Postpartum_Thyroiditis_Flashcards
What are the three stages of postpartum thyroiditis?
The three stages of postpartum thyroiditis are thyrotoxicosis, hypothyroidism, and normal thyroid function.
What is the first stage of postpartum thyroiditis?
The first stage of postpartum thyroiditis is thyrotoxicosis.
What is the second stage of postpartum thyroiditis?
The second stage of postpartum thyroiditis is hypothyroidism.
What is the third stage of postpartum thyroiditis?
The third stage of postpartum thyroiditis is normal thyroid function, but there is a high recurrence rate in future pregnancies.
What percentage of patients with postpartum thyroiditis have thyroid peroxidase antibodies?
Thyroid peroxidase antibodies are found in 90% of patients with postpartum thyroiditis.
How is the thyrotoxic phase of postpartum thyroiditis typically managed?
The thyrotoxic phase of postpartum thyroiditis is typically managed with propranolol for symptom control.
Why are anti-thyroid drugs not usually used in the thyrotoxic phase of postpartum thyroiditis?
Anti-thyroid drugs are not usually used in the thyrotoxic phase of postpartum thyroiditis because the thyroid is not overactive.
How is the hypothyroid phase of postpartum thyroiditis typically managed?
The hypothyroid phase of postpartum thyroiditis is usually treated with thyroxine.
Summarise Postpartum thyroiditis
Postpartum thyroiditis
Three stages
1. Thyrotoxicosis
2. Hypothyroidism
3. Normal thyroid function (but high recurrence rate in future pregnancies)
Thyroid peroxidase antibodies are found in 90% of patients
Management
thyrotoxic phase
propranolol is typically used for symptom control
not usually treated with anti-thyroid drugs as the thyroid is not overactive.
hypothyroid phase
usually treated with thyroxine
A 25-year-old woman presents to the GP with a 3-days history of episodic sweating, agitation, palpitations, and restlessness. Two months ago, she underwent an uncomplicated vaginal delivery at 39 weeks gestation. She has a past medical history of coeliac disease.
Investigations are performed:
Thyroid-stimulating hormone (TSH) 0.1 mU/L (0.5-5.5)
Free thyroxine (T4) 26 pmol/L (9.0 - 18)
What is the most appropriate next step in her management?
Prescribe NSAIDs and monitor
Prescribe carbimazole
Prescribe levothyroxine
Prescribe propranolol
Prescribe propylthiouracil
The thyrotoxicosis phase of postpartum thyroiditis is generally managed with propranolol alone
Prescribe propranolol is correct. This patient has presented with signs and symptoms of hyperthyroidism 2 months postpartum. This should raise suspicion of postpartum thyroiditis. It is thought that this occurs due to the immune system rebounding causing anti-thyroid antibodies to rise in women who are susceptible, as during the pregnancy the immune system is suppressed to induce tolerance of the foetus. This is usually self-resolving, therefore the most appropriate step in her management is symptomatic relief, which would involve the use of propranolol.
Prescribe NSAIDs and monitor is incorrect. This would be an appropriate management step if this patient was experiencing subacute (de Quervain’s) thyroiditis which usually follows a viral infection. Given that there is no painful goitre, this option would be less appropriate.
Prescribe carbimazole is incorrect. Given that postpartum thyroiditis is typically self-limiting, prescribing antithyroid drugs would be less appropriate as this may induce a state of hypothyroidism, requires careful monitoring and also carries side effects despite this patient not necessarily needing them. Postpartum thyroiditis involves symptomatic treatment using propranolol.
Prescribe levothyroxine is incorrect. This would be appropriate if this patient was experiencing hypothyroidism, which would present with cold intolerance, low mood, fatigue, and weight gain, and the thyroid function tests would show a low T4 and raised TSH, which is not the case here.
Prescribe propylthiouracil is incorrect. Postpartum thyroiditis is typically self-limiting, therefore, prescribing antithyroid drugs would be less appropriate as this may induce a state of hypothyroidism, requires careful monitoring and also carries side effects despite this patient not necessarily needing them. Postpartum thyroiditis involves symptomatic treatment using propranolol.
A 36-year-old woman comes into your GP clinic, 3 months after giving birth. She reports ongoing palpitations, weight loss of 5kg since the delivery and some tremors in her hands. She reports her baby is doing well and she is bottle feeding.
You perform thyroid function tests and the results are shown below.
TSH 3.5 mU/L
T4 20 pmol/L
Given the likely diagnosis, which one of the following treatments is most appropriate?
Aspirin
Carbimazole
Propranolol
Levothyroxine
Radioactive iodine
Propranolol
This patient has presented with symptoms of postpartum thyroiditis. This is an autoimmune condition which presents as the body transitions back from the immunosuppressed state of pregnancy to normal immunity.
Postpartum thyroiditis can present for up to 1 year following delivery, but most frequently occurs 3-4 months post-partum. The hyperthyroid phase should be treated with beta blockers and not antithyroid drugs.
