Postpartum thyroiditis diagnostic criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2], Furqan M M. M.B.B.S[3]

Overview

There are no established criteria for the diagnosis of PPT but it can be diagnosed on basis of level of TSH, free T, free T3, radio-iodine, uptake presence of anit-TPO antibodies and absence of TSH receptor antibodies depending on the phase of disease

Diagnostic Criteria

• There are no established criteria for the diagnosis of PPT but it can be diagnosed on basis of level of TSH, free T, free T3, radio-iodine, uptake presence of anit-TPO antibodies and absence of TSH receptor antibodies depending on the phase of disease.
• 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.
• ESR: Normal

Stepwise clinical diagnosis of Postpartum thyroiditis

The following flowchart describes the clinical approach to the diagnosis of thyroiditis.

Neck pain

Yes

No

RAIU*

Presenting symptoms and TFTs‡

Increased

Decreased

Hyperthyroid

Hypothyroid

Euthyroid

RAIU*

Suppurative thyroiditis

De Quervain's thyroiditis

Increased

Decreased

De Quervain's thyroiditis

Riedel's thyroiditis††

Graves disease†

Silent thyroiditis Postpartum thyroiditis

‡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.
Table modified from

References

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.