treatment focuses on reduction of symptoms. Antithyroid medication is not indicated. Women who develop PPT are at high risk for future development of hypothyroidism.
A 36-year-old woman who is 8 months postpartum presents for care in the endocrinology clinic. For the past few weeks she has felt "on edge" with occasional palpitations, increased frequency of bowel movements, difficulty concentrating, and insomnia. Her hands feel tremulous when she tries to write. She has felt too shaky to perform her usual exercise routine. She has lost 7 pounds in the last 9 months, dropping from 149 pounds to 142 pounds. She denies any visual changes or heat intolerance. She has a history notable for postpartum thyroiditis (PPT) with transient hyperthyroidism after the birth of her first child 2 years ago. Thyroid-stimulating hormone (TSH) and free thyroxine (T4) levels checked at 6 weeks postpartum several months ago were both normal. She is currently amenorrheic as a result of progesterone intrauterine device (IUD) for birth control. She is on no other medications, and has no allergies. She is not breastfeeding. She admits that she is anxious about this recurrence of thyroid symptoms and about how long she will feel bad. She does not smoke or use recreational drugs. She drinks four glasses of wine weekly. She is married with two small children. Significant family history includes a mother with Graves' disease treated with radioactive iodine, maternal grandmother with hypothyroidism, and maternal great grandmother with hyperthyroidism.
Physical Exam
Blood pressure: 114/80
Pulse: 90
Weight: 142 pounds
Height: 65 inches, BMI 23.6
Skin: warm and dry, no onycholysis
Eyes: no lid lag, lid retraction, or exopthalmus
Thyroid: slightly enlarged, firm, symmetrical, nontender. No nodules. No bruit auscultated over thyroid
Heart: regular rate, rhythm
Upper extremities: fine bilateral tremor. Biceps and patellar reflexes are symmetrical, 3+. Achilles reflexes 2+ bilaterally. Normal relaxation phase.
Initial Diagnostics
TSH: 0.05 μIU/mL (normal 0.34–5.66)
T4: 2.36 ng/dL (normal 0.52–1.21)
Thyroid scan and radioiodine uptake: radioiodine 24-hour uptake calculated at 1% (normal 10%–30%).
The trend of her thyroid studies in subsequent clinic visits is shown in Table 1 .
Postpartum thyroiditis (PPT) is a common condition that can occur in the first 12 months after delivery, affecting 5% to 7% of all postpartum women. This article provides a case illustration of this disorder. The typical clinical course for PPT is that of initial thyrotoxicosis (hyperthyroidism), followed by a hypothyroid state, and eventual return to normal thyroid function. Symptoms of thyroid dysfunction can be mistaken for normal postpartum adjustment and fatigue by the patient. PPT must be distinguished from other causes of abnormal thyroid function. Treatment focuses on reduction of symptoms. Antithyroid medication is not indicated. Women who develop PPT are at high risk for future development of hypothyroidism.
A 36-year-old woman who is 8 months postpartum presents for care in the endocrinology clinic. For the past few weeks she has felt "on edge" with occasional palpitations, increased frequency of bowel movements, difficulty concentrating, and insomnia. Her hands feel tremulous when she tries to write. She has felt too shaky to perform her usual exercise routine. She has lost 7 pounds in the last 9 months, dropping from 149 pounds to 142 pounds. She denies any visual changes or heat intolerance. She has a history notable for postpartum thyroiditis (PPT) with transient hyperthyroidism after the birth of her first child 2 years ago. Thyroid-stimulating hormone (TSH) and free thyroxine (T4) levels checked at 6 weeks postpartum several months ago were both normal. She is currently amenorrheic as a result of progesterone intrauterine device (IUD) for birth control. She is on no other medications, and has no allergies. She is not breastfeeding. She admits that she is anxious about this recurrence of thyroid symptoms and about how long she will feel bad. She does not smoke or use recreational drugs. She drinks four glasses of wine weekly. She is married with two small children. Significant family history includes a mother with Graves' disease treated with radioactive iodine, maternal grandmother with hypothyroidism, and maternal great grandmother with hyperthyroidism.
Physical Exam
Blood pressure: 114/80
Pulse: 90
Weight: 142 pounds
Height: 65 inches, BMI 23.6
Skin: warm and dry, no onycholysis
Eyes: no lid lag, lid retraction, or exopthalmus
Thyroid: slightly enlarged, firm, symmetrical, nontender. No nodules. No bruit auscultated over thyroid
Heart: regular rate, rhythm
Upper extremities: fine bilateral tremor. Biceps and patellar reflexes are symmetrical, 3+. Achilles reflexes 2+ bilaterally. Normal relaxation phase.
Initial Diagnostics
TSH: 0.05 μIU/mL (normal 0.34–5.66)
T4: 2.36 ng/dL (normal 0.52–1.21)
Thyroid scan and radioiodine uptake: radioiodine 24-hour uptake calculated at 1% (normal 10%–30%).
The trend of her thyroid studies in subsequent clinic visits is shown in Table 1 .
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