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[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 following flowchart describes the clinical approach to the diagnosis of postpartum thyroiditis.
{{Diagnosis and management of PPT}}
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 TSH Free T4 Anti-TPO antibodies titers | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 | Possible AITD | 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 | subclinical hyperthyroidisum | possible hypopituitary cause | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| TSH>4.0 Treat Levothyroxine | TSH=0.3-4.0 Repeat TSH 3-6months | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
‡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 [4]
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ "Thyroiditis: Differential Diagnosis and Management - American Family Physician".
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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)