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Postpartum thyroiditis

BMJ 2021; 372 doi: (Published 03 March 2021) Cite this as: BMJ 2021;372:n495
  1. Riley Epp, resident, Endocrinology and Metabolism Program1 2,
  2. Janine Malcolm, endocrinologist, associate professor1 2,
  3. Khiera Jolin-Dahel, family physician, assistant professor3,
  4. Michaela Clermont, patient partner4,
  5. Erin Keely, endocrinologist, full professor1 2
  1. 1Department of Medicine University of Ottawa, Ottawa, Ontario, Canada
  2. 2Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
  3. 3Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
  4. 4Ottawa, Ontario, Canada
  1. Correspondence to: E Keely Ekeely{at}

What you need to know

  • Symptoms of hyperthyroidism or hypothyroidism can be overlooked as “normal” in the postpartum period, resulting in delayed diagnosis and treatment of postpartum thyroiditis

  • Testing of thyroid stimulating hormone (TSH) level is recommended during 6-12 weeks postpartum among high risk populations and patients experiencing postpartum depression, lactation difficulties, or multiple symptoms of hyperthyroidism or hypothyroidism

  • Postpartum thyroiditis (PPT) confers an increased lifetime risk of developing permanent hypothyroidism, so annual monitoring of patients with a history of PPT is recommended

A 27 year old woman with type 1 diabetes presents at four months postpartum after the uncomplicated pregnancy and delivery of her second child complaining of hair loss, anxiety, irritability, and insomnia. She recalls that, following her first pregnancy, she had gradual onset of fatigue, weakness, sleep disruption, low milk supply, and a halt in weight loss at approximately three weeks postpartum. These symptoms had been diagnosed as postpartum depression and treated with antidepressants. After a few months trial of antidepressants was ineffective, a thyroid stimulating hormone (TSH) level was drawn and found to be elevated. Her symptoms improved after initiation of levothyroxine replacement. For this presentation she is again prescribed antidepressants for postpartum depression, but, after these are ineffective, a TSH level is drawn and found to be low, revealing hyperthyroidism.

What is postpartum thyroiditis?

Postpartum thyroiditis (PPT) is the development of thyroid dysfunction within the first year postpartum in a patient without toxic nodule or presence of TSH receptor antibodies (which would suggest Graves’ disease).1 PPT affects an estimated one in 20 women.2 It is an autoimmune lymphocytic thyroiditis which flares as a result of immunologic “rebound” from the relative immunosuppression of pregnancy.3 Classically, PPT is described as triphasic: an initial transient thyrotoxic phase occurring one to six months postpartum and lasting for two to three months is followed by a …

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