Postpartum thyroiditis can be so discreet that the patient will not even notice any symptoms of the disease, and it can lead to a significant reduction in the quality of life. What are the causes and symptoms of postpartum thyroiditis? How is the treatment going?
Postpartum thyroiditis(Latinthyreoditis post partum ) may be hyperthyroidism or hypothyroidism, but may also be variable both of these conditions occur in patients. Postpartum thyroiditis does not always require treatment, yet patients suffering from it should definitely be under the care of an endocrinologist - some of them develop chronic hypothyroidism (Hashimoto's disease). Problems with the functioning of the thyroid gland can be classified as postpartum thyroiditis when they occur within 12 months of the termination of pregnancy. The condition is not common, according to statistics it affects about 5 out of 100 women who have recently had a childbirth.
Postpartum thyroiditis: causes
The exact cause of postpartum thyroiditis in patients has not been clearly established to date. However, changes in the functions of the immune system that occur after the birth of the child are suspected to be involved in the development of the disease.
Well, during pregnancy, the immune system is physiologically weakened - this is to prevent the mother's immune cells from treating the fetus as a source of foreign antigens, against which an immune response could be directed, ultimately leading to the death of the pregnancy. When it comes to childbirth, the above-mentioned condition ceases to apply - the immune system returns to its pre-pregnancy state, and what's more - its activity may be even more intense than before pregnancy. Some researchers consider this pathomechanism, associated with over-reactivity of the immune system after pregnancy, to be the cause of postpartum thyroiditis. The role of the immune system in the pathogenesis of postpartum thyroiditis may also be demonstrated by the increased risk of this condition in these patients. It turns out that women suffering fromtype 1 diabetes mellitus suffer from postpartum thyroiditis three times more often than patients without insulin secretion disorders. Other risk factors for postpartum thyroid disorders are:
- occurrence of thyroid diseases in the patient's family
- experienced thyroid dysfunction in the past