51
Recommendations Table 25. Other Postpartum Thyroid
Dysfunction
Management of postpartum hyperthyroidism
unrelated to PPT Strength
*
Level
#
e lowest effective dose of ATD in lactation should be used.
a
Strong Moderate
Consider applying the same considerations for starting an
ATD to women during lactation as those for the general non-
pregnant population.
Conditional Low
If scintigraphy is required during lactation for the diagnostic
evaluation of hyperthyroidism, breastmilk should be pumped
and discarded for 3–4 days aer administering I-123 and 36
hours aer administering Tc-99m, before breastfeeding is
resumed.
Strong Low
Do not offer I-131 treatment during lactation. Before I-131
therapy is administered, breastfeeding should be stopped
for at least 3 months. A diagnostic I-123 uptake scan may
be performed before therapy to assess for mammary iodine
uptake, or off-label dopamine agonist therapy may be given
to decrease mammary iodine uptake and radiation exposure
to mammary tissue.
Conditional Low
Postpartum follow-up of levothyroxine treatment
initiated in pregnancy Strength
*
Level
#
If levothyroxine was started for the treatment of subclinical
or mild overt hypothyroidism in pregnancy, a cessation trial
may be performed, the timing of which may be determined
following shared decision-making. e follow-up frequency
and decision to restart levothyroxine may be based on
hypothyroid symptoms, thyroid function, TPOAb status,
and/or if pregnancy is being planned imminently.
Conditional Low
a
Doses of up to 20 mg/day of MMI, or 450 mg/day of PTU do not affect newborn thyroid function
or neurodevelopment. If lower doses are ineffective, MMI up to 30 mg/day during lactation may be
considered in select cases based on the low passage into breast milk.
* Strength of Recommendation;
#
Level of Evidence; Good Practice Statement.
