Table of ContentsView AllTable of ContentsTypes of PPTRisk FactorsTypical CourseSymptomsDiagnosisThyrotoxic TreatmentHypothyroid TreatmentIf You’re BreastfeedingA Word From Verywell
Table of ContentsView All
View All
Table of Contents
Types of PPT
Risk Factors
Typical Course
Symptoms
Diagnosis
Thyrotoxic Treatment
Hypothyroid Treatment
If You’re Breastfeeding
A Word From Verywell
Brooke Pelczynski / Verywell
There are several types of postpartum thyroiditis, including:
Though this resolves in the majority of cases, 20% to 40% of women develop permanent hypothyroidism.
The condition is fairly common, as it’s estimated to affect approximately 5-10% of women.
Certain risk factors may help predict who is at an increased risk for developing postpartum thyroiditis.
These include:
Thyroid Disease Symptoms: Signs of Thyroid Problems
The next most common presentation is mild thyrotoxicosis, which begins one to four months after delivery, after which your thyroid normalizes.
While some cases of postpartum thyroiditis resolve over time, there is a strong risk that the woman will continue to have a thyroid condition.
It’s estimated that as many as half of women with postpartum thyroiditis will develop persistent hypothyroidism, a goiter (an enlarged thyroid gland), or both, within four to eight years of onset. For this reason, you should have your TSH level checked every year after the resolution of postpartum thyroiditis.
There are a number of symptoms of postpartum thyroiditis that may appear during both the thyrotoxic and hypothyroid phases of the condition.
Symptoms during the thyrotoxic phase of postpartum thyroiditis are usually milder versions ofgeneral hyperthyroidism symptoms. These symptoms may include anxiety, muscle weakness, irritability,heart palpitations, fast heartbeat, tremor, weight loss, and diarrhea.
The symptoms during the hypothyroid phase of postpartum thyroiditis are milder versions of general hypothyroidism symptoms. They may include sluggishness, dry skin, difficultylosing weight(orweight gain), constipation, low body temperature, and puffiness in the eyes, face, and hands.
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Your healthcare provider will typically run several blood tests to diagnose postpartum thyroiditis.
In some cases of postpartum thyroiditis, an ultrasound is performed and will show enlargement of the thyroid gland.
Graves' Disease
Some distinguishing features of Graves' disease include more severe symptoms, more thyroid enlargement, and eye-related symptoms (calledGraves' ophthalmopathy).
In some cases, a radioiodine uptake test is done to differentiate postpartum thyroiditis from Graves' disease. Note, however, that this test is contraindicated if you’re breastfeeding unless you pump and discard your milk for a few days afterward.
Postpartum ThyroiditisTSH receptor antibodies are typically not presentYou may have an elevated T4 to T3 ratioRadioiodine uptake is very lowGraves' DiseaseTSH receptor antibodies are present in nearly all patientsYou may have a goiter or bulging eyesRadioiodine uptake is elevated
Postpartum ThyroiditisTSH receptor antibodies are typically not presentYou may have an elevated T4 to T3 ratioRadioiodine uptake is very low
TSH receptor antibodies are typically not present
You may have an elevated T4 to T3 ratio
Radioiodine uptake is very low
Graves' DiseaseTSH receptor antibodies are present in nearly all patientsYou may have a goiter or bulging eyesRadioiodine uptake is elevated
TSH receptor antibodies are present in nearly all patients
You may have a goiter or bulging eyes
Radioiodine uptake is elevated
Thyroid Testing and Diagnosis
Antithyroid drugs aren’t recommended for the thyrotoxic period of postpartum thyroiditis because it isn’t actually hyperthyroidism.
If you have symptoms, your healthcare provider may prescribe a beta-blocker such as propranolol or metoprolol at the lowest possible dose for a few weeks to relieve them. Propranolol is preferred if you’re breastfeeding since it doesn’t transfer to the breastmilk as easily and also because it decreases the activation of the thyroid hormone (T4 into T3).
The American Thyroid Association (ATA) recommends that once your thyrotoxic phase subsides, your TSH level should be checked again after four to six weeks to screen for the hypothyroid phase, which occurs in about 75% of cases.
