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" 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}}

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 TSH
Free T4
Anti-TPO antibodies titers
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 
 
Possible
AITD
 
 
 
 
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
subclinical
hyperthyroidisum
 
possible hypopituitary cause
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
TSH>4.0
Treat
Levothyroxine
 
TSH=0.3-4.0
Repeat TSH
3-6months

‡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.
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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