Postpartum Thyroiditis: Not Just a Worn Out Mom

Katherine Pereira; Ann J. Brown

Disclosures

Journal for Nurse Practitioners. 2008;4(3):175-182. 

In This Article

Introduction

PPT is defined as transient thyroiditis that occurs within 12 months after delivery,[1] and can also occur after miscarriage.[2] Like other forms of thyroiditis, such as Hashimoto's thyroiditis, PPT is a result of thyroid autoimmunity. Classically, it is characterized by transient painless thyrotoxicosis (hyperthyroidism) and corresponding low thyroid radioactive iodine (RAI) uptake. The characteristic course begins with hyperthyroidism, followed by a hypothyroid phase, then full resolution and return to a euthyroid state. Because PPT typically resolves spontaneously, it is important to distinguish it from other causes of abnormal thyroid function, most of which are not transient. Women with history of PPT are at high risk for subsequent development of permanent hypothyroidism and are also at high risk of developing PPT in relation to future pregnancies.

Postpartum thyroiditis is not uncommon. Epidemiological studies have noted a prevalence of 5.9% to 7.4% in the first year after delivery.[3] A recent quantitative review noted that PPT occurs in 5.8% of women in the United States and 8.3% of women worldwide.[4] Women who have had previous PPT are at very high risk for developing PPT in subsequent pregnancies, with one prospective study of women with PPT showing a 69% prevalence of recurrence in ensuing pregnancies.[5] Other prospective studies of pregnant women have noted that women with positive antithyroid antibodies during early pregnancy (but with normal thyroid function) have higher risk of developing PPT.[3] Women with type 1 diabetes, another autoimmune disorder, have a three times higher incidence of PPT.[6] Despite this, there is no clear evidence to suggest that women with other autoimmune disorders, such as rheumatoid arthritis or scleroderma, are at higher risk of developing PPT.[7] Family history of autoimmune dysfunction, particularly thyroid dysfunction, is associated with increased risk for thyroid disease.[8]

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