Postpartum thyroiditis diagnostic criteria: Difference between revisions

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===Stepwise clinical diagnosis of Postpartum thyroiditis===
===Stepwise clinical diagnosis of Postpartum thyroiditis===
The following flowchart describes the clinical approach to the diagnosis of postpartum thyroiditis.
The following flowchart describes the clinical approach to the diagnosis of postpartum thyroiditis.
 
{{familytree/start|summary=Sample 1}}
{{familytree/start |summary=Sample 1}}
{{familytree | | | | X01 | | | X02 | | | | X03 | | | | X04 |X01=Prior [[Postpartum thyroiditis]] episode|X02=Family history of [[autoimmune]] disease or [[thyroid]] disease or Postive [[anti-TPO antibody]]|X03=[[Goiter]] or [[diabetes mellitus]]|X04=symptoms or signs of [[thyroid dysfunction in postpartum period]]}}
{{familytree | | | | X01 | | | X02 | | | | X03 | | | | X04 |X01=Prior [[Postpartum thyroiditis]] episode|X02=Family history of [[autoimmune]] disease or [[thyroid]] disease or Postive [[anti-TPO antibody]]|X03=[[Goiter]] or [[diabetes mellitus]]|X04=symptoms or signs of [[thyroid dysfunction in postpartum period]]}}
{{familytree | | | | |!| | | | |!| | | | | |!| | | | | |!}}
{{familytree | | | | |!| | | | |!| | | | | |!| | | | | |!}}
{{familytree | | | | |`|-|-|-|-|^|-|-|v|-|-|^|-|-|-|-|-|'}}
{{familytree | | | | |`|-|-|-|-|^|-|-|v|-|-|^|-|-|-|-|-|'}}
{{familytree | | | | | | | | | | | | Z01 | | | Z01=Check TSH<br>Free T4<br>Anti-TPO antibodies titers }}
{{familytree | | | | | | | | | | | | Z01 | | | Z01=Check ‡TFT<br>Anti-TPO antibodies titres<br>in postpartum peroid}}
{{familytree | | | | |,|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|-|-|-|-|-|-|-|.| | | | }}
{{familytree | | | | |,|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|-|-|-|-|-|-|-|.| | | | }}
{{familytree | | | | A01 | | | A02 | | | | A03 | | | | | | | | | | |!|A01=Panel A<br>TSH>4.0 <br> normal FT4 <br> -/+ anti-TPO|A02=Panel B<br>TSH>4.0 <br> low FT4 <br> -/+ anti-TPO|A03=Panel C<br>TSH=0.3-4.0 <br> normal FT4 <br> + anti-TPO}}
{{familytree | | | | A01 | | | A02 | | | | A03 | | | | | | | | | | |!|A01=Panel A<br>TSH>4.0<br>normal FT4 <br>-/+ anti-TPO|A02=Panel B<br>TSH>4.0 <br> low FT4 <br> -/+ anti-TPO|A03=Panel C<br>TSH=0.3-4.0 <br> normal FT4 <br> + anti-TPO}}
{{familytree | | | | |!| | | | |!| | | | | |!| | | | | | | | | | | |!}}
{{familytree | | | | |!| | | | |!| | | | | |!| | | | | | | | | | | |!}}
{{familytree | | | | B01 | | | B02 | |,|-| B03 |-| B04|-|-|-|-|-|-|(|B01=subclinical<br>[[hypothyroid]]|B02=Possible<br>AITD|B03=Repeat TSH<br>3-6months|B04=If TSH<1.0}}
{{familytree | | | | B01 | | | B02 | |,|-| B03 |-| B04|-|-|-|-|-|-|(|B01=subclinical<br>[[hypothyroid]] phase of †[[PPT]]|B02=Possible<br>[[Autoimmune thyroidits]]|B03=Repeat TSH<br>3-6months|B04=If TSH<1.0}}
{{familytree | | | | |!| | | | |!| | |!| | |!| | | | | | | || | | |!| | | || |}}
{{familytree | | | | |!| | | | |!| | |!| | |!| | | | | | | || | | |!| | | || |}}
{{familytree | | | | |)|-|-|-|-|'| | |!| | |!| | | | | | | || | | |!| | | || |}}
{{familytree | | | | |)|-|-|-|-|'| | |!| | |!| | | | | | | || | | |!| | | || |}}
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{{familytree | | | |E01| | | | | | | | | | | | | | | | | |!| | | |!| | ||!|E01=Consider tapering [[Levothyroxine]]}}
{{familytree | | | |E01| | | | | | | | | | | | | | | | | |!| | | |!| | ||!|E01=Consider tapering [[Levothyroxine]]}}
{{familytree | | | ||!|| | | | | | | | | | | | | | | | | |!| | | |!| | ||!|}}
{{familytree | | | ||!|| | | | | | | | | | | | | | | | | |!| | | |!| | ||!|}}
{{familytree | | | |F01| | | | | | | | | | | | | | | | |F02||F03| |F04|F01=Repeat TSH<br>3-6months|F02=dignosed as<br> hyperthyroid|F03=subclinical<br>hyperthyroidisum|F04=possible hypopituitary cause}}
{{familytree | | | |F01| | | | | | | | | | | | | | | | |F02||F03| |F04|F01=Repeat TSH<br>3-6months|F02=dignosed as<br> hyperthyroid<br>phase of †[[PPT]]|F03=subclinical<br>hyperthyroidisum<br>phase of †[[PPT]]|F04=possible hypo-pituitary [[hypothyroidism]]}}
{{familytree | | | ||)|-|-|.| }}
{{familytree | | | ||)|-|-|.| }}
{{familytree | | | |J01| |J02 |J01=TSH>4.0 <br>Treat<br>[[Levothyroxine]]|J02=TSH=0.3-4.0<br>Repeat [[TSH]]<br>3-6months}}
{{familytree | | | |J01| |J02 |J01=TSH>4.0 <br>Treat<br>[[Levothyroxine]]|J02=TSH=0.3-4.0<br>Repeat [[TSH]]<br>3-6months}}
{{Diagnosis and management of [[PPT]]}}
{{Diagnosis and management of [[PPT]]}}
 
