17
Postpartum Thyroiditis (PPT)
Î All patients with depression, including postpartum depression, should
be screened for thyroid dysfunction. (S-L)
Î During the thyrotoxic phase of PPT, symptomatic women may be
treated with beta-blockers. A beta-blocker which is safe for lactating
women, such as propranolol or metoprolol, at the lowest possible dose
to alleviate symptoms, is the treatment of choice. Therapy is typically
required for a few weeks. (S-M)
Î Antithyroid drugs are NOT recommended for the treatment of the
thyrotoxic phase of PPT. (S-H)
Î Following the resolution of the thyrotoxic phase of PPT, serum TSH
should be measured in approximately 4–8 weeks (or if new symptoms
develop) to screen for the hypothyroid phase. (S-H)
Î LT4 should be considered for women with symptomatic hypothyroidism
due to PPT. If treatment is not initiated, their TSH level should be
repeated every 4–8 weeks until thyroid function normalizes. LT4
should also be started in hypothyroid women who are attempting
pregnancy or who are breastfeeding. (W-M)
Î If LT4 is initiated for PPT, discontinuation of therapy should be
attempted after 12 months. Tapering of LT4 should be avoided when a
woman is actively attempting pregnancy or is pregnant. (W-L)
Î Women with a prior history of PPT should have TSH testing annually to
evaluate for the development of permanent hypothyroidism. (S-H)
Î Treatment of euthyroid thyroid antibody-positive pregnant woman
with either LT4 or iodine to prevent PPT is ineffective and is NOT
recommended. (S-H)
