Postpartum thyroiditis diagnostic criteria: Difference between revisions
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==Overview== | ==Overview== | ||
There are no established criteria for the diagnosis of [[postpartum thyroiditis]] | There are no established criteria for the diagnosis of [[postpartum thyroiditis]] ([[Postpartum thyroiditis|PPT]]). However, PPT can be diagnosed on the basis of level of [[Thyroid-stimulating hormone|TSH]], free [[Thyroxine|T4]], free [[Triiodothyronine|T3]], radio-iodine uptake, presence of anit-[[Thyroid peroxidase|TPO]] [[antibodies]] and absence of [[TSH receptor]] antibodies. | ||
==Diagnostic Criteria== | ==Diagnostic Criteria== | ||
*There are no established criteria for the diagnosis of [[Postpartum thyroiditis|PPT]] | *There are no established criteria for the diagnosis of [[Postpartum thyroiditis|PPT]]. The following findings may contribute to the diagnosis of PPT:<ref name="pmid12213841">{{cite journal| author=Stagnaro-Green A| title=Clinical review 152: Postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2002 | volume= 87 | issue= 9 | pages= 4042-7 | pmid=12213841 | doi=10.1210/jc.2002-020524 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12213841 }}</ref> | ||
'''Hyperthyroid phase''': Set of following laboratory values on one or more occasions | '''Hyperthyroid phase''': Set of following laboratory values on one or more occasions | ||
*[[Thyroid-stimulating hormone|'''TSH''']]: low or suppresed | *[[Thyroid-stimulating hormone|'''TSH''']]: low or suppresed | ||
*'''Anti-[[Thyroid peroxidase|TPO]] [[antibodies]]''': Postive | *'''Anti-[[Thyroid peroxidase|TPO]] [[antibodies]]''': Postive | ||
*'''TSH-receptor [[antibodies]]''': Negative | *'''TSH-receptor [[antibodies]]''': Negative | ||
*'''Free T4''': Typical raised but may be normal | *'''Free T4''': Typical raised but may be normal | ||
*'''Free T3''': Raised or normal with or without raised FT4 | *'''Free T3''': Raised or normal with or without raised FT4 | ||
*'''Radio-iodine uptake''': Decreased | *'''Radio-iodine uptake''': Decreased | ||
'''Hypothyroid phase:''' | '''Hypothyroid phase:''' | ||
*'''TSH''': >3.6 mU/L | *'''TSH''': >3.6 mU/L | ||
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*'''Free T4''': <8 pmol/l | *'''Free T4''': <8 pmol/l | ||
*'''Free T3''': <4.2 pmol/l | *'''Free T3''': <4.2 pmol/l | ||
*'''Radio-iodine uptake''': Decreased | *'''Radio-iodine uptake''': Decreased | ||
*'''[[Thyroid gland]] tenderness''': Non-tender but may be tender sometime | *'''[[Thyroid gland]] tenderness''': Non-tender but may be tender sometime<ref name="pmid122138413">{{cite journal| author=Stagnaro-Green A| title=Clinical review 152: Postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2002 | volume= 87 | issue= 9 | pages= 4042-7 | pmid=12213841 | doi=10.1210/jc.2002-020524 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12213841 }}</ref> | ||
*'''ESR''': Normal<ref name="pmid122138412">{{cite journal| author=Stagnaro-Green A| title=Clinical review 152: Postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2002 | volume= 87 | issue= 9 | pages= 4042-7 | pmid=12213841 | doi=10.1210/jc.2002-020524 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12213841 }}</ref> | *'''ESR''': Normal<ref name="pmid122138412">{{cite journal| author=Stagnaro-Green A| title=Clinical review 152: Postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2002 | volume= 87 | issue= 9 | pages= 4042-7 | pmid=12213841 | doi=10.1210/jc.2002-020524 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12213841 }}</ref> | ||
===Stepwise clinical diagnosis of Postpartum thyroiditis=== | ===Stepwise clinical diagnosis of Postpartum thyroiditis=== | ||
The | 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]] 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]]}} | ||
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<small> | <small> | ||
TSH units in micro-grams per deciliter<br> | TSH units in micro-grams per deciliter<br> | ||
Table modified from <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> | Table modified from <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> | ||
Revision as of 16:56, 10 November 2017
Postpartum thyroiditis Microchapters |
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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.
{{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,.
TSH units in micro-grams per deciliter
Table modified from [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=
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