Postpartum thyroid dysfunction

Postpartum thyroid dysfunction
Overview
Classification Graves disease Hashimoto's thyroiditis Postpartum thyroiditis Silent thyroiditis

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

Synonyms and keywords: Postpartum thyroid dysfunction syndrome

Overview

Postpartum thyroid dysfunction also known as postpartum thyroid dysfunction syndrome, is characterized by abnormal functioning of the thyroid gland after child birth. Postpartum thyroid dysfunction can either be a pre-existing thyroid disease became clinically significant after delivery or it may appear as a newly developed dysfunction. Postpartum thyroid dysfunction may present as Grave's disease, Hashimoto's thyroiditis, postpartum thyroiditis or silent thyroiditis. Postpartum thyroid dysfunction most commonly presents as hyperthyroidism followed by hypothyroidism. In some cases the second phase may proceed to either normal thyroid status or remains hypothyroid. The hyperthyroidism phase may be asymptomatic or patients may experience neuroexcitatory symptoms like palpitations. The hypothyroidism phase is usually symptomatic and may need treatment. Postpartum thyroid dysfunction may also present as exclusive hypothyroidism or hyperthyroidism.

Classification

Postpartum thyroid dysfunction can be classified on the base of presentation and the clinical course of the disease.

Classification of postpartum thyroid dysfunction based on thyroid diseases:

Postpartum Thyroid Dysfunction

Grave's disease

Hashimoto's thyroiditis

Postpartum thyroiditis

Silent thyroiditis

Subacute infective thyroiditis

Classification of postpartum thyroid dysfunction based on clinical course:

Postpartum Thyroid Dysfunction

Hyperthyroidism followed by hypothyroidism

Exclusive hyperthyroidism

Exclusive hypothyroidism

Hypothyroidism followed by hyperthyroidism

Differentiating various diseases on the basis of type of thyroid dysfunction

Stages	Peek presenting purpural month	Disease	Symptoms and Signs				Labs							Mechanisum
			Fatiuge	Neck swelling	Low mood	Irritability	TSH	FT4	TPO ab	ESR	RAI U	Thyroid U/S	Microscopic Picture
Persistent hyperthyroidism	4-6	Grave's disease	+	Small painful mass	+	+ Early	↓	↑↑	Neg	↑	↑	Diffusely enlarged hypervascular heterogeneous echotexture	hyperplastic follicles due to eosinophilic cytoplasm scalloping	TSHR activating antibodies
Transient hyperthyroidism	2-4	Silent thyroiditis	+	Small painless goiter	+ Late	+ Early	NL or ↓	↑↑	50%	NL	↓	Markedly decreased vascularity variable heterogeneous texture	Lymphocytic infiltration & follicles	CD4 T-cell activation mutation
		Postpartum thyroiditis	+	Small painless goiter	+ Late	+ Early	NL or ↓	↑↑	>80%	↑	↓	Hypoechoic diffusely enlarged with normal or decreased vascularity	Lymphocytic infiltration & follicles	Reg T-cell gain in function mutation
		Subacute (de Quervain's) granulomatous thyroiditis	+	Small painful mass	+ late	+ early	nl or ↓	↑↑	neg	↑	↓	Diffusely enlarged & normal or decreased  vascularity	Giant cells granulomas	Systemic viral infections
		Factitious thyrotoxicosis	+	Nl	Neg	+ Early	NL or ↓	↑↑	Neg	NL	↓	NL	Normal histology	Thyroixine intake
		Acute suppurative thyroiditis	+	Small painful mass	+ Late	+ Early	NL or ↓	↑↑	Neg	↑	↓	Variable heterogeneous texture perithyroidal hypoechoic space due to abscess	Polymorphonuclear leukocytes lymphocytes exudates	Viral, Bacterial
Destructive hyperthyroidism	4-6	Subacute (de Quervain's) granulomatous thyroiditis	+	Small painful mass	+ Late	+ Early	NL or ↓	↑↑	Neg	↑	↓	Diffusely enlarged & normal or decreased  vascularity	Gaint cells granulomas	Systemic viral infections
		Postpartum thyroiditis	+	Small painless goiter	+ Late	+ Early	NL or ↓	↑↑	>80%	↑	↓	Hypoechoic diffusely enlarged& normal or decreased vascularity	Lymphocytic infiltration & follicles	Reg T-cell gain in function mutation
		Acute suppurative thyroiditis	+	Small painful mass	+ Late	+ Early	NL or ↓	↑↑	neg	↑	↓	Variable heterogeneous texture perithyroidal hypoechoic space due to abscess	Polymorphonuclear leukocytes lymphocytes exudates	Viral, Bacterial
Transient hypothyroidism	2-4	Postpartum thyroiditis	+	Small painless goiter	+ Late	+ Early	NL or ↑	↓	>80%	↑	↓	Hypoechoic diffusely enlarged & normal or decreased vasclarity	Lymphocytic infiltration & follicles	Reg T-cell gain in function mutation
		Silent thyroiditis	+	Small painless goiter	+ Late	+ Early	NL or ↑	↓	+	NL	↓	Markedly decreased vascularity variable heterogeneous texture	Lymphocytic infiltration & follicles	CD4 T-cell activation mutation
		Subacute (de Quervain's) granulomatous thyroiditis	+	Small painful mass	+ Late	+ Early	NL or ↑	↓	Neg	↑	↓	Diffusely enlarged normal or decreased  vasclarity	Giant cells & granulomas	Systemic viral infections
		Acute suppurative thyroiditis	+	Small painful mass	+ Late	+ Early	NL or ↑	↓	Neg	↑	↓	Variable heterogeneous texture perithyroidal hypoechoic space due to abcess	Polymorphonuclear leukocytes lymphocytes exudates	Infections viral,bacterial
Persistent hypothyroidism	6	Riedel's thyroiditis	+	Small painful mass	+ Late	+ Early	↑	↓	75%	↑	↓	Homogeneously hypoechoic fibrotic invasion of the adjacent structures	Lymphocytes, plasma cells, and eosinophils in a dense matrix of hyalinized connective tissue	Viral Bacterial
		Postpartum thyroiditis	+	Small painless goiter	+ Late	+ Early	↑	↓	>80%	↑	↓	Hypoechoic diffusely enlarged& normal or decreased vasclarity	Variable heterogeneous texture, hypoechogenic	Reg T-cell gain in function mutation
		Hashimoto's thyroiditis	+	Painful mass	+ Late	+ Early	↑	↓	95%	↑	↓	Heterogeneous echotexture decreased vasclarity hypoechoic micronodules	Lymphoid follicles germinal centers Hurthle cells	Reg T-cell dysfunction
		Acute suppurative thyroiditis	+	Small painful mass	+ Late	+ Early	↑	↓	Neg	↑	↓	Variable heterogeneous texture perithyroidal hypoechoic space due to abcess	Polymorphonuclear leukocytes lymphocytes exudates	Systemic viral infections