The “2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum” were coauthored by an international task force of expert clinicians and researchers in the field of thyroidology. Led by Co-chairs Erik Alexander MD, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA and Elizabeth Pearce, MD, MSc, Boston University School of Medicine, the task force provides a solid foundation of knowledge on the assessment and treatment of thyroid disease in women during pregnancy, preconception, and the postpartum period. The Guidelines include recommendations related to the diagnosis and management of hypothyroidism, thyrotoxicosis, thyroid nodules, and thyroid cancer, as well as thyroid considerations in infertile women, fetal and neonatal considerations, and directions for future research.

“These guidelines provide a superb overview on the pathophysiology and the clinical management of thyroid disorders during and after pregnancy. In addition, they also define areas where additional research is needed; this will allow keeping the document living with further updates in the coming years,” says Peter A. Kopp, MD, Editor-in-Chief of Thyroid and Professor of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago.

“Produced by an international panel of recognized experts, these updated guidelines add to the library of similar documents on thyroid disease that serve as the gold standard for diagnosis and management of thyroid disorders and identify critical areas where more research and knowledge is needed,” says, John C. Morris, III, MD, President of the ATA, Mayo Clinic, Rochester, MN.

“With an estimated 300,000 pregnancies impacted by thyroid disease in the United States annually, these guidelines coalesce the best available evidence into clear clinical recommendations, and will improve the health of many, many mothers and newborns alike,” say Dr. Alexander and Dr. Pearce.

About the Journal
Thyroid, the official journal of the American Thyroid Association, is an authoritative peer-reviewed journal published monthly online with open access options and in print. The Journal publishes original articles and timely reviews that reflect the rapidly advancing changes in our understanding of thyroid physiology and pathology, from the molecular biology of the cell to clinical management of thyroid disorders. Complete tables of content and a sample issue may be viewed on the Thyroid  website. The complete Thyroid Journal Program includes the highly valued abstract and commentary publication Clinical Thyroidology, led by Editor-in-Chief Jerome M. Hershman, MD and published monthly, and the groundbreaking videojournal companion VideoEndocrinology, led by Editor Gerard Doherty, MD and published quarterly. Complete tables of content and sample issues may be viewed on the Thyroid website.

About the Society
The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international multi-discipline medical society with over 1,700 endocrinologists, surgeons, oncologists from 43 countries around the world. Celebrating its 94^th anniversary, the ATA delivers its mission—of being devoted to thyroid biology and to the treatment of thyroid disease through excellence in research, clinical care, education, and public health—through several key endeavors: the publication of highly regarded professional journals, Thyroid, Clinical Thyroidology, and VideoEndocrinology; annual scientific meetings; biennial clinical and research symposia; research grant programs for young investigators, support of online professional, public and patient educational programs; and the development of guidelines for clinical management of thyroid disease and thyroid cancer. The ATA promotes thyroid awareness and information through its online Clinical Thyroidology for the Public (distributed free of charge to over 11,000 patients and public subscribers) and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet.

About the Publisher
Mary Ann Liebert, Inc., publishers is a privately held, fully integrated media company known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research, including Diabetes Technology & Therapeutics, Journal of Women’s Health, and Metabolic Syndrome and Related Disorders. Its biotechnology trade magazine, GEN (Genetic Engineering & Biotechnology News), was the first in its field and is today the industry’s most widely read publication worldwide. A complete list of the firm’s more than 80 journals, books, and newsmagazines is available on the Mary Ann Liebert, Inc., publishers website.

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What is the thyroid gland?

The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid’s job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.

What are the symptoms of postpartum thyroiditis?

Thyroiditis is a general term that refers to “inflammation of the thyroid gland” (see Thyroiditis Brochure); thus, postpartum thyroiditis is thyroiditis that occurs in women after the delivery of a baby. Thyroiditis can cause both thyrotoxicosis (high thyroid hormone levels in the blood) and hypothyroidism (low thyroid hormone levels in the blood). In postpartum thyroiditis, thyrotoxicosis occurs first followed by hypothyroidism.

What causes postpartum thyroiditis?

The exact cause is not known but it is believed to be an autoimmune disease very similar to Hashimoto’s thyroiditis. In fact, these two disorders cannot be distinguished from one another on pathology specimens. As in Hashimoto’s thyroiditis, postpartum thyroiditis is associated with the development of anti-thyroid (anti-thyroid peroxidase, anti-thyroglobulin) antibodies. Women with positive antithyroid antibodies are at a much higher risk of developing postpartum thyroiditis than women who do not have have positive antibodies. It is believed that women who develop postpartum thyroiditis have an underlying asymptomatic autoimmune thyroiditis that flares in the postpartum period when there are fluctuations in immune function.

How comon is postpartum thyroiditis?

In the United Status, postpartum thyroiditis occurs in approximately 5-10% of women. The incidence can be greater in certain highrisk 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. Not all women demonstrate evidence of going through both phases; approximately 1/3 of patients will manifest both phases, while 1/3 of patients will have only a thyrotoxic or hypothyroid phase. The thyrotoxic phase occurs 1-4 months after delivery of a child, lasts for 1-3 months and is associated with symptoms including anxiety, insomnia, palpitations (fast heart rate), fatigue, weight loss, and irritability. Since these symptoms are often attributed to being postpartum and the stress of having a new baby, the thyrotoxic phase of postpartum thyroiditis is often missed. It is much more common for women to present in the hypothyroid phase, which typically occurs 4-8 months after delivery and may last up to 9 –12 months. Typical symptoms include fatigue, weight gain, constipation, dry skin, depression and poor exercise tolerance. Most women will have return of their thyroid function to normal within 12-18 months of the onset of symptoms. However, approximately 20% of those that go into a hypothyroid phase will remain hypothyroid.

How is postpartum thyroiditis treated?

Treatment depends on the phase of thyroiditis and degree of symptoms that patients exhibit. Women presenting with thyrotoxicosis 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). If the hypothyroidism is mild, and the patient has few, if any, symptoms, no therapy may be necessary. If thyroid hormone therapy is begun, treatment should be continued for approximately 6-12 months and then tapered to see if thyroid hormone is required permanently. It is always important to try to discontinue thyroid hormone after postpartum thyroiditis, since 80% of patients will regain normal thyroid function and not require chronic therapy.

Further Information

Further details on this and other thyroid-related topics are available in the patient information section on the American Thyroid Association^® website at www.thyroid.org.

Postpartum Thyroiditis Brochure for Saving and Printing (PDF File, 445 KB)

Postpartum Thyroiditis Brochure for Saving and Printing (PDF File, 187 KB)

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