Journal List > Int J Thyroidol > v.8(2) > 1082726

Kim, Song, and Kim: Recurrent Hyperthyroidism Following Postpartum Thyroiditis in a Woman with Hashimoto' s Thyroiditis


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.


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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
Dates and events Free T4, ng/dL
(normal range)
TSH, μ IU/mL
(normal range)
TPO-Ab, U/mL
(normal range)
TBII (%)
(normal range)
Early February 2007 0.81
N/A 0 → 50 μ g/d Subclinical hypothyroidism
(Hashimoto' s thyroiditis)
Early May 2008 Delivery of the first child
Late June 2008
(6 weeks from first delivery)
1.29 0.09 N/A N/A 50 μ g/d→ 0 Thyrotoxic state
Late August 2008
(3 months from first delivery)
5.05 0.1 55.87 9.07
0 Postpartum thyroiditis
Early November 2008 0.09 107.46
N/A N/A 0 → 100 μ g/d Hypothyroid state
Late December 2008 2.14 1.3 N/A N/A 100 → 50 μ g/d Euthyroid state
Mid-April 2009 2.68 0.06 N/A N/A 50 μ g/d → 0 Thyrotoxic state
Mid-May 2009
(12 months from first delivery)
3.89 0.04 N/A 14
0 The first episode of hyperthyroidism
Late June 2009 2.91 0.13 N/A N/A 0 Hyperthyroid state
Late September 2009 0.87 0.82 N/A N/A 0 Euthyroid state
Early June 2010
(25 months from first delivery)
3.66 0.13 52.8
0 The second episode of hyperthyroidism
Early August 2010 2.19 0.3 N/A 13.08
0 Euthyroid state
Mid-January 2013 Delivery of the second child
Mid-April 2013
(3 months from second delivery)
0.07 969.9
0 A relapse of postpartum thyroiditis
Late June 2013 0.64 36.6 N/A N/A 0 → 50 μ g/d Hypothyroid state
Early August 2013 1.19 0.53 N/A N/A 50 μ g/d Euthyroid state
Early August 2014 1.52 0.45 N/A N/A 50 μ g/d Euthyroid state

L-T4: levothyroxine, N/A: not applicable

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

GD: Graves' disease, N/A: not-applicable, PPT: postpartum thyroiditis

mother: permanent hypothyroidism after postpartum thyroiditis, maternal grandmother: Hashimoto' s thyroiditis,

older sister: Graves' disease,

: in 24 months after recurrent painless thyroiditis

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