Postpartum thyroiditis diagnostic criteria: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(4 intermediate revisions by 2 users not shown)
Line 4: Line 4:
{{CMG}}; {{AE}}{{SKA}}
{{CMG}}; {{AE}}{{SKA}}
==Overview==
==Overview==
There are no established criteria for the diagnosis of [[postpartum thyroiditis]]"[[Postpartum thyroiditis|PPT]]" but it can be diagnosed on basis of level of [[Thyroid-stimulating hormone|TSH]], free [[Thyroxine|T4]], free [[Triiodothyronine|T3]], radio-iodine uptake, presence of anit-[[Thyroid peroxidase|TPO]] [[antibodies]] and absence of [[TSH receptor]] antibodies depending on the phase of disease.
There are no established criteria for the diagnosis of [[postpartum thyroiditis]] ([[Postpartum thyroiditis|PPT]]). However, PPT can be diagnosed on the basis of level of [[Thyroid-stimulating hormone|TSH]], free [[Thyroxine|T4]], free [[Triiodothyronine|T3]], radio-iodine uptake, presence of anit-[[Thyroid peroxidase|TPO]] [[antibodies]] and absence of [[TSH receptor]] antibodies.


==Diagnostic Criteria==
==Diagnostic Criteria==
*There are no established criteria for the diagnosis of [[Postpartum thyroiditis|PPT]] but it can be diagnosed on basis of level of [[Thyroid-stimulating hormone|TSH]], free [[Thyroxine|T4]], free [[Triiodothyronine|T3]], radio-iodine, uptake presence of anit-[[Thyroid peroxidase|TPO]] [[antibodies]] and absence of [[Thyrotropin receptor|TSH receptor]] [[antibodies]] depending on the phase of disease<ref name="pmid12213841">{{cite journal| author=Stagnaro-Green A| title=Clinical review 152: Postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2002 | volume= 87 | issue= 9 | pages= 4042-7 | pmid=12213841 | doi=10.1210/jc.2002-020524 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12213841  }}</ref>.
*There are no established criteria for the diagnosis of [[Postpartum thyroiditis|PPT]]. The following findings may contribute to the diagnosis of PPT:<ref name="pmid12213841">{{cite journal| author=Stagnaro-Green A| title=Clinical review 152: Postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2002 | volume= 87 | issue= 9 | pages= 4042-7 | pmid=12213841 | doi=10.1210/jc.2002-020524 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12213841  }}</ref>
'''Hyperthyroid phase''': Set of following laboratory values on one or more occasions
'''Hyperthyroid phase''': Set of following laboratory values on one or more occasions
*[[Thyroid-stimulating hormone|'''TSH''']]: low or suppresed
*[[Thyroid-stimulating hormone|'''TSH''']]: low or suppresed
*'''Anti-[[Thyroid peroxidase|TPO]] [[antibodies]]''': Postive
*'''Anti-[[Thyroid peroxidase|TPO]] [[antibodies]]''': Postive
*'''TSH-receptor [[antibodies]]''': Negative
*'''TSH-receptor [[antibodies]]''': Negative
*'''Free T4''': Typical raised but may be normal.
*'''Free T4''': Typical raised but may be normal
*'''Free T3''': Raised or normal with or without raised FT4.
*'''Free T3''': Raised or normal with or without raised FT4
*'''Radio-iodine uptake''': Decreased.
*'''Radio-iodine uptake''': Decreased
'''Hypothyroid phase:'''
'''Hypothyroid phase:'''
*'''TSH''': >3.6 mU/L
*'''TSH''': >3.6 mU/L
Line 20: Line 20:
*'''Free T4''': <8 pmol/l
*'''Free T4''': <8 pmol/l
*'''Free T3''': <4.2 pmol/l
*'''Free T3''': <4.2 pmol/l
*'''Radio-iodine uptake''': Decreased.
*'''Radio-iodine uptake''': Decreased
*'''[[Thyroid gland]] tenderness''': Non-tender but may be tender sometime.<ref name="pmid122138413">{{cite journal| author=Stagnaro-Green A| title=Clinical review 152: Postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2002 | volume= 87 | issue= 9 | pages= 4042-7 | pmid=12213841 | doi=10.1210/jc.2002-020524 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12213841  }}</ref>
*'''[[Thyroid gland]] tenderness''': Non-tender but may be tender sometime<ref name="pmid122138413">{{cite journal| author=Stagnaro-Green A| title=Clinical review 152: Postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2002 | volume= 87 | issue= 9 | pages= 4042-7 | pmid=12213841 | doi=10.1210/jc.2002-020524 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12213841  }}</ref>
*'''ESR''': Normal<ref name="pmid122138412">{{cite journal| author=Stagnaro-Green A| title=Clinical review 152: Postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2002 | volume= 87 | issue= 9 | pages= 4042-7 | pmid=12213841 | doi=10.1210/jc.2002-020524 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12213841  }}</ref>
*'''ESR''': Normal<ref name="pmid122138412">{{cite journal| author=Stagnaro-Green A| title=Clinical review 152: Postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2002 | volume= 87 | issue= 9 | pages= 4042-7 | pmid=12213841 | doi=10.1210/jc.2002-020524 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12213841  }}</ref>


