What is postpartum thyroiditis?
Postpartum thyroiditis is an inflammation of the thyroid that occurs in women after the delivery of a baby.
What causes postpartum thyroiditis?
Postpartum thyroiditis is caused by of anti-thyroid (anti-thyroid peroxidase, anti-thyroglobulin) antibodies that attack the thyroid and cause inflammation.
How common is postpartum thyroiditis?
In the United Status, postpartum thyroiditis occurs in approximately 5-10% of women. The incidence can be greater in certain high-risk populations (see below).
Who is at risk for developing postpartum thyroiditis?
Any woman with:
- Autoimmune disorders (such as Type 1, or juvenile onset, Diabetes Mellitus)
- Positive anti-thyroid antibodies (risk correlates with antibody levels, the higher the antibody the higher the risk)
- History of previous thyroid dysfunction
- History of previous postpartum thyroiditis (20% of women will have recurrence of thyroiditis with subsequent pregnancies)
- Family history of thyroid dysfunction
What is the clinical course of postpartum thyroiditis?
The classic description of postpartum thyroiditis includes thyrotoxicosis followed by hypothyroidism. The thyrotoxic phase usually lasts for 1-3 months and is associated with symptoms including anxiety, insomnia, palpitations (fast heart rate) fatigue, weight loss, and irritability. The hypothyroid phase typically occurs 1-3 months after the thyrotoxic phase and may last up to 9 –12 months. Typical symptoms include fatigue, weight gain, constipation, dry skin, depression and poor exercise tolerance. Most patients (~80%) will have return of their thyroid function to normal within 12-18 months of the onset of symptoms.
How is postpartum thyroiditis treated?
The thyrotoxic phase may be treated with beta blockers to decrease palpitations and reduce shakes and tremors. As symptoms improve, the medication is tapered off since the thyrotoxic phase is transient. Antithyroid medications (see Hyperthyroid brochure) are not used for the thyrotoxic phase since the thyroid is not overactive.
The hypothyroid phase is often treated with thyroid hormone replacement (see Thyroid Hormone Therapy brochure). It is important to try to discontinue thyroid hormone after 6-9 months, since 80% of patients will regain normal thyroid function and not require chronic therapy.
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