Lab Value


A 27-year-old woman with a history of lupus develops symptoms of hyperthyroidism 2 months after delivery of her first child. Three months later, she develops symptoms of hypothyroidism that persist. A small, nontender goiter is present.

What is the best method of treatment for her disease?

The patient described in the question has the classic findings of postpartum painless thyroiditis. This disease is characterized by lymphocytic inflammation of the thyroid after pregnancy. It occurs within 1 year of delivery in 2–16% of women and is more prevalent in women with known history of autoimmune disorders. It can cause transient or permanent thyroid dysfunction. The classic pattern begins with thyrotoxicosis. This usually is first seen 1–6 months after delivery and lasts for up to 2 months. This is followed by a hypothyroid phase that lasts between 4 and 6 months. A majority of women (80%) will return to a euthyroid state within a year of delivery. A small fraction of women develop persistent hypothyroidism.

On physical examination, patients will have a firm, nontender goiter. Thyroid peroxidase antibodies and thyroglobulin antibodies are elevated in 85% of these patients. If Graves is suspected, iodine uptake scan may be useful to distinguish painless postpartum thyroiditis (low uptake) from Graves disease (high uptake).

Treatment is usually not necessary for either the thyrotoxicosis or hypothyroid phases of the disease. If the patient does have a persistent hypothyroid state, replacement therapy is indicated. An attempt to discontinue thyroid hormone at 6–9 months should be done to determine if the patient has returned to a euthyroid state.