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Abstract
Postpartum thyroid dysfunction occurs in 5–10% of women within one year after delivery. Women with hypo-thyroidism antedating pregnancy are at high risk for postpartum thyroiditis and should be closely monitored during the first year post-partum. Here, we report a case of recurrent hyperthyroidism between two episodes of postpartum thyroiditis in a woman diagnosed with subclinical hypothyroidism prior to pregnancy. It is of particular interest that spontaneously remitting hyperthyroidism as a sequela of postpartum thyroiditis can occur.
References
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Fig. 1.
Anterior view images of a Tc-99m pertechnetate scan in thyrotoxic phase. (A) Postpartum thyroiditis, (B) The first episode of hyperthyroidism, (C) The second episode of hyperthyroidism, (D) A relapse of postpartum thyroiditis. The normal range of thyroid trapping index in our laboratory is 2.5–6.0. In this case, they were 1.2 (A), 11.3 (B), 3.4 (C), and 1.1 (D).
Fig. 2.
Serum free T4 change during pregnancy and after delivery in our patient with Hashimoto's thyroiditis. The dosages of L-T4 (levothyroxine) are shown at the top.
Table 1.
Temporal profile of thyroid function tests and levothyroxine treatment for a patient with recurrent hyperthyroidism following postpartum thyroiditis
Table 2.
Summary of literature describing cases of Graves' disease following postpartum thyroiditis
| Case number (reference) | Age | Family history of thyroid disease | Personal history of pre-pregnancy | PPT (months after delivery) | GD (months after delivery) | Anti-thyroid treatment | Final thyroid outcome |
|---|---|---|---|---|---|---|---|
| 1 (4) | 23 | No | No | 3 | 9 | PTU → Methimazole | Hypothyroidism due to Hashimoto' s thyroiditis |
| 2 (5) | 36 | No | PPT (at age 30) | 4 | 48‡ | Methimazole | N/A |
| 3 (5) | 17 | Yes∗ | Latent lupus | 1 | 5 | No | N/A |
| 4 (6) | 47 | No | No | 4 | 25 | PTU & 131 I | Post-131 I hypothyroidism |
| 5 (7) | 30 | No | No | 5 | 28 | Methimazole | N/A |
| 6 (8) | 31 | Yes† | PPT (3 years ago) | 2.5 | 10.5 | PTU | Euthyroid state |
| 7 (our case) | 29 | No | Hashimoto' s thyroiditis | 3 | 12 (first)25 (second) | No | L-T4 treatment |
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