===Stepwise clinical diagnosis of Postpartum thyroiditis===
===Stepwise clinical diagnosis of Postpartum thyroiditis===
The following flowchart describes the clinical approach to the diagnosis of postpartum thyroiditis.
The clinical approach to the diagnosis of postpartum thyroiditis is given below.
 
{{familytree/start|summary=Sample 1}}
{{familytree/start |summary=Sample 1}}
{{familytree | | | | X01 | | | X02 | | | | X03 | | | | X04 |X01=Prior episode of [[Postpartum thyroiditis]]|X02=Family history of [[autoimmune]] disease or [[thyroid]] disease or postive [[anti-TPO antibody]]|X03=[[Goiter]] or [[diabetes mellitus]]|X04=Symptoms or signs of [[thyroid dysfunction in postpartum period]]}}
{{familytree | | | | X01 | | | X02 | | | | X03 | | | | X04 |X01=Prior [[Postpartum thyroiditis]] episode|X02=Family history of [[autoimmune]] disease or [[thyroid]] disease or Postive [[anti-TPO antibody]]|X03=[[Goiter]] or [[diabetes mellitus]]|X04=symptoms or signs of [[thyroid dysfunction in postpartum period]]}}
{{familytree | | | | |!| | | | |!| | | | | |!| | | | | |!}}
{{familytree | | | | |!| | | | |!| | | | | |!| | | | | |!}}
{{familytree | | | | |`|-|-|-|-|^|-|-|v|-|-|^|-|-|-|-|-|'}}
{{familytree | | | | |`|-|-|-|-|^|-|-|v|-|-|^|-|-|-|-|-|'}}
{{familytree | | | | | | | | | | | | Z01 | | | Z01=Check TSH<br>Free T4<br>Anti-TPO antibodies titers }}
{{familytree |boxstyle=text-align: left; | | | | | | | | | | | | Z01 | | | Z01=Check: <br>• ‡TFT and<br>• Anti-TPO antibodies titres in postpartum period}}
{{familytree | | | | |,|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|-|-|-|-|-|-|-|.| | | | }}
{{familytree | | | | |,|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|-|-|-|-|-|-|-|.| | | | }}
{{familytree | | | | A01 | | | A02 | | | | A03 | | | | | | | | | | |!|A01=Panel A<br>TSH>4.0 <br> normal FT4 <br> -/+ anti-TPO|A02=Panel B<br>TSH>4.0 <br> low FT4 <br> -/+ anti-TPO|A03=Panel C<br>TSH=0.3-4.0 <br> normal FT4 <br> + anti-TPO}}
{{familytree |boxstyle=text-align: left; | | | | A01 | | | A02 | | | | A03 | | | | | | | | | | |!|A01='''Panel A:'''<br>•TSH>4.0<br>•Normal FT4 <br>•-/+ Anti-TPO|A02='''Panel B:'''<br>•TSH>4.0 <br>•Low FT4 <br>•-/+ Anti-TPO|A03='''Panel C:'''<br>•TSH=0.3-4.0 <br>•Normal FT4 <br>•+ Anti-TPO}}
{{familytree | | | | |!| | | | |!| | | | | |!| | | | | | | | | | | |!}}
{{familytree | | | | |!| | | | |!| | | | | |!| | | | | | | | | | | |!}}
{{familytree | | | | B01 | | | B02 | |,|-| B03 |-| B04|-|-|-|-|-|-|(|B01=subclinical<br>[[hypothyroid]]|B02=Possible<br>AITD|B03=Repeat TSH<br>3-6months|B04=If TSH<1.0}}
{{familytree | | | | B01 | | | B02 | |,|-| B03 |-| B04|-|-|-|-|-|-|(|B01=Subclinical<br>[[hypothyroid]] phase of †[[PPT]]|B02=Possible<br>[[autoimmune thyroidits]]|B03=Repeat TSH<br> after 3-6months|B04=If TSH<1.0}}
