Postpartum thyroiditis medical therapy: Difference between revisions
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*Pharmacological medical therapy is recommended among PPT with asymptomatic and symptomatic patients according to levels of TSH, phase of disease and planning of pregnancy. | *Pharmacological medical therapy is recommended among PPT with asymptomatic and symptomatic patients according to levels of TSH, phase of disease and planning of pregnancy. | ||
*In hyperthyroid phase radioiodine and antithyroid treatment is not useful because the increase in serum T3 and T4 is due to release of thyroid hormone in blood due to destruction of thyroid follicle rather than increased production. | *In hyperthyroid phase radioiodine and antithyroid treatment is not useful because the increase in serum T3 and T4 is due to release of thyroid hormone in blood due to destruction of thyroid follicle rather than increased production. | ||
===Postpartum thyroiditis=== | ===Postpartum thyroiditis<ref name="pmid11588143">{{cite journal| author=Muller AF, Drexhage HA, Berghout A| title=Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care. | journal=Endocr Rev | year= 2001 | volume= 22 | issue= 5 | pages= 605-30 | pmid=11588143 | doi=10.1210/edrv.22.5.0441 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11588143 }}</ref>=== | ||
* '''Asymptomatic hyperthyroid phase''': | * '''Asymptomatic hyperthyroid phase''': | ||
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* Preferred regimen (3): Metoprolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal | * Preferred regimen (3): Metoprolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal | ||
* '''Symptomatic hyperthyroid phase in breast feeding mothers:''' | * '''Symptomatic hyperthyroid phase in breast feeding mothers:''' | ||
* Preferred regimen (1): Propranolol 40 mg PO once daily; may increase to 120 mg once daily until their serum T3 and serum free T4 concentrations are normal | * Preferred regimen (1): Propranolol 40 mg PO once daily; may increase to 120 mg once daily until their serum T3 and serum free T4 concentrations are normal | ||
* Alternate regimen (1): Atenolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal. | * Alternate regimen (1): Atenolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal. | ||
* Alternate regimen (2): Metoprolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal. | * Alternate regimen (2): Metoprolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal. | ||
* '''Asymptomatic hypothyroid phase TSH above reference range, less than 10 mU/L not planning a subsequent pregnancy:''' | * '''Asymptomatic hypothyroid phase TSH above reference range, less than 10 mU/L not planning a subsequent pregnancy:''' | ||
* Preferred regimen (1): Regular monitoring of TSH every 4 to 8 weeks to decide treatment of sever hypothyroid phase. | * Preferred regimen (1): Regular monitoring of TSH every 4 to 8 weeks to decide treatment of sever hypothyroid phase. | ||
* Alternate regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal | * Alternate regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal consider weaning T4 after 6 to 12 months | ||
* '''Asymptomatic hypothyroid phase TSH above reference range, less than 10 mU/L planning a subsequent pregnancy:''' | * '''Asymptomatic hypothyroid phase TSH above reference range, less than 10 mU/L planning a subsequent pregnancy:''' | ||
* Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal | * Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal consider weaning T4 after 6 to 12 months | ||
* Alternate regimen (1): Regular monitoring of TSH every 4 to 8 weeks to decide treatment of sever hypothyroid phase. | * Alternate regimen (1): Regular monitoring of TSH every 4 to 8 weeks to decide treatment of sever hypothyroid phase. | ||
* '''Asymptomatic hypothyroid phase TSH above 10 mU/L:''' | * '''Asymptomatic hypothyroid phase TSH above 10 mU/L:''' | ||
* Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal | * Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal consider weaning T4 after 6 to 12 months | ||
* '''Symptomatic hypothyroid phase irrespective of TSH levels:''' | * '''Symptomatic hypothyroid phase irrespective of TSH levels:''' | ||
* Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal. | * Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal consider weaning T4 after 6 to 12 months. | ||
* '''Symptomatic hypothyroid phase highly elevated TSH levels (above 50-100) and decreasing T4:''' | |||
* Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily continue thyroid hormone indefinitely monitoring TSH every 4 to 8 weeks. | |||
==References== | ==References== | ||
Revision as of 23:04, 3 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Patients of PPT with hyperthyroid phase are treated with beta blockers , whereas patients with hypothyroid phase are treated with levothyroxine LT4.
Medical Therapy
- Pharmacological medical therapy is recommended among PPT with asymptomatic and symptomatic patients according to levels of TSH, phase of disease and planning of pregnancy.
- In hyperthyroid phase radioiodine and antithyroid treatment is not useful because the increase in serum T3 and T4 is due to release of thyroid hormone in blood due to destruction of thyroid follicle rather than increased production.
Postpartum thyroiditis[1]
- Asymptomatic hyperthyroid phase:
- No treatment required. Regular monitoring of FT3 and FT4 every 4 to 8 weeks to decide treatment of sever hyperthyroid phase.
- Symptomatic hyperthyroid phase:
- Preferred regimen (1): Propranolol 40 mg PO once daily; may increase to 120 mg once daily until their serum T3 and serum free T4 concentrations are normal
- Preferred regimen (2): Atenolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal
- Preferred regimen (3): Metoprolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal
- Symptomatic hyperthyroid phase in breast feeding mothers:
- Preferred regimen (1): Propranolol 40 mg PO once daily; may increase to 120 mg once daily until their serum T3 and serum free T4 concentrations are normal
- Alternate regimen (1): Atenolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal.
- Alternate regimen (2): Metoprolol 25 mg PO once daily; may increase to 50 mg once daily after until their serum T3 and serum free T4 concentrations are normal.
- Asymptomatic hypothyroid phase TSH above reference range, less than 10 mU/L not planning a subsequent pregnancy:
- Preferred regimen (1): Regular monitoring of TSH every 4 to 8 weeks to decide treatment of sever hypothyroid phase.
- Alternate regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal consider weaning T4 after 6 to 12 months
- Asymptomatic hypothyroid phase TSH above reference range, less than 10 mU/L planning a subsequent pregnancy:
- Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal consider weaning T4 after 6 to 12 months
- Alternate regimen (1): Regular monitoring of TSH every 4 to 8 weeks to decide treatment of sever hypothyroid phase.
- Asymptomatic hypothyroid phase TSH above 10 mU/L:
- Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal consider weaning T4 after 6 to 12 months
- Symptomatic hypothyroid phase irrespective of TSH levels:
- Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily after until their serum TSH concentrations are normal consider weaning T4 after 6 to 12 months.
- Symptomatic hypothyroid phase highly elevated TSH levels (above 50-100) and decreasing T4:
- Preferred regimen (1): T4 (levothyroxine) 50 mcg PO once daily; may increase to 100 mcg once daily continue thyroid hormone indefinitely monitoring TSH every 4 to 8 weeks.
References
- ↑ Muller AF, Drexhage HA, Berghout A (2001). "Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care". Endocr Rev. 22 (5): 605–30. doi:10.1210/edrv.22.5.0441. PMID 11588143.