An update on thyroid disorders in the postpartum period.
J Endocrinol Invest
; 45(8): 1497-1506, 2022 Aug.
Article
in En
| MEDLINE
| ID: mdl-35181848
ABSTRACT
PURPOSE:
To review the pathophysiology, diagnosis and management of postpartum thyroid dysfunction, and related management of thyroid disorders during lactation.METHODS:
We reviewed the literature on postpartum thyroid dysfunction and management of thyroid disorders during lactation.RESULTS:
The postpartum period is characterized by a rebound from the immunotolerance induced by pregnancy. Routine thyroid function screening is not recommended for asymptomatic women in the postpartum period. Testing thyroid function should be considered at 6-12-week postpartum for high-risk populations, including women with a previous episode of postpartum thyroiditis, Graves' disease, or those with Hashimoto's thyroiditis on thyroid hormone replacement, known thyroid peroxidase antibody positivity, type 1 diabetes mellitus, other nonthyroidal autoimmune disease, or chronic hepatitis C. A serum TSH should also be checked in the setting of postpartum depression or difficulty lactating. If patients have thyrotoxicosis, new-onset or recurrent Graves' disease must be differentiated from postpartum thyroiditis, because the management differs. Periodic thyroid function testing is recommended following recovery from postpartum thyroiditis due to high lifetime risk of developing permanent hypothyroidism. Levothyroxine, and the lowest effective dose of antithyroid drugs, (propylthiouracil, methimazole, and carbimazole) can be safely used in lactating women. The use of radiopharmaceutical scanning is avoided during lactation and radioactive iodine treatment is contraindicated.CONCLUSIONS:
Diagnosing postpartum thyroid dysfunction is challenging, because symptoms may be subtle. A team approach involving primary care providers, endocrinologists, and obstetricians is essential for transitioning thyroid care from the gestational to the postpartum setting.Key words
Full text:
1
Collection:
01-internacional
Health context:
11_ODS3_cobertura_universal
Database:
MEDLINE
Main subject:
Puerperal Disorders
/
Thyroid Diseases
/
Thyroid Neoplasms
/
Graves Disease
/
Postpartum Thyroiditis
Type of study:
Diagnostic_studies
/
Etiology_studies
Limits:
Female
/
Humans
/
Pregnancy
Language:
En
Journal:
J Endocrinol Invest
Year:
2022
Document type:
Article