{{familytree | | | | |!| | | | |!| | |!| | |!| | | | | | | || | | |!| | | || |}}
{{familytree | | | | |!| | | | |!| | |!| | |!| | | | | | | || | | |!| | | || |}}
{{familytree | | | | |)|-|-|-|-|'| | |!| | |!| | | | | | | || | | |!| | | || |}}
{{familytree | | | | |)|-|-|-|-|'| | |!| | |!| | | | | | | || | | |!| | | || |}}
{{familytree | | | |C01|-|-|C02|-|'| |C03| | | | | | | | | |C04| |C01=Treat<br>[[Levothyroxine]]|C02=TSH>4.0 <br>low FT4|C03=[[TSH]]=0.3-4.0 <br>normal FT4|C04=Panel D<br>[[TSH]]<1.0 <br>+ anti-TPO}}
{{familytree | | | |C01|-|-|C02|-|'| |C03| | | | | | | | | |C04| |C01=Treat with<br>[[Levothyroxine]]|C02=•TSH>4.0 <br>•Low FT4|C03=•[[TSH]]=0.3-4.0 <br>•Normal FT4|C04='''Panel D:'''<br>•[[TSH]]<1.0 <br>•+ Anti-TPO}}
{{familytree | | | | |!| | | | | | | | || |!|| | | | | | | |,|-|-|+|-|-|-|.| }}
{{familytree | | | | |!| | | | | | | | || |!|| | | | | | | |,|-|-|+|-|-|-|.| }}
{{familytree | | | | D01 | | | | | | | ||D02 | | | | ||D03| |D04| |D05|D01=Repeat [[TSH]]<br>3-6months|D02=Repeat [[TSH]]<br>3-6months|D03=[[FT4]]<br>high|D04=[[FT4]]<br>normal|D05=[[FT4]]<br>low}}
{{familytree | | | | D01 | | | | | | | ||D02 | | | | ||D03| |D04| |D05|D01=Repeat [[TSH]]<br>in 3-6 months|D02=Repeat [[TSH]] in <br>3-6months|D03=[[FT4]]<br>high|D04=[[FT4]]<br>normal|D05=[[FT4]]<br>low}}
{{familytree | | | | |!| | | | | | | | | | | | | | | | | | |!| | | |!| | ||!|}}
{{familytree | | | | |!| | | | | | | | | | | | | | | | | | |!| | | |!| | ||!|}}
{{familytree | | | |E01| | | | | | | | | | | | | | | | | |!| | | |!| | ||!|E01=Consider tapering [[Levothyroxine]]}}
{{familytree | | | |E01| | | | | | | | | | | | | | | | | |!| | | |!| | ||!|E01=Consider tapering [[levothyroxine]]}}
{{familytree | | | ||!|| | | | | | | | | | | | | | | | | |!| | | |!| | ||!|}}
{{familytree | | | ||!|| | | | | | | | | | | | | | | | | |!| | | |!| | ||!|}}
{{familytree | | | |F01| | | | | | | | | | | | | | | | |F02||F03| |F04|F01=Repeat TSH<br>3-6months|F02=dignosed as<br> hyperthyroid|F03=subclinical<br>hyperthyroidisum|F04=possible hypopituitary cause}}
{{familytree | | | |F01| | | | | | | | | | | | | | | | |F02||F03| |F04|F01=Repeat TSH in<br>3-6months|F02=Dignosed as<br> hyperthyroid<br>phase of †[[PPT]]|F03=Subclinical<br>hyperthyroidisum<br>phase of †[[PPT]]|F04=Possible hypo-pituitary [[hypothyroidism]]}}
{{familytree | | | ||)|-|-|.| }}
{{familytree | | | ||)|-|-|.| }}
{{familytree | | | |J01| |J02 |J01=TSH>4.0 <br>Treat<br>[[Levothyroxine]]|J02=TSH=0.3-4.0<br>Repeat [[TSH]]<br>3-6months}}
{{familytree | | | |J01| |J02 |J01=•TSH>4.0 <br>•Treat<br>[[Levothyroxine]]|J02=•TSH=0.3-4.0<br>•Repeat [[TSH]]<br>3-6months}}
{{Diagnosis and management of [[PPT]]}}
 