{{'''Postpartum thyroiditis'''}}
'''Postpartum thyroiditis'''}}
{{familytree/end}}
{{familytree/end}}


<small>‡TFT; Thyroid function tests(TSH, T4, and T3), [[Grave's disease]] is not a thyroiditis, *RAIU; Radioiodine uptake.††One third of [[Riedel's thyroiditis]] presents with [[hypothyroidism]].</small>  
<small>‡TFT; Thyroid function tests(TSH, T4, and T3), †PPT=[[Postpartum thyroiditis]],.</small>  
<small>
<small>
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Revision as of 17:05, 19 October 2017

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

Overview

There are no established criteria for the diagnosis of postpartum thyroiditis"PPT" but it can be diagnosed on basis of level of TSH, free T4, free T3, radio-iodine uptake, presence of anit-TPO antibodies and absence of TSH receptor antibodies depending on the phase of disease.

Diagnostic Criteria

  • There are no established criteria for the diagnosis of PPT but it can be diagnosed on basis of level of TSH, free T4, free T3, radio-iodine, uptake presence of anit-TPO antibodies and absence of TSH receptor antibodies depending on the phase of disease[1].

Hyperthyroid phase: Set of following laboratory values on one or more occasions

  • TSH: low or suppresed
  • Anti-TPO antibodies: Postive
  • TSH-receptor antibodies: Negative
  • Free T4: Typical raised but may be normal.
  • Free T3: Raised or normal with or without raised FT4.
  • Radio-iodine uptake: Decreased.

Hypothyroid phase:

  • TSH: >3.6 mU/L
  • Anti-TPO antibodies: Postive
  • Free T4: <8 pmol/l
  • Free T3: <4.2 pmol/l
  • Radio-iodine uptake: Decreased.
  • Thyroid gland tenderness: Non-tender but may be tender sometime.[2]
  • ESR: Normal[3]

Stepwise clinical diagnosis of Postpartum thyroiditis

The following flowchart describes the clinical approach to the diagnosis of postpartum thyroiditis.

{{Diagnosis and management of †PPT}} Template:'''Postpartum thyroiditis'''

 
 
 
Prior Postpartum thyroiditis episode
 
 
Family history of autoimmune disease or thyroid disease or Postive anti-TPO antibody
 
 
 
Goiter or diabetes mellitus
 
 
 
symptoms or signs of thyroid dysfunction in postpartum period
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Check ‡TFT
Anti-TPO antibodies titres
in postpartum peroid
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Panel A
TSH>4.0
normal FT4
-/+ anti-TPO
 
 
Panel B
TSH>4.0
low FT4
-/+ anti-TPO
 
 
 
Panel C
TSH=0.3-4.0
normal FT4
+ anti-TPO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
subclinical
hypothyroid phase of †PPT
 
 
Possible
Autoimmune thyroidits
 
 
 
 
Repeat TSH
3-6months
 
If TSH<1.0
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treat
Levothyroxine
 
 
TSH>4.0
low FT4
 
 
 
 
TSH=0.3-4.0
normal FT4
 
 
 
 
 
 
 
 
 
Panel D
TSH<1.0
+ anti-TPO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Repeat TSH
3-6months
 
 
 
 
 
 
 
Repeat TSH
3-6months
 
 
 
 
FT4
high
 
FT4
normal
 
FT4
low
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider tapering Levothyroxine
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Repeat TSH
3-6months
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
dignosed as
hyperthyroid
phase of †PPT
subclinical
hyperthyroidisum
phase of †PPT
 
possible hypo-pituitary hypothyroidism
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
TSH>4.0
Treat
Levothyroxine
 
TSH=0.3-4.0
Repeat TSH
3-6months

‡TFT; Thyroid function tests(TSH, T4, and T3), †PPT=Postpartum thyroiditis,.
Table modified from [4]

References

  1. Stagnaro-Green A (2002). "Clinical review 152: Postpartum thyroiditis". J Clin Endocrinol Metab. 87 (9): 4042–7. doi:10.1210/jc.2002-020524. PMID 12213841.
  2. Stagnaro-Green A (2002). "Clinical review 152: Postpartum thyroiditis". J Clin Endocrinol Metab. 87 (9): 4042–7. doi:10.1210/jc.2002-020524. PMID 12213841.
  3. Stagnaro-Green A (2002). "Clinical review 152: Postpartum thyroiditis". J Clin Endocrinol Metab. 87 (9): 4042–7. doi:10.1210/jc.2002-020524. PMID 12213841.
  4. "Thyroiditis: Differential Diagnosis and Management - American Family Physician".

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