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

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

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.

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.
jkta-6-75f1.tif
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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