If you do end up in the hypothyroid phase of PPT, your treatment plan will depend on several factors. Here’s what’s generally recommended:
Levothyroxine is typically prescribed for about a year and then gradually tapered off while closely monitoring your TSH levels to make sure you haven’t developed permanent hypothyroidism. The exception to this is if you get pregnant or want to get pregnant during this time. In that case, your healthcare provider will leave you on your medication until a later time.
Breastfeeding Considerations
Experts recommend that the maximum daily dose of antithyroid medication while breastfeeding should be 20 mg of methimazole (MMI) or 450 mg of propylthiouracil (PTU).
Taking Thyroid Medication While Breastfeeding
Once you’ve had postpartum thyroiditis, you have a substantially increased risk of developing it again during future pregnancies. When planning a pregnancy, or upon finding out you are pregnant, make sure to inform your healthcare providers about any past thyroid issues.
In addition, an episode of postpartum thyroiditis increases your risk of developing hypothyroidism or a goiter later on in life, so it’s important to have your thyroid function evaluated annually.
Fertility and Pregnancy Challenges With Thyroid Disease
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Stagnaro-green A.Approach to the patient with postpartum thyroiditis.J Clin Endocrinol Metab. 2012;97(2):334-42. doi:10.1210/jc.2011-2576American Thyroid Association.Postpartum Thyroiditis.Di Bari F, Granese R, Le Donne M, Vita R, Benvenga S.Autoimmune Abnormalities of Postpartum Thyroid Diseases.Front Endocrinol (Lausanne). 2017;8:166. doi:10.3389/fendo.2017.00166Johns Hopkins Medicine.Postpartum Thyroiditis.Stagnaro-Green A, Abalovich M, Alexander E, et al.Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum.Thyroid. 2011;21(10):1081–1125. doi:10.1089/thy.2011.0087U.S. National Library of Medicine. Drugs and Lactation Database.Levothyroxine. Updated October 31, 2018.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Stagnaro-green A.Approach to the patient with postpartum thyroiditis.J Clin Endocrinol Metab. 2012;97(2):334-42. doi:10.1210/jc.2011-2576American Thyroid Association.Postpartum Thyroiditis.Di Bari F, Granese R, Le Donne M, Vita R, Benvenga S.Autoimmune Abnormalities of Postpartum Thyroid Diseases.Front Endocrinol (Lausanne). 2017;8:166. doi:10.3389/fendo.2017.00166Johns Hopkins Medicine.Postpartum Thyroiditis.Stagnaro-Green A, Abalovich M, Alexander E, et al.Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum.Thyroid. 2011;21(10):1081–1125. doi:10.1089/thy.2011.0087U.S. National Library of Medicine. Drugs and Lactation Database.Levothyroxine. Updated October 31, 2018.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Stagnaro-green A.Approach to the patient with postpartum thyroiditis.J Clin Endocrinol Metab. 2012;97(2):334-42. doi:10.1210/jc.2011-2576American Thyroid Association.Postpartum Thyroiditis.Di Bari F, Granese R, Le Donne M, Vita R, Benvenga S.Autoimmune Abnormalities of Postpartum Thyroid Diseases.Front Endocrinol (Lausanne). 2017;8:166. doi:10.3389/fendo.2017.00166Johns Hopkins Medicine.Postpartum Thyroiditis.Stagnaro-Green A, Abalovich M, Alexander E, et al.Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum.Thyroid. 2011;21(10):1081–1125. doi:10.1089/thy.2011.0087U.S. National Library of Medicine. Drugs and Lactation Database.Levothyroxine. Updated October 31, 2018.
Stagnaro-green A.Approach to the patient with postpartum thyroiditis.J Clin Endocrinol Metab. 2012;97(2):334-42. doi:10.1210/jc.2011-2576
American Thyroid Association.Postpartum Thyroiditis.
Di Bari F, Granese R, Le Donne M, Vita R, Benvenga S.Autoimmune Abnormalities of Postpartum Thyroid Diseases.Front Endocrinol (Lausanne). 2017;8:166. doi:10.3389/fendo.2017.00166
Johns Hopkins Medicine.Postpartum Thyroiditis.
Stagnaro-Green A, Abalovich M, Alexander E, et al.Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum.Thyroid. 2011;21(10):1081–1125. doi:10.1089/thy.2011.0087
U.S. National Library of Medicine. Drugs and Lactation Database.Levothyroxine. Updated October 31, 2018.
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