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]

Overview

There are no established criteria for the diagnosis of postpartum thyroiditis"PPT" but it can be diagnosed on basis of level of TSH, free T4, 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 T4, 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 postpartum thyroiditis.

{{Diagnosis and management of †PPT}} Template:'''Postpartum thyroiditis'''

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,.
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.