Clinical Case #1 - Postpartum Thyroiditis - Pearson Flashcards
What specific findings would one look for on physical exam that may provide evidence of underlying thyroid disease?
Palpation of neck for mass, nodularity, thyromegaly, thrill
Thyroid bruit
Reflexes (hypo vs. hyper-reflexia)
Vitals (bradycardia w/ hypo vs. tachycardia w/ hyper)
Also may see elevated BP and/or rhythm irregularities w/ hyperthyroidism
Weight/changes (weight gain with hypo, weight loss with hyper)
Body Temp. (low temp possible in hypo)
Face (loss of hair/ eyebrows, puffiness or swelling in the eyelids or face in hypo)
Eyes (exopthalmos, lid lag in hyper)
Hair growth patterns (loss seen in both; coarse, brittle or strawlike, w/ diffuse alopecia and loss of lateral eyebrows in hypo; thinning in hyper)
Skin (palmar erythema, diaphoresis in hyper; dry skin w/ slight palor in hypo; pretibial myxedema, most common in Graves disease)
Hands and Nails (onycholysis, swollen fingers/acropachy in hyperthyroidism)
Tremor, shaky hands, hyperkinetic movements in hyper
Dull facial expression, slow movement, slow speech, hoarseness, edema in hypo
What is the plan for further evaluation given a differential diagnosis with thyroid abnormality?
TSH test
Free T4/T3
Anti-peroxidase ABs, Anti-TSH ABs, Anti-thyroglobulin ABs
Thyroid Ultrasound
Nuclear Scan/Radioactive Iodine Uptake Test
Fine Needle Aspiration of Thyroid
What is the treatment for postpartum thyroiditis?
Treatment depends on the phase of thyroiditis and degree of symptoms that patients exhibit.
Women presenting with thyrotoxicosis may be treated with beta blockers (although not recommended for nursing mothers) to decrease palpitations and reduce shakes and tremors.
The hypothyroid phase is often treated with thyroid hormone replacement (6-12 months). If the hypothyroidism is mild, and the patient has few, if any, symptoms, no therapy may be necessary.
What are the symptoms of postpartum thyroiditis?
Thyrotoxic phase (occurs 1-4 months after delivery of a child, lasts for 1-3 months): symptoms including anxiety, insomnia, palpitations (fast heart rate), fatigue, weight loss, and irritability.
Hypothyroid phase (typically occurs 4-8 months after delivery and may last up to 9 –12 months): symptoms include fatigue, weight gain, constipation, dry skin, depression and poor exercise tolerance
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 speculated cause of postpartum thyroiditis?
Exact cause = unknown.
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.
What are the signs and symptoms of Postpartum Depression?
strong feelings of sadness, anxiety, or despair that they have trouble coping with their daily tasks
What is the timing of Postpartum Depression (onset/duration)?
can occur at any time after childbirth, but it most commonly starts 1–3 weeks after delivery
may last up to a year
What is the best management/treatment options for Postpartum Depression?
Test thyroid for abnormalities!!! Then discuss treatment options:
Increased support
Counseling/Psychotherapy (CBT or interpersonal)
SSRIs (also SNRIs)
What is the time of Postpartum blues or “baby blues” (onset/duration)?
begins 2-3 days after birth and resolves within 10 days
might also become Postpartum Depression
How do you use the Edinburgh Postnatal Depression Scale in evaluation of postpartum depression?
Screening at 4-6 week postpartum visit or 2-month well-child visit
Possible depression: 10+
Maximum score: 30
***Always look at item #10 => illustrates whether pt is having suicidal thoughts
What are the biggest risk factors for Postpartum depression?
Hx of postpartum major depression with previous pregnancy
Antenatal depressive symptoms
Hx of major depressive disorder
Poor social support
Major life events or stressors during pregnancy
Family Hx of postpartum major depression
Hx of gestational diabetes and birth to multiples
