Postpartum thyroid dysfunction

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Postpartum thyroid dysfunction

Overview

Classification

Graves disease
Hashimoto's thyroiditis
Postpartum thyroiditis
Silent thyroiditis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]Sunny Kumar MD [3]

Synonyms and keywords: Postpartum thyroid dysfunction syndrome

Overview

Postpartum thyroid dysfunction also known as postpartum thyroid dysfunction syndrome, is characterized by abnormal functioning of the thyroid gland after child birth. Postpartum thyroid dysfunction can either be a pre-existing thyroid disease became clinically significant after delivery or it may appear as a newly developed dysfunction. Postpartum thyroid dysfunction may present as Grave's disease, Hashimoto's thyroiditis, postpartum thyroiditis or silent thyroiditis. Postpartum thyroid dysfunction most commonly presents as hyperthyroidism followed by hypothyroidism. In some cases the second phase may proceed to either normal thyroid status or remains hypothyroid. The hyperthyroidism phase may be asymptomatic or patients may experience neuroexcitatory symptoms like palpitations. The hypothyroidism phase is usually symptomatic and may need treatment. Postpartum thyroid dysfunction may also present as exclusive hypothyroidism or hyperthyroidism.

Classification

Postpartum thyroid dysfunction can be classified on the base of presentation and the clinical course of the disease.[1][2][3][4]

Classification of postpartum thyroid dysfunction based on thyroid diseases:

 
 
 
 
 
 
 
 
 
Postpartum Thyroid Dysfunction
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Grave's disease
 
 
Hashimoto's thyroiditis
 
Postpartum thyroiditis
 
 
Silent thyroiditis
 
 
Subacute infective thyroiditis
 





Classification of postpartum thyroid dysfunction based on clinical course:



 
 
 
 
 
 
 
Postpartum Thyroid Dysfunction
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hyperthyroidism followed by hypothyroidism
 
 
Exclusive hyperthyroidism
 
Exclusive hypothyroidism
 
 
Hypothyroidism followed by hyperthyroidism
 
 
 
 




Differentiating various diseases on the basis of type of thyroid dysfunction

Stages Peek

presenting purpural month

Disease Symptoms and Signs Labs Mechanisum
Fatiuge Neck

swelling

Low

mood

Irritability TSH FT4 TPO ab ESR RAI

U

Thyroid U/S Microscopic

Picture

Persistent

hyperthyroidism

4-6 Grave's disease + Small

painful

mass

+ +

Early

↑↑ Neg Diffusely

enlarged

hypervascular

heterogeneous

echotexture

hyperplastic

follicles due to

eosinophilic

cytoplasm

scalloping

TSHR

activating

antibodies

Transient

hyperthyroidism

2-4 Silent thyroiditis + Small

painless

goiter

+

Late

+

Early

NL

or ↓

↑↑ 50% NL Markedly

decreased

vascularity

variable

heterogeneous

texture

Lymphocytic

infiltration & follicles

CD4

T-cell

activation

mutation

Postpartum thyroiditis + Small

painless goiter

+

Late

+

Early

NL

or ↓

↑↑ >80%  Hypoechoic

diffusely

enlarged

with

normal

or decreased

vascularity

Lymphocytic

infiltration & follicles

Reg

T-cell

gain in

function

mutation

Subacute (de Quervain's)

granulomatous thyroiditis

+ Small

painful

mass

+

late

+

early

nl

or ↓

↑↑ neg Diffusely

enlarged &

normal or

decreased

 vascularity

Giant cells

granulomas

Systemic

viral

infections

Factitious

thyrotoxicosis

+ Nl Neg +

Early

NL

or ↓

↑↑ Neg NL NL Normal

histology

Thyroixine

intake

Acute suppurative

thyroiditis

+ Small

painful

mass

+

Late

+

Early

NL

or ↓

↑↑ Neg Variable

heterogeneous

texture

perithyroidal

hypoechoic

space due to

abscess

Polymorphonuclear

leukocytes

lymphocytes

exudates

Viral, Bacterial
Destructive

hyperthyroidism

4-6 Subacute (de Quervain's)

