Journal List > Int J Thyroidol > v.11(1) > 1095048

Yoo: Recurrent Painless Thyroiditis in Patients with History of Postpartum Thyroiditis

초록

It is well known that the long-term prognosis of postpartum thyroiditis (PPT) is excellent except recurrent PPT in subsequent pregnancies and risk of progression to permanent hypothyroidism in some patients. However, the prospective observation of PPT patients who have neither consecutive gestation nor any evidence of hypothyroidism were limited. We describe three patients who have history of PPT and showed repeated painless thyroiditis in the span of more than ten years. The clinical courses of repeated painless thyroiditis were the transient thyrotoxicosis, self-limited, and not related to pregnancy. Based on the clinical courses of our three patients, it is recommended to remember that transient painless thyroiditis could be repeated as a possible long-term course of the patients with history of PPT.

REFERENCES

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Fig. 1.
Thyroid scans of painless thyroiditis episodes in cases 1 and 3.
ijt-11-49f1.tif
Fig. 2.
Thyroid ultrasonographic findings of painless thyroiditis episodes in the three cases.
ijt-11-49f2.tif
Table 1.
Data of thyroid function tests of case 1
Date TSH (0.25-4.0) uIU/ml FT4(0.78-1.94) ng/dL AMA (0-100) IU/ml ATA (0-70) IU/ml TSI (0-1.5) IU/L Descriptions
Sep. 2007: Delivery
Dec. 2007 0.01 4.95 4.9 120 0.3 PPT
Jan. 2008 5.27 0.5 40 171 0.45  
Sep. 2008 1.98 1.17 215 83 0.3 Euthyroid
15 months after PPT
Mar. 2009 0.01 1.73 25.5 326 0.5 First episode of painless thyroiditis
Apr. 2009 3.38 0.86 71.2 713 0.5  
Dec. 2009 0.99 1.13 7.6 416 0.3 Euthyroid
26 months after PPT
Feb. 2010 0.01 3.31       Second episode of painless thyroiditis
Apr. 2010 15.5 0.08        
May 2010 2.94 0.92       Euthyroid
38 months after PPT
Feb. 2011 0.01 4.32 43.7 970 0.3 Third episode of painless thyroiditis
Mar. 2011 0.67 1.03 51.7 1422 0.3  
Mar. 2012 1.04 1.04 22.7 638 0.2 Euthyroid

AMA: anti microsomal antibody, ATA: anti thyroglobulin antibody, FT4: free thyroxine, PPT: postpartum thyroiditis, TSH: thyroid stimulating hormone, TSI: thyroid stimulating immunoglobulin

Table 2.
Data of thyroid function tests of case 2
Date TSH (0.25-4.0) uIU/ml FT4(0.78-1.94) ng/dL AMA (0-100) IU/ml ATA (0-70) IU/ml TSI (0-1.5) IU/L Descriptions
Nov. 2003: Delivery
Feb. 2004 0.03 3.65 22.3 454.3 0.5 PPT
Apr. 2004 17.79 0.77 32.3 772.9 0.3  
Oct. 2004 2.5 1.18 64.1 471.1 0.3 Euthyroid
22 months after PPT
Dec. 2005 0.01 3.20 33.4 1298 0.3 First episode of painless thyroiditis
Feb. 2006 0.01 2.12 109.3 1196 0.3  
Aug. 2006 2.72 1.22 11.1 639.6 0.3 Euthyroid
Oct. 2008 4.33 1.23       Subclinical hypothyroid state
Dec. 2009 3.06 1.22       Euthyroid
6 years after PPT
Apr. 2010 0.07 3.15 102.3 1344.9 0.2 Second episode of painless thyroiditis
Oct. 2010 2.87 1.13 14.9 384.1 0.1 Euthyroid
8 years after PPT
Sep. 2012 0.02 3.81 47.2 422.4 0.1 Third episode of painless thyroiditis
Jan. 2013 2.80 1.11       Euthyroid
Sep. 2015 1.83 1.12       Euthyroid
Jun. 2017 2.10 1.14 20.8 855.5 0.1 Euthyroid

AMA: anti microsomal antibody, ATA: anti thyroglobulin antibody, FT4: free thyroxine, PPT: postpartum thyroiditis, TSH: thyroid stimulating hormone, TSI: thyroid stimulating immunoglobulin

Table 3.
Data of thyroid function tests of case 3
Date TSH (0.25-4.0) uIU/ml FT4(0.78-1.94) ng/dL AMA (0-100) IU/ml ATA (0-70) IU/ml TSI (0-1.5) IU/L Descriptions
Sep. 2002: Delivery (first baby)
Apr. 2003 0.01 1.34 4.0 80.2 0.3 First PPT
May 2003 0.03 3.98        
Mar. 2008: Delivery (second baby)
Jul. 2008 0.01 2.14 14.25 254.8 0.3 Second PPT
Sep. 2008 20.42 0.69 21.82 307.7 0.3  
Dec. 2008 4.88 0.8 7.41 210.1 0.3  
Jun. 2009 1.12 1.19 60.35 175.5 0.3 Euthyroid
2 years after second PPT
Apr. 2010 0.03 2.12 7.5 726.1 0.3 First episode of painless thyroiditis
Jan. 2013 2.1 1.21       Euthyroid
5 years after second PPT
Jun. 2013 0.01 2.43 10.0 10.2 0.3 Second episode of painless thyroiditis
Jul. 2013 0.01 1.58 7.4 15.5 0.1  
Oct. 2013 2.9 1.36 10.0 78 0.1 Euthyroid
May 2015 2.32 1.34 18.2 149 0.1  
Apr. 2016 0.12 1.53 1.3 147.3 0.1 Subclinical hyperthyroid state
Oct. 2017 2.62 1.15       Euthyroid

AMA: anti microsomal antibody, ATA: anti thyroglobulin antibody, FT4: free thyroxine, PPT: postpartum thyroiditis, TSH: thyroid stimulating hormone, TSI: thyroid stimulating immunoglobulin

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