Thyroid Dysfunction Postpartum
50
Figure
7.
Trajectories
of
Postpartum
Thyroiditis
Subtypes
Example
of
postpartum
exacerbation
of
Graves'
disease
Delivery
Month
2
Month
4
Month
6–8
-
β-blocker
if
symptomatic
-
No
indication
for
antithyroid
drugs
-
Levothyroxine
therapy
-
Taper
dosage
after
6–12
months
to
assess
recovery
Serum thyroid hormone concentrations
a
Up
to
50%
of
women
who
initially
return
to
a
euthyroid
state
will
develop
chronic
hypothyroidism
later
in
life.
e
typical
trends
of
thyroid
hormone
trends
seen
in
various
subtypes
of
postpartum
thyroiditis
are
summarized.
During
the
thyrotoxic
phases
of
the
destructive
subtypes,
antithyroid
drugs
are
not
indicated,
as
the
underlying
etiolog
y
is
not
increased
thyroid
hormone
production
(as
compared
to
the
postpartum
recurrence
or
exacerbation
of
Graves'
disease,
shown
in
the
gray
dotted
line).
During
the
hypothyroid
phase
of
thyroiditis,
a
short
course
of
thyroid
hormone
replacement
may
be
considered
in
women
with
profound
symptoms
of
hypothyroidism,
with
the
plan
to
taper
or
stop
the
dose
aer
6–12
months.
Postpartum
Thyroiditis
Subtypes
a
Destructive
thyroiditis
(50%)
Biphasic
destructive
thyroiditis
(20%)
Transient
hypothyroidism
(25%)
Permanent
hypothyroidism
(5%)
