Postpartum Thyroiditis

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.

Postpartum Thyroiditis FAQs

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 hormones help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.

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. As in Hashimoto’s thyroiditis, postpartum thyroiditis is associated with the presence of anti-thyroid antibodies (anti-thyroid peroxidase, anti-thyroglobulin). Women with positive antithyroid antibodies are at a much higher risk of developing postpartum thyroiditis than women who do not have have positive antibodies.

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 additional pregnancies)
  • Family history of thyroid dysfunction

WHAT IS THE DIAGNOSIS AND CLINICAL COURSE OF POSTPARTUM THYROIDITIS?

The classic description of postpartum thyroiditis includes thyrotoxicosis followed by hypothyroidism. Not all women appear to go through both phases; approximately 1/3 of patients will manifest both, while 1/3 of patients will have only a thyrotoxic or only a hypothyroid phase.

The thyrotoxic phase occurs 1-4 months after delivery of a child and lasts for 1-3 months. It is associated with symptoms including anxiety, insomnia, palpitations (fast heart rate), fatigue, weight loss, and irritability. Since these symptoms may often be attributed to changes after delivery and the stress of having a new baby, the thyrotoxic phase of post-partum thyroiditis is often overlooked.

It is much more common for women to present during the hypothyroid phase. This typically occurs 4-8 months after delivery and may last up to 9 โ€“12 months. Typical symptoms include fatigue, weight gain, constipation, dry skin, depression and poor exercise tolerance. 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.

HOW IS POSTPARTUM THYROIDITIS TREATED?

Treatment depends on the phase of thyroiditis and degree of symptoms that a patient has. Women presenting with thyrotoxicosis may be treated with beta blockers to decrease symptoms such as palpitations and tremors. As symptoms improve, the medication can be reduced and stopped 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 may be 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 started, treatment should be continued for approximately 6-12 months and then reduced to see if thyroid hormone is required permanently.

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Articles

January 15, 2017 in 2017 News Releases, Featured, News Releases, Postpartum Thyroiditis, Thyroid Disease and Pregnancy

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June 9, 2012 in Postpartum Thyroiditis

FAQ: Postpartum Thyroiditis

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June 4, 2012 in Postpartum Thyroiditis

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FURTHER INFORMATION

For information on thyroid patient support organizations, please visit the Patient Support Links section on the ATA website at www.thyroid.org