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

Treatment

Antithyroid medications such as methimazole and propylthiouricil (PTU) are not needed for women with PPT. These medications act by inhibiting thyroid hormone synthesis within the thyrocyte. Because hyperthyroidism in PPT is caused by release of preformed thyroid hormone into the circulation (and not overproduction), the use of antithyroid drugs (which affect thyroid hormone synthesis) is not useful in improving symptoms or affecting the course of the disease. Therefore, treatment of hyperthyroidism is focused on symptom management, usually with beta-blocker therapy. Propranolol 10 to 40 mg every 6 hours, or atenolol 25 to 50 mg daily, can be used to treat symptoms. Propranolol at the lowest effective dose should be chosen for women who are nursing, as it is compatible with breastfeeding. Atenolol is associated with risk for fetal cyanosis and bradycardia and therefore should be avoided in nursing mothers.[16]

Women with PPT who become hypothyroid can be treated for a short interval (6–9 months) with levothyroxine therapy, with the goal of normalization of TSH. Thyroid medication should then be discontinued to determine if thyroid function has returned to normal or if the patient has permanent hypothyroidism.[9] Lifelong thyroid hormone treatment is indicated in those with persistent hypothyroidism.

There is little research on how PPT can affect breastfeeding. Animal studies provide some information on the effects of maternal hypothyroidism and hyperthyroidism on lactation and milk supply. Hypothyroidism may reduce release of oxytocin that occurs in breastfeeding animals, and hyperthyroidism may impair milk ejection.[20]

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