Postpartum Thyroiditis

Postpartum thyroiditis requires careful diagnosis and treatment, according to 2011 guidelines published by the American Thyroid Association.. istockphoto

Postpartum thyroiditis is defined as thyroid dysfunction and inflammation that develops or is diagnosed in the year after childbirth in women who had otherwise normal thyroid function prior to pregnancy.

According to the 2011 "Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum," about 25 percent of women have what's considered a "classical" case of postpartum thyroiditis.

Classical postpartum thyroiditis follows a typical course: a period of hyperthyroidism (overactivity), followed by a period of hypothyroidism (underactivity), followed by normalization of thyroid function taking place within the first year after childbirth.

The hyperthyroid phase of postpartum thyroiditis typically occurs between two and six months after childbirth, and in most cases, it resolves on its own, and requires no treatment. The hypothyroid phase of postpartum thyroiditis typically takes place from around three to twelve months months postpartum.

Some 32 percent of women with thyroiditis have isolated postpartum hyperthyroidism - never going through a hypothyroid phase. Around 43 percent have thyroiditis with isolated postpartum hypothyroidism, meaning they never go through a hyperthyroid phase.

Of particular interest to women and their physicians: An estimated 10 to 20 percent of the women who have postpartum thyroiditis that manifests as hypothyroidism end up with permanent hypothyroidism that requires lifelong treatment.

In women who test positive for thyroid antibodies during the first trimester of pregnancy, a third to a half of them will develop postpartum thyroiditis. This is in contrast to approximately 8 percent of all pregnant women. Postpartum thyroiditis is also more common in women who have other autoimmune disorders.

For example: 25 percent of women who have Type 1 diabetes mellitus or chronic viral hepatitis develop postpartum thyroiditis; 14 percent of women with lupus develop it; and it affects 44 percent of women with a prior history of Graves' disease. Having postpartum thyroiditis in a previous pregnancy means a woman has a 70 percent chance of developing it in subsequent pregnancies.


Symptoms of postpartum thyroiditis depend on the phase of thyroiditis a woman is in. During the postpartum phase, symptoms may include insomnia, rapid weight loss, diarrhea, anxiety, and other common hyperthyroidism symptoms. During the hypothyroid phase, fatigue, constipation, weight gain (or inability to lose weight), hair loss, and mood changes are common.  


Typically, antithyroid drugs are not recommended for the hyperthyroid period of postpartum thyroiditis. If women are symptomatic, a beta blocker may be used: the recommended is propranolol, at the lowest possible dose to relieve symptoms.

The Guidelines recommend that after the hyperthyroid phase, TSH should be monitored every two months until 1 year postpartum, to screen for hypothyroidism.

If symptoms are severe, or if conception is being attempted, a woman in the hypothyroid phase of postpartum thyroiditis should be treated. If a woman is asymptomatic, the Guidelines recommend having TSH rechecked every four to eight weeks.

In a woman who is being treated for the hypothyroid phase of postpartum thyroiditis, how long the treatment should continue is determined by whether she is attempting pregnancy, pregnant again, or breastfeeding, in which case, continued treatment is recommended. Otherwise, the Guidelines recommend that the treatment be tapered down within 6 to 12 months after the start of treatment, and potentially discontinued.

The Guidelines recommend that any woman with a prior history of postpartum thyroiditis have an annual TSH test performed to evaluate for permanent hypothyroidism.

Postpartum Thyroiditis and Postpartum Depression

According to the Guidelines, research results are mixed, but some studies have shown a significant association between postpartum thyroiditis and postpartum depression. The Guidelines recommend that women with postpartum depression should have thyroid stimulating hormone (TSH), free thyroxine (Free T4), and thyroid peroxidase antibody (TPOAb) tests performed.


Stagnaro-Green, Alex, et. al. "Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum." Thyroid. Volume 21, Number 10, 2011 (Online)

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