Journal List > J Korean Thyroid Assoc > v.6(1) > 1056545

J Korean Thyroid Assoc. 2013 May;6(1):75-79. Korean.
Published online May 31, 2013.
Copyright © 2013. the Korean Thyroid Association. All rights reserved.
Two Cases of Postpartum Thyroiditis Followed by Graves' Disease
Ji Hoon Yang, Eun Jin Han and Chang Hoon Yim
Department of Internal Medicine, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine, Seoul, Korea.

Correspondence: 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, Email:
Received September 22, 2012; Revised April 12, 2013; Accepted April 22, 2013.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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


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.
Click for larger image


Table 1
Summary of laboratory test results in case 1
Click for larger image

Table 2
Summary of laboratory test results in case 2
Click for larger image

1. Nicholson WK, Robinson KA, Smallridge RC, Ladenson PW, Powe NR. Prevalence of postpartum thyroid dysfunction: a quantitative review. Thyroid 2006;16(6):573–582.
2. Amino N, Mori H, Iwatani Y, Tanizawa O, Kawashima M, Tsuge I, et al. High prevalence of transient post-partum thyrotoxicosis and hypothyroidism. N Engl J Med 1982;306(14):849–852.
3. Browne-Martin K, Emerson CH. Postpartum thyroid dysfunction. Clin Obstet Gynecol 1997;40(1):90–101.
4. Shigemasa C, Mitani Y, Taniguchi S, Ueta Y, Urabe K, Tanaka T, et al. Development of postpartum spontaneously resolving transient Graves' hyperthyroidism followed immediately by transient hypothyroidism. J Intern Med 1990;228(1):23–28.
5. Sarlis NJ, Brucker-Davis F, Swift JP, Tahara K, Kohn LD. Graves' disease following thyrotoxic painless thyroiditis. Analysis of antibody activities against the thyrotropin receptor in two cases. Thyroid 1997;7(6):829–836.
6. Stagnaro-Green A. Clinical review 152: Postpartum thyroiditis. J Clin Endocrinol Metab 2002;87(9):4042–4047.
7. Amino N, Tada H, Hidaka Y. Postpartum autoimmune thyroid syndrome: a model of aggravation of autoimmune disease. Thyroid 1999;9(7):705–713.
8. Benhaim Rochester D, Davies TF. Increased risk of Graves' disease after pregnancy. Thyroid 2005;15(11):1287–1290.
9. Yim CH, Choi HA, Han SS, Kim HS, Lee CU, Chung HY, et al. The postpartum recurrence of Graves' disease and its contributing factors. J Korean Soc Endocrinol 2002;17(2):189–196.
10. Tagami T, Hagiwara H, Kimura T, Usui T, Shimatsu A, Naruse M. The incidence of gestational hyperthyroidism and postpartum thyroiditis in treated patients with Graves' disease. Thyroid 2007;17(8):767–772.
11. Shigemasa C, Mitani Y, Taniguchi S, Adachi T, Ueta Y, Urabe K, et al. Three patients who spontaneously developed persistent hypothyroidism during or following treatment with antithyroid drugs for Graves' hyperthyroidism. Arch Intern Med 1990;150(5):1105–1109.
12. Nakamura S, Saio Y, Shimada T, Matsui I. Transient hypothyroidism in a case of untreated Graves' disease. Endocr J 1995;42(1):77–81.
13. Iitaka M, Ishii J, Ishikawa N, Yoshimura H, Momotani N, Saitou H, et al. A case of Graves' disease with false hyperthyrotropinemia who developed silent thyroiditis. Endocrinol Jpn 1991;38(6):667–671.
14. Momotani N, Noh J, Ishikawa N, Ito K. Relationship between silent thyroiditis and recurrent Graves' disease in the postpartum period. J Clin Endocrinol Metab 1994;79(1):285–289.
15. Iitaka M, Morgenthaler NG, Momotani N, Nagata A, Ishikawa N, Ito K, et al. Stimulation of thyroid-stimulating hormone (TSH) receptor antibody production following painless thyroiditis. Clin Endocrinol (Oxf) 2004;60(1):49–53.
16. Nagai Y, Toya T, Fukuoka K, Tanaka N, Yanagi S, Kobayashi K. Occurrence and spontaneous remission of Graves' hyperthyroidism preceded by painless thyroiditis. Endocr J 1997;44(6):881–885.