Postpartum thyroiditis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Patients of PPT with hyperthyroid phase are treated with beta blockers , whereas patients with hypothyroid phase are treated with levothyroxine LT4.
Medical Therapy
- Pharmacological medical therapy is recommended among PPT with asymptomatic and symptomatic patients according to levels of TSH, phase of disease and planning of pregnancy.
- In hyperthyroid phase radioiodine and antithyroid treatment is not useful because the increase in serum T3 and T4 is due to release of thyroid hormone in blood due to destruction of thyroid follicle rather than increased production.
Postpartum thyroiditis
- Asymptomatic hyperthyroid phase:
- No treatment required. Regular monitoring of FT3 and FT4 every 4 to 8 weeks to decide treatment of sever hyperthyroid phase.
- Symptomatic hyperthyroid phase:
- Preferred regimen (1): Propranolol 40 mg PO once daily; may increase to 120 mg once daily until their serum T3 and serum free T4 concentrations are normal
- Preferred regimen (2): Atenolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal
- Preferred regimen (3): Metoprolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal
- Symptomatic hyperthyroid phase in breast feeding mothers:
- Preferred regimen (1): Propranolol 40 mg PO once daily; may increase to 120 mg once daily until their serum T3 and serum free T4 concentrations are normal.
- Alternate regimen (1): Atenolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal.
- Alternate regimen (2): Metoprolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal.
- Asymptomatic hypothyroid phase TSH above reference range, less than 10 mU/L not planning a subsequent pregnancy:
- Preferred regimen (1): Regular monitoring of TSH every 4 to 8 weeks to decide treatment of sever hypothyroid phase.
- Alternate regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal.
- Asymptomatic hypothyroid phase TSH above reference range, less than 10 mU/L planning a subsequent pregnancy:
- Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal.
- Alternate regimen (1): Regular monitoring of TSH every 4 to 8 weeks to decide treatment of sever hypothyroid phase.
- Asymptomatic hypothyroid phase TSH above 10 mU/L:
- Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal.
- Symptomatic hypothyroid phase irrespective of TSH levels:
- Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal.