Postpartum thyroiditis medical therapy
Jump to navigation
Jump to search
|
Postpartum thyroiditis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Postpartum thyroiditis medical therapy On the Web |
|
American Roentgen Ray Society Images of Postpartum thyroiditis medical therapy |
|
Risk calculators and risk factors for Postpartum thyroiditis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]
Overview
Pharmacological medical therapy is recommended among asymptomatic and symptomatic postpartum thyroiditis (PPT) patients. The medical therapy for PPT is based upon the levels of TSH, the phase of disease, and planning of next pregnancy. PPT patients with hyperthyroid phase are treated with beta blockers, whereas patients with hypothyroid phase are treated with levothyroxine LT4. In hyperthyroid phase radioiodine and antithyroid treatment acting on the thyroid hormone production or release is not useful because the increase in serum T3 and T4 is due to release of thyroid hormone in the blood secondary to the destruction of thyroid follicles rather than increased production.
Medical Therapy
- Pharmacological medical therapy is recommended among PPT patients who are asymptomatic and symptomatic, according to the levels of TSH, phase of disease, and planning of pregnancy.[1]
- In hyperthyroid phase radioiodine and antithyroid treatment is not useful because the increase in serum T3 and T4 is due to release of thyroid hormone in blood due to destruction of thyroid follicle rather than increased production.
Postpartum thyroiditis
- 1.1 Asymptomatic hyperthyroid phase:[2][3]
- No treatment required. Regular monitoring of FT3 and FT4 every 4 to 8 weeks to decide treatment of severe hyperthyroid phase.
- 1.2 Symptomatic hyperthyroid phase:
- Preferred regimen (1): Propranolol 40 mg PO once daily; may increase to 120 mg once daily until their serum T3 and serum free T4 concentrations are normal
- Preferred regimen (2): Atenolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal
- Preferred regimen (3): Metoprolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal
- 1.3 Symptomatic hyperthyroid phase in breastfeeding mothers:
- Preferred regimen (1): Propranolol 40 mg PO once daily; may increase to 120 mg once daily until their serum T3 and serum free T4 concentrations are normal
- Alternate regimen (1): Atenolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal.
- Alternate regimen (2): Metoprolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal.
- 1.4 Asymptomatic hypothyroid phase TSH above reference range, less than 10 mU/L not planning a subsequent pregnancy:
- Preferred regimen (1): Regular monitoring of TSH every 4 to 8 weeks to decide treatment of severe hypothyroid phase.
- Alternate regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal consider weaning T4 after 6 to 12 months
- 1.5 Asymptomatic hypothyroid phase TSH above reference range, less than 10 mU/L planning a subsequent pregnancy:
- Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal consider weaning T4 after 6 to 12 months
- Alternate regimen (1): Regular monitoring of TSH every 4 to 8 weeks to decide treatment of severe hypothyroid phase.
- 1.6 Asymptomatichypothyroid phase TSH above 10 mU/L:
- Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal consider weaning T4 after 6 to 12 months
- 1.7 Symptomatic hypothyroid phase irrespective of TSH levels:
- Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal consider weaning T4 after 6 to 12 months.
- 1.8 Symptomatic hypothyroid phase highly elevated TSH levels (above 50-100) and decreasing T4:
- Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily continue thyroid hormone indefinitely monitoring TSH every 4 to 8 weeks.
| Prior Postpartum thyroiditis episode | Family history of autoimmune disease or thyroid disease or Postive anti-TPO antibody | Goiter or diabetes mellitus | symptoms or signs of thyroid dysfunction in postpartum period | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Check ‡TFT Anti-TPO antibodies titres in postpartum peroid | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Panel A TSH>4.0 normal FT4 -/+ anti-TPO | Panel B TSH>4.0 low FT4 -/+ anti-TPO | Panel C TSH=0.3-4.0 normal FT4 + anti-TPO | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Subclinical hypothyroid phase of †PPT | Possible Autoimmune thyroidits | Repeat TSH 3-6months | If TSH<1.0 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Treat Levothyroxine | TSH>4.0 low FT4 | TSH=0.3-4.0 normal FT4 | Panel D TSH<1.0 + anti-TPO | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Repeat TSH 3-6months | Repeat TSH 3-6months | FT4 high | FT4 normal | FT4 low | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Consider tapering Levothyroxine | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Repeat TSH 3-6months | Dignosed as hyperthyroid phase of †PPT | Subclinical hyperthyroidisum phase of †PPT | Possible hypo-pituitary hypothyroidism | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| TSH>4.0 Treat Levothyroxine | TSH=0.3-4.0 Repeat TSH 3-6months | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
‡TFT; Thyroid function tests(TSH, T4, and T3), †PPT=Postpartum thyroiditis
References
- ↑ De Groot, Leslie; Abalovich, Marcos; Alexander, Erik K.; Amino, Nobuyuki; Barbour, Linda; Cobin, Rhoda H.; Eastman, Creswell J.; Lazarus, John H.; Luton, Dominique; Mandel, Susan J.; Mestman, Jorge; Rovet, Joanne; Sullivan, Scott (2012). "Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 97 (8): 2543–2565. doi:10.1210/jc.2011-2803. ISSN 0021-972X.
- ↑ Alvarez-Marfany M, Roman SH, Drexler AJ, Robertson C, Stagnaro-Green A (1994). "Long-term prospective study of postpartum thyroid dysfunction in women with insulin dependent diabetes mellitus". J Clin Endocrinol Metab. 79 (1): 10–6. doi:10.1210/jcem.79.1.8027213. PMID 8027213.
- ↑ Muller AF, Drexhage HA, Berghout A (2001). "Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care". Endocr Rev. 22 (5): 605–30. doi:10.1210/edrv.22.5.0441. PMID 11588143.