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

Diagnosis of PPT

Patients who present with thyroid dysfunction ( Table 2 provides a list of symptoms) in the first year postpartum will likely have PPT. The most important alternate diagnosis to consider is new onset Graves' disease (incidence 0.2% vs approximately 7% for PPT).[16] Refer to "diagnostic testing" section on page 179 for additional information.

Many women (and health care providers) may attribute these symptoms to the demands of caring for a new infant, expected struggles with weight postpartum, and drastic change in routine that occurs with new mothers. Some speculate that women may not seek health care for symptoms that are "just related to being a new mom." Thus, it is important to consider thyroid disorders when these symptoms are present, and to consider the possibility of a postpartum thyroiditis in the differential of symptoms that develop in the postpartum year.

Postpartum depression shares many symptoms with thyroid disease, so care should be taken in distinguishing these two entities. Symptoms of postpartum depression include either depressed mood or decreased interest or pleasure in activities, lasting for at least 2 weeks. In addition, five of the following symptoms must be present:[17]

  • Depressed mood, often accompanied by severe anxiety

  • Markedly diminished interest or pleasure in activities

  • Appetite disturbance–usually loss of appetite with weight loss

  • Sleep disturbance, most often insomnia and fragmented sleep, even when infant is sleeping

  • Physical agitation (more common) or psychomotor slowing

  • Fatigue, decreased energy

  • Feelings of worthlessness or excessive or inappropriate guilt

  • Decreased concentration or ability to make decisions

  • Recurrent thoughts of death or suicidal ideation

Women with postpartum depression are also more likely to have had previous history of depression, family history of depression, and increased life stress in addition to childbirth (such as financial hardships, neonatal health problems, stillbirth, or marital conflict).[18] A careful patient history, review of systems, and physical exam are important in discriminating between PPT and postpartum depression. When in doubt, obtaining a TSH can help distinguish between the two disorders.

Are women with PPT at higher risk of developing postpartum depression or other mood disorders? One study assessed 748 postpartum women for both abnormal TSH, free T4, thyroid peroxidase antibodies, and the presence of symptoms of depression, anxiety, and panic disorder. Those diagnosed with PPT were more likely to meet criteria for anxiety, but not depression.[1,5]

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