Post Partum Thyroiditis

May be misdiagnosed as postnatal depression so be sure to check TFTS

About

• May be seen up to 1 yr post-delivery
• Often lasts several weeks to months

Aetiology

• Increased in diabetics, history of thyroid and autoimmune disease

Histology

• Histologically causes a lymphocytic thyroiditis.

Clinical

• Initially hyperthyroid and then hypothyroid but either can occur
• Hyper: Anxiety, Irritability, Rapid heartbeat or palpitations, Unexplained weight loss, Increased sensitivity to heat, Fatigue, Tremor, Insomnia
• Hypo: Lack of energy, Increased sensitivity to cold Constipation, Dry skin, Weight gain, Depression
• Mild or No eye signs, perhaps lid lag. Minimal thyroid enlargement

Investigations

• TFTS: hypo (Low T4 high TSH) or hyper thyroid (High T4 low TSH)
• High titre of anti-TPO antibodies

Management

• Manage symptomatically - hyperthyroid may be transient. Use beta blockers.
• May not need usual antithyroid medications as phase is often transient.
• Monitoring and can proceed to hypothyroidism needing T4 replacement
• If T4 started this can be withdrawn after 12 months and reassessed to see if still needed.
• Most women will regain normal thyroid function within 12-18 months after the onset of symptoms.
• However, approximately 20% of those that go into a hypothyroid phase will remain hypothyroid.

References

• Post Partum Thyroiditis Patient leaflet