Postpartum thyroiditis medical therapy: Difference between revisions

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Revision as of 22:46, 3 October 2017

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

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.
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.
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.
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.

References

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@@ Line 4: / Line 4: @@
 ==Overview==
-There is no treatment for [disease name]; the mainstay of therapy is supportive care.
-OR
+Patients of PPT with hyperthyroid phase are treated with beta blockers , whereas patients with hypothyroid phase are treated with levothyroxine LT4.
-Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
-OR
-The majority of cases of [disease name] are self-limited and require only supportive care.
-OR
-[Disease name] is a medical emergency and requires prompt treatment.
-OR
-The mainstay of treatment for [disease name] is [therapy].
-OR
-The optimal therapy for [malignancy name] depends on the stage at diagnosis.
-OR
-[Therapy] is recommended among all patients who develop [disease name].
-OR
-Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
-OR
-Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
-OR
-Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
-OR
-Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
 ==Medical Therapy==
-*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
+*Pharmacological medical therapy is recommended among PPT with asymptomatic and symptomatic patients according to levels of TSH, phase of disease and planning of pregnancy.
-*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
+*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.
-*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
+===Postpartum thyroiditis===
-*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
-===Disease Name===
-* '''1 Stage 1 - Name of stage'''
-** 1.1 '''Specific Organ system involved 1'''
-*** 1.1.1 '''Adult'''
-**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)'''
-**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
-**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
-**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
-**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
-**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
-*** 1.1.2 '''Pediatric'''
-**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
-***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
-***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
-***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
-***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
-***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
-****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
-***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
-***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
-***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
-***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
-** 2.1 '''Specific Organ system involved 2'''
-*** 2.1.1 '''Adult'''
-**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
-*** 2.1.2  '''Pediatric'''
-**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
-* 2 '''Stage 2 - Name of stage'''
+* '''Asymptomatic hyperthyroid phase''':
-** 2.1 '''Specific Organ system involved 1 '''
+* No treatment required. Regular monitoring of FT3 and FT4 every 4 to 8 weeks to decide treatment of sever hyperthyroid phase.
-**: '''Note (1):'''
+* '''Symptomatic hyperthyroid phase''':
-**: '''Note (2)''':
+* 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
-**: '''Note (3):'''
+* 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
-*** 2.1.1 '''Adult'''
+* 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
-**** Parenteral regimen
+* '''Symptomatic hyperthyroid phase in breast feeding mothers:'''
-***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
+* 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.
-***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
+* 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.
-***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
+* 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.
-**** Oral regimen
+* '''Asymptomatic hypothyroid phase TSH above reference range, less than 10 mU/L not planning a subsequent pregnancy:'''
-***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
+* Preferred regimen (1): Regular monitoring of TSH every 4 to 8 weeks to decide treatment of sever hypothyroid phase.
-***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
+* 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.
-***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
+* '''Asymptomatic hypothyroid phase TSH above reference range, less than 10 mU/L planning a subsequent pregnancy:'''
-***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
+* 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.
-***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
+* Alternate regimen (1): Regular monitoring of TSH every 4 to 8 weeks to decide treatment of sever hypothyroid phase.
-***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
+* '''Asymptomatic hypothyroid phase TSH above 10 mU/L:'''
-*** 2.1.2 '''Pediatric'''
+* 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.
-**** Parenteral regimen
+* '''Symptomatic hypothyroid phase irrespective of TSH  levels:'''
-***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
+* 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.
-***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
-***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
-**** Oral regimen
-***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
-***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
-***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
-***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
-** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
-**: '''Note (1):'''
-**: '''Note (2)''':
-**: '''Note (3):'''
-*** 2.2.1 '''Adult'''
-**** Parenteral regimen
-***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
-***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
-***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
-**** Oral regimen
-***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
-***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
-***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
-***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
-***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
-***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
-*** 2.2.2 '''Pediatric'''
-**** Parenteral regimen
-***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
-***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
-***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
-**** Oral regimen
-***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
-***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
-***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
-***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
 ==References==