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.
Who to refer:
- ALL women with hyperthyroidism
- Patients with a history of Graves’ Disease who are euthyroid or hypothyroid through radioiodine treatment or surgery – who are TRAbs positive
- Any woman with unstable TFTs
- TPO Ab-positive women: management is covered in the section on sub-clinical hypothyroidism. These women do not necessarily need referral, but if advice is required, please discuss with a consultant endocrinologist by sending an ‘Advice Only’ referral on SCI Gateway
- Community midwife to inform obstetrician if hypothyroidism diagnosed during pregnancy
- All women with hyperthyroid profile post-partum to assess for post-partum thyroiditis and Graves’ disease – refer to Endocrinology
- Any woman with a HISTORY of hyperthyroidism should also be discussed or referred
- All women with hyperthyroidism in pregnancy should be seen by a Consultant Endocrinologist and a Consultant Obstetrician from early in pregnancy – please see Hyperthyroidism in Pregnancy section for full details.
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