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Recommendations Table 24. Postpartum Thyroiditis
Strength
*
Level
#
TPOAb-positive women or those with a history of PPT may
be educated about the high risk of PPT (recurrence) and
symptoms that may warrant thyroid function testing.
Conditional Low
During the thyrotoxic phase of PPT, women with
hyperthyroidism-related symptoms should be treated with
the lowest effective dose of a beta-blocker (propranolol or
metoprolol may be used if lactating ).
Strong High
Levothyroxine may be considered during the hypothyroid
phase of PPT if the woman is symptomatic, breastfeeding, or
if pregnancy is planned within 6 months.
Conditional Low
Upon normalization of thyroid function tests aer PPT, thyroid
function testing should be repeated aer one year or upon the
development of any hypothyroidism-related symptoms.
Good Practice Statement
* Strength of Recommendation;
#
Level of Evidence; Good Practice Statement.
Table 9. Distinguishing Between the Thyrotoxic Phase of
Postpartum Thyroiditis (PPT) and Graves' Disease
Feature
Thyrotoxic (destructive)
phase of PPT Graves' disease
Onset of thyrotoxicosis 1–6 months aer delivery 3–12 months aer delivery
TRAb and/or TSI
concentration
Negative Positive in most
Hyperthyroid symptoms Usually mild Can be severe
Eye symptoms Absent Can be present
Hyperthyroid signs May be absent May be present, along with
specific signs of Graves' disease
a
Duration of thyrotoxic
phase
0–3 months >3 months
TT3 (ng/dL) to TT4
(mcg/dL) ratio
Typically <20 Typically >20
yroid vascularity by
ultrasound
Low High
Radioactive iodine uptake
b
Low or absent High
a
Diffuse goiter, thyroid bruit, pretibial myxedema, and/or thyroid eye disease.
b
Contraindicated if the woman is lactating, thus temporary discontinuation of breastfeeding would
be needed following administration of the radioisotope.
Dysfunction Postpartum
