Postpartum thyroid dysfunction
Postpartum thyroid dysfunction |
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) | + | Small
painful mass |
+
late |
+
early |
nl
or ↓ |
↑↑ | neg | ↑ | ↓ | Diffusely
enlarged & normal or decreased vascularity |
Giant cells
granulomas |
Systemic
viral infections | ||
Factitious | + | 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) | + | Small
painful mass |
+
Late |
+
Early |
NL
or ↓ |
↑↑ | Neg | ↑ | ↓ | Diffusely
enlarged & normal or decreased vascularity |
Gaint cells
granulomas |
Systemic
viral infections |
Postpartum | + | 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 | + | 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 | + | 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) | + | 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 | + | 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 | + | 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 | + | 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
- ↑ Goldman JM (1986). "Postpartum thyroid dysfunction". Arch Intern Med. 146 (7): 1296–9. PMID 3718125.
- ↑ 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.
- ↑ 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.
- ↑ Gerstein HC (1993). "Incidence of postpartum thyroid dysfunction in patients with type I diabetes mellitus". Ann Intern Med. 118 (6): 419–23. PMID 8439115.