Hoon Yang Ji; Jin Han Eun; Hoon Yim Chang

doi:10.11106/jkta.2013.6.1.75

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Ji, Eun, and Chang: Two Cases of Postpartum Thyroiditis Followed by Graves’ Disease

Original Article

J Korean Thyroid Assoc 2013;6(1):75-79.

Published online: 3 May 2013

DOI: https://doi.org/10.11106/jkta.2013.6.1.75

Two Cases of Postpartum Thyroiditis Followed by Graves’ Disease

Hoon Yang Ji, Jin Han Eun, Hoon Yim Chang

Department of Internal Medicine, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine, Seoul, Korea

Address reprint requests to Chang Hoon Yim, MD, PhD, Department of Internal Medicine, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine, 1-19 Mukjeong-dong, Jung-gu, Seoul 100-380, Korea Tel: 82-2-2000-4719, Fax: 82-2-2000-7147, E-mail: changhoon.yim@cgh.co.kr

Received 12 April 2013 Accepted 22 April 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The most common thyroid dysfunctions that occur after delivery are postpartum thyroiditis (PPT) and Graves’ disease (GD). PPT is more likely to occur among patients who had a history of PPT or GD. For that reason, it is possible to assume that both PPT and GD occur concomitantly after delivery. Here we report two cases of atypical postpartum thyroid dysfunctions presenting the simultaneous occurrence of PPT and GD. A 31-year-old woman with history of PPT had thyrotoxicosis and hypothyroidism of PPT followed by GD with mild symptoms. The patient recovered quickly afterwards. In the second case, a 28-year-old woman with a history of GD presented with thyrotoxicosis of PPT followed by severe GD. The patient required long-term antithyroid treatment.

Keywords: Graves’ disease, Postpartum thyroiditis, Thyrotoxicosis

References

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Table 1.

Summary of laboratory test results In case 1

Postpartum (weeks)	T3 (ng/dL)	fT4 (pmol/L)	TSH (mU/L)	TBII (%)	TPOAb (U/mL)	Medication
10 19 31 42 49 58 73	343 102 120 360 169 87 99	50 6.6 17 54 21 10 11	< 0.1 21 0.4 < 0.1 < 0.1 < 0.1 2.2	9 2 11 35 30 5 1	43 27 > 100 72 35 84 29	– LT 0.1 mg LT 0.1 mg PTU 100 mg PTU 100 mg PTU discontinued –

fT4: free thyroxine, LT: levothyroxine, PTU: propylthiouracil, T3: triiodothyronine, TBII: thyrotropin binding Inhibiting Immunoglobulin, TPOAb: thyroid peroxidase antibodies, TSH: thyroid-stimulating hormone

Fig. 1.

Serum free T4 and TBII change during postpartum period. The dosages of LT4 (levothyroxine) or PTU (propylthiouracil) are shown at the top. (A) Case 1, (B) Case 2.

Table 2.

Summary of laboratory test results in case 2

Postpartum (weeks)	T3 (ng/dL)	fT4 (pmol/L)	TSH (mU/L)	TBII (%)	TPOAb (U/mL)	Medication
16	698	87	< 0.1	14	>100	–
20	97	11	< 0.1	59	>100	–
25	241	15	< 0.1	77	–	–
33	–	48	< 0.1	82	>100	PTU 100 mg
44	365	34	< 0.1	74	83	PTU 100 mg
53	396	50	< 0.1	60	–	PTU 200 mg
63	347	34	< 0.1	55	–	PTU 150 mg
82	177	21	< 0.1	31	–	PTU 150 mg

fT4: free thyroxine, PTU: propylthiouracil, T3: triiodothyronine, TBII: thyrotropin binding inhibiting immunoglobulin, TPOAb: thyroid peroxidase antibodies, TSH: thyroid-stimulating hormone

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