'''Postpartum thyroiditis'''}}
{{familytree/end}}
{{familytree/end}}


<small>‡TFT; Thyroid function tests(TSH, T4, and T3), †[[Grave's disease]] is not a thyroiditis, *RAIU; Radioiodine uptake.††One third of [[Riedel's thyroiditis]] presents with [[hypothyroidism]].</small>  
<small>‡TFT; Thyroid function tests(TSH, T4, and T3), †PPT=[[Postpartum thyroiditis]],.</small>  
<small>
<small>
<br>
TSH units in micro-grams per deciliter<br>
Table modified from <ref name="urlThyroiditis: Differential Diagnosis and Management - American Family Physician">{{cite web |url=http://www.aafp.org/afp/2000/0215/p1047.html#afp20000215p1047-b7 |title=Thyroiditis: Differential Diagnosis and Management - American Family Physician |format= |work= |accessdate=}}</ref></small>
 
Adopted from AFP<ref name="urlThyroiditis: Differential Diagnosis and Management - American Family Physician">{{cite web |url=http://www.aafp.org/afp/2000/0215/p1047.html#afp20000215p1047-b7 |title=Thyroiditis: Differential Diagnosis and Management - American Family Physician |format= |work= |accessdate=}}</ref></small>


==References==
==References==

Latest revision as of 17:35, 10 November 2017

Postpartum thyroiditis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Postpartum Thyroiditis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Postpartum thyroiditis diagnostic criteria On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Postpartum thyroiditis diagnostic criteria

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Postpartum thyroiditis diagnostic criteria

CDC on Postpartum thyroiditis diagnostic criteria

Postpartum thyroiditis diagnostic criteria in the news

Blogs on Postpartum thyroiditis diagnostic criteria

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Postpartum thyroiditis diagnostic criteria

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Overview

There are no established criteria for the diagnosis of postpartum thyroiditis (PPT). However, PPT can be diagnosed on the basis of level of TSH, free T4, free T3, radio-iodine uptake, presence of anit-TPO antibodies and absence of TSH receptor antibodies.

Diagnostic Criteria

  • There are no established criteria for the diagnosis of PPT. The following findings may contribute to the diagnosis of PPT:[1]

Hyperthyroid phase: Set of following laboratory values on one or more occasions

  • TSH: low or suppresed
  • Anti-TPO antibodies: Postive
  • TSH-receptor antibodies: Negative
  • Free T4: Typical raised but may be normal
  • Free T3: Raised or normal with or without raised FT4
  • Radio-iodine uptake: Decreased

Hypothyroid phase:

  • TSH: >3.6 mU/L
  • Anti-TPO antibodies: Postive
  • Free T4: <8 pmol/l
  • Free T3: <4.2 pmol/l
  • Radio-iodine uptake: Decreased
  • Thyroid gland tenderness: Non-tender but may be tender sometime[2]
  • ESR: Normal[3]

Stepwise clinical diagnosis of Postpartum thyroiditis

The clinical approach to the diagnosis of postpartum thyroiditis is given below.

 
 
 
Prior episode of Postpartum thyroiditis
 
 
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 and
• Anti-TPO antibodies titres in postpartum period
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
after 3-6months
 
If TSH<1.0
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treat with
Levothyroxine
 
 
•TSH>4.0
•Low FT4
 
 
 
 
•TSH=0.3-4.0
•Normal FT4
 
 
 
 
 
 
 
 
 
Panel D:
•TSH<1.0
•+ Anti-TPO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Repeat TSH
in 3-6 months
 
 
 
 
 
 
 
Repeat TSH in
3-6months
 
 
 
 
FT4
high
 
FT4
normal
 
FT4
low
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider tapering levothyroxine
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Repeat TSH in
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,. TSH units in micro-grams per deciliter

Adopted from AFP[4]

References

  1. ↑ Stagnaro-Green A (2002). "Clinical review 152: Postpartum thyroiditis". J Clin Endocrinol Metab. 87 (9): 4042–7. doi:10.1210/jc.2002-020524. PMID 12213841.
  2. ↑ Stagnaro-Green A (2002). "Clinical review 152: Postpartum thyroiditis". J Clin Endocrinol Metab. 87 (9): 4042–7. doi:10.1210/jc.2002-020524. PMID 12213841.
  3. ↑ Stagnaro-Green A (2002). "Clinical review 152: Postpartum thyroiditis". J Clin Endocrinol Metab. 87 (9): 4042–7. doi:10.1210/jc.2002-020524. PMID 12213841.
  4. ↑ "Thyroiditis: Differential Diagnosis and Management - American Family Physician".

Template:WH Template:WS De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Lazarus J. PMID 25905287. Missing or empty |title= (help)

Retrieved from "https://www.wikidoc.org/index.php?title=Postpartum_thyroiditis_diagnostic_criteria&oldid=1387397"