granulomatous thyroiditis

+ Small

painful

mass

+

Late

+

Early

NL

or ↓

↑↑ Neg Diffusely

enlarged

& normal or

decreased

 vascularity

Gaint cells

granulomas

Systemic

viral

infections

Postpartum

thyroiditis

+ Small

painless

goiter

+

Late

+

Early

NL

or ↓

↑↑ >80%  Hypoechoic

diffusely

enlarged&

normal or

decreased

vascularity

Lymphocytic

infiltration & follicles

Reg

T-cell

gain in

function

mutation

Acute suppurative

thyroiditis

+ Small

painful

mass

+

Late

+

Early

NL

or ↓

↑↑ neg Variable

heterogeneous

texture

perithyroidal

hypoechoic

space due to

abscess

Polymorphonuclear leukocytes

lymphocytes

exudates

Viral,

Bacterial

Transient

hypothyroidism

2-4 Postpartum

thyroiditis

+ Small

painless

goiter

+

Late

+

Early

NL

or ↑

>80%   Hypoechoic

diffusely

enlarged

& normal or

decreased

vasclarity

Lymphocytic

infiltration & follicles

Reg

T-cell

gain in

function

mutation

Silent

thyroiditis

+ Small

painless

goiter

+

Late

+

Early

NL

or ↑

+ NL Markedly

decreased

vascularity

variable

heterogeneous

texture

Lymphocytic infiltration

& follicles

CD4

T-cell

activation

mutation

Subacute (de Quervain's)

granulomatous thyroiditis

+ Small

painful

mass

+

Late

+

Early

NL

or ↑

Neg Diffusely

enlarged

normal or

decreased

 vasclarity

Giant cells &

granulomas

Systemic

viral

infections

Acute suppurative

thyroiditis

+ Small

painful

mass

+

Late

+

Early

NL

or ↑

Neg Variable

heterogeneous

texture

perithyroidal

hypoechoic

space due to

abcess

Polymorphonuclear leukocytes

lymphocytes

exudates

Infections

viral,bacterial

Persistent

hypothyroidism

6 Riedel's

thyroiditis

+ Small

painful

mass

+

Late

+

Early

75% Homogeneously

hypoechoic

fibrotic

invasion of the

adjacent

structures

Lymphocytes, plasma cells, and eosinophils in a dense matrix of hyalinized connective tissue Viral

Bacterial

Postpartum

thyroiditis

+ Small

painless

goiter

+

Late

+

Early

>80%  Hypoechoic

diffusely

enlarged&

normal

or decreased

vasclarity

Variable

heterogeneous

texture,

hypoechogenic

Reg

T-cell

gain in

function

mutation

Hashimoto's

thyroiditis

+ Painful

mass

+

Late

+

Early

95% Heterogeneous

echotexture

decreased

vasclarity

hypoechoic

micronodules

Lymphoid

follicles

germinal centers

Hurthle cells

Reg T-cell

dysfunction

Acute suppurative

thyroiditis

+ Small

painful

mass

+

Late

+

Early

Neg Variable

heterogeneous

texture

perithyroidal

hypoechoic

space due to

abcess

Polymorphonuclear leukocytes

lymphocytes

exudates

Systemic

viral

infections

References

  1. Goldman JM (1986). "Postpartum thyroid dysfunction". Arch Intern Med. 146 (7): 1296–9. PMID 3718125.
  2. Fung HY, Kologlu M, Collison K, John R, Richards CJ, Hall R; et al. (1988). "Postpartum thyroid dysfunction in Mid Glamorgan". Br Med J (Clin Res Ed). 296 (6617): 241–4. PMC 2544770. PMID 3124900.
  3. Lazarus JH (2011). "The continuing saga of postpartum thyroiditis". J Clin Endocrinol Metab. 96 (3): 614–6. doi:10.1210/jc.2011-0091. PMID 21378224.
  4. Gerstein HC (1993). "Incidence of postpartum thyroid dysfunction in patients with type I diabetes mellitus". Ann Intern Med. 118 (6): 419–23. PMID 8439115.