Postpartum Thyroiditis

What is Postpartum Thyroiditis?

Postpartum thyroiditis is a thyroid disease in new mothers that results from inflammation of the thyroid gland. It affects women in the first year after childbirth or miscarriage.

The thyroid gland is a butterfly-shaped gland in the front of the neck. It secretes thyroid hormone, which controls various metabolic processes. Secretion of thyroid hormone is controlled by another hormone, thyroid stimulating hormone (TSH) that is secreted by a small but vital gland in the brain called the pituitary gland. Thyroid problems are more common in women than in men.

What are the Causes of Postpartum Thyroiditis?

Postpartum thyroiditis is an autoimmune condition where the immune system attacks and destroys the cells of the thyroid gland. In general, women in the postpartum period are more prone to autoimmune diseases.

Conditions that increase the risk of developing postpartum thyroiditis include:

• A high titer of anti-thyroid antibodies
• Past history of thyroid disease
• Presence of type I diabetes
• Family history of thyroid disease

What are the Phases of Postpartum Thyroiditis?

Postpartum thyroiditis occurs in two phases. However, both the phases may not be present in all patients:

• A short hyperthyroid phase, where the levels of thyroid hormone are higher than normal. This occurs due to the leaking out of thyroid hormone from the gland following damage to its cells
• A longer hypothyroid phase, where the thyroid hormone levels are lower than normal

Recovery occurs following the hypothyroid state. Some women may, however, develop chronic hypothyroidism. In addition, postpartum thyroiditis may recur in future pregnancies.

What are the Symptoms and Signs of Postpartum Thyroiditis?

Symptoms of postpartum thyroiditis depend on the phase of the thyroid disorder.

Symptoms in the hyperthyroid phase include:

• Palpitations
• Tremor
• Excessive sweating
• Increased bowel movements
• Insomnia
• Weight loss

Symptoms in the hypothyroid phase include:

• Excessive weight gain
• Dry skin and hair
• Constipation
• Excessive sleeping
• Cold intolerance in women
• Depression

The above symptoms are commonly noted in postpartum women and therefore postpartum thyroiditis may not be suspected and may go unnoticed.

How do you Diagnose Postpartum Thyroiditis?

Postpartum thyroiditis is diagnosed based on symptoms of the patient, physical examination and blood tests. Blood tests that are used to diagnose postpartum thyroiditis:

• Thyroid function tests: The blood test measures the levels of the thyroid hormones T3 and T4, and the thyroid stimulating hormone TSH, which stimulates the thyroid gland to produce thyroid hormone. In hyperthyroidism, the levels of T3 and T4 may be above normal while TSH levels are low. The reverse occurs in hypothyroidism

• Anti-thyroid antibodies: High titers of antibodies directed against the thyroid gland, which includes the anti-thyroid peroxidase antibodies and anti-thyroglobulin antibodies can be detected in the blood

How do you Treat Postpartum Thyroiditis?

Mild hyperthyroidism in postpartum thyroiditis does not require medications. Beta blockers like propranolol are used to control symptoms such as palpitations.

Hypothyroidism may be treated with thyroid hormone if the hypothyroidism causes symptoms or lasts for a long duration.

How do you Prevent Postpartum Thyroiditis?

It is not possible to prevent postpartum thyroiditis. However, early diagnosis could help to treat and relieve any symptoms associated with the condition.

References:

1. Symptoms and Signs Associated with Postpartum Thyroiditis - (http://dx.doi.org/10.1155/2014/531969)
2. Hanseree P, Salvador VB, Sachmechi I, Kim P. Recurrent Silent Thyroiditis as a Sequela of Postpartum Thyroiditis. Case Rep Endocrinol. 2014; 2014: 286373. doi: 10.1155/2014/286373
3. Thyroid disease - (http://www.womenshealth.gov/publications/our-publications/fact-sheet/thyroid-disease.html)

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