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

Diagnostic Testing

Once suspicion of thyroid disease is established by history and physical exam, laboratory testing is indicated (Figure 1). If the patient presents during the hyperthyroid phase of PPT, thyroid labs will reveal suppressed TSH. Further thyroid labs will reveal accompanied elevated free T4. With this pattern of thyroid function studies, it is important to rule out other causes of hyperthyroidism, especially Graves' disease. Differentiating features between Graves' disease and PPT, including physical exam findings, are included in Table 4 .[7] Symptoms of hyperthyroidism may be more pronounced in Graves' disease versus PPT. Graves' opthalmopathy is also absent in PPT.[1] The 24-hour radioactive iodine uptake on thyroid scan is typically low in PPT (related to thyrocyte destruction by the autoimmune process), whereas uptake will be high in Graves' disease (related to persistent activation of thyrocytes by the auto-antibody thyroid-stimulating immunoglobulin). A radioactive iodine thyroid uptake study may not be an appropriate diagnostic tool for all women, as it is contraindicated in women who are breastfeeding.

Clinical decision tree.

Patients may also present in the hypothyroid phase of PPT. A history of hyperthyroid symptoms preceding hypothyroid symptoms (as listed in Table 2 ) would provide support for a diagnosis of PPT. In the hypothyroid state, the TSH will be above normal, and free T4 will be low.

Findings of an asymmetric or nodular thyroid gland would lead to consideration of toxic multinodular goiter or a single toxic nodule. A tender thyroid gland that is accompanied by symptoms of viral infection would be associated with acute painful thyroiditis.[16]

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