Postpartum thyroiditis diagnostic criteria: Difference between revisions
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The clinical approach to the diagnosis of postpartum thyroiditis is given below. | The clinical approach to the diagnosis of postpartum thyroiditis is given below. | ||
{{familytree/start|summary=Sample 1}} | {{familytree/start|summary=Sample 1}} | ||
{{familytree | | | | X01 | | | X02 | | | | X03 | | | | X04 |X01=Prior [[Postpartum thyroiditis]] | {{familytree | | | | X01 | | | X02 | | | | X03 | | | | X04 |X01=Prior episode of [[Postpartum thyroiditis]]|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 ‡TFT<br>Anti-TPO antibodies titres | {{familytree |boxstyle=text-align: left; | | | | | | | | | | | | Z01 | | | Z01=Check: <br>• ‡TFT and<br>• Anti-TPO antibodies titres in postpartum period}} | ||
{{familytree | | | | |,|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|-|-|-|-|-|-|-|.| | | | }} | {{familytree | | | | |,|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|-|-|-|-|-|-|-|.| | | | }} | ||
{{familytree | | | | A01 | | | A02 | | | | A03 | | | | | | | | | | |!|A01=Panel A<br> | {{familytree |boxstyle=text-align: left; | | | | 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= | {{familytree | | | | B01 | | | B02 | |,|-| B03 |-| B04|-|-|-|-|-|-|(|B01=Subclinical<br>[[hypothyroid]] phase of †[[PPT]]|B02=Possible<br>[[autoimmune thyroidits]]|B03=Repeat TSH<br> after 3-6months|B04=If TSH<1.0}} | ||
{{familytree | | | | |!| | | | |!| | |!| | |!| | | | | | | || | | |!| | | || |}} | {{familytree | | | | |!| | | | |!| | |!| | |!| | | | | | | || | | |!| | | || |}} | ||
{{familytree | | | | |)|-|-|-|-|'| | |!| | |!| | | | | | | || | | |!| | | || |}} | {{familytree | | | | |)|-|-|-|-|'| | |!| | |!| | | | | | | || | | |!| | | || |}} | ||
{{familytree | | | |C01|-|-|C02|-|'| |C03| | | | | | | | | |C04| |C01=Treat<br>[[Levothyroxine]]|C02= | {{familytree | | | |C01|-|-|C02|-|'| |C03| | | | | | | | | |C04| |C01=Treat with<br>[[Levothyroxine]]|C02=•TSH>4.0 <br>•Low FT4|C03=•[[TSH]]=0.3-4.0 <br>•Normal FT4|C04='''Panel D:'''<br>•[[TSH]]<1.0 <br>•+ Anti-TPO}} | ||
{{familytree | | | | |!| | | | | | | | || |!|| | | | | | | |,|-|-|+|-|-|-|.| }} | {{familytree | | | | |!| | | | | | | | || |!|| | | | | | | |,|-|-|+|-|-|-|.| }} | ||
{{familytree | | | | D01 | | | | | | | ||D02 | | | | ||D03| |D04| |D05|D01=Repeat [[TSH]]<br>3- | {{familytree | | | | D01 | | | | | | | ||D02 | | | | ||D03| |D04| |D05|D01=Repeat [[TSH]]<br>in 3-6 months|D02=Repeat [[TSH]] in <br>3-6months|D03=[[FT4]]<br>high|D04=[[FT4]]<br>normal|D05=[[FT4]]<br>low}} | ||
{{familytree | | | | |!| | | | | | | | | | | | | | | | | | |!| | | |!| | ||!|}} | {{familytree | | | | |!| | | | | | | | | | | | | | | | | | |!| | | |!| | ||!|}} | ||
{{familytree | | | |E01| | | | | | | | | | | | | | | | | |!| | | |!| | ||!|E01=Consider tapering [[ | {{familytree | | | |E01| | | | | | | | | | | | | | | | | |!| | | |!| | ||!|E01=Consider tapering [[levothyroxine]]}} | ||
{{familytree | | | ||!|| | | | | | | | | | | | | | | | | |!| | | |!| | ||!|}} | {{familytree | | | ||!|| | | | | | | | | | | | | | | | | |!| | | |!| | ||!|}} | ||
{{familytree | | | |F01| | | | | | | | | | | | | | | | |F02||F03| |F04|F01=Repeat TSH<br>3-6months|F02= | {{familytree | | | |F01| | | | | | | | | | | | | | | | |F02||F03| |F04|F01=Repeat TSH in<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= | {{familytree | | | |J01| |J02 |J01=•TSH>4.0 <br>•Treat<br>[[Levothyroxine]]|J02=•TSH=0.3-4.0<br>•Repeat [[TSH]]<br>3-6months}} | ||
{{familytree/end}} | {{familytree/end}} | ||
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TSH units in micro-grams per deciliter<br> | TSH units in micro-grams per deciliter<br> | ||
Adopted from AFP<ref name="urlThyroiditis: Differential Diagnosis and Management - American Family Physician">{{cite web |url=http://www.aafp.org/afp/2000/0215/p1047.html#afp20000215p1047-b7 |title=Thyroiditis: Differential Diagnosis and Management - American Family Physician |format= |work= |accessdate=}}</ref></small> | |||
==References== | ==References== | ||
Latest revision as of 17:35, 10 November 2017
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Postpartum thyroiditis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Postpartum thyroiditis diagnostic criteria On the Web |
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American Roentgen Ray Society Images of Postpartum thyroiditis diagnostic criteria |
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Risk calculators and risk factors for Postpartum thyroiditis diagnostic criteria |
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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ "Thyroiditis: Differential Diagnosis and Management - American Family Physician".
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De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, Korbonits M, McLachlan R, New M, Purnell J, Rebar R, Singer F, Vinik A, Lazarus J. PMID 25905287. Missing or empty |title= (help)