Postpartum thyroiditis diagnostic criteria

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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). However, PPT can be diagnosed on the basis of level of TSH, free T4, free T3, radio-iodine uptake, presence of anit-TPO antibodies and absence of TSH receptor antibodies.

Diagnostic Criteria

  • There are no established criteria for the diagnosis of PPT. The following findings may contribute to the diagnosis of PPT:[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 clinical approach to the diagnosis of postpartum thyroiditis is given below.

 
 
 
Prior episode of Postpartum thyroiditis
 
 
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 and
• Anti-TPO antibodies titres in postpartum period
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
after 3-6months
 
If TSH<1.0
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Treat with
Levothyroxine
 
 
•TSH>4.0
•Low FT4
 
 
 
 
TSH=0.3-4.0
•Normal FT4
 
 
 
 
 
 
 
 
 
Panel D:
TSH<1.0
•+ Anti-TPO
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Repeat TSH
in 3-6 months
 
 
 
 
 
 
 
Repeat TSH in
3-6months
 
 
 
 
FT4
high
 
FT4
normal
 
FT4
low
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider tapering levothyroxine
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Repeat TSH in
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,. TSH units in micro-grams per deciliter

Adopted from AFP[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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