This is a destructive autoimmune thyroiditis causing release of pre-formed thyroid hormone and then hypothyroidism as the reserve is depleted. It occurs in 5% of women within 2-6 months of delivery or miscarriage. It presents with non-specific symptoms such as tiredness, anxiety and depression. Typically the patient will demonstrate a hyperthyroid hormone profile, which will resolve or be followed by transient hypothyroidism. Occasionally, thyroid function may not return to normal after postpartum thyroiditis. Persistent hypothyroidism may require treatment with thyroid hormone.
If a hyperthyroid profile is found (TSH <0.01 mU/L; FT4/FT3 raised) an endocrine opinion is warranted to differentiate post-partum thyroiditis from other causes of hyperthyroidism such as Graves’ disease. Measurement of TRAbs will be helpful (negative in thyroiditis).
Post-partum patients should have thyroid function tests checked at 8 – 12 weeks if they have:
- Symptoms of hyper- or hypo-thyroidism
- Goitre
- Previous history of post-partum thyroiditis or autoimmune thyroid disease
- Positive TPO Ab.
Women with post-partum thyroiditis should be referred to endocrinology.
REFERENCES – please see the Resources and Links section of the main Thyroid Conditions and Pregnancy page.
C.M. & N.Z. 08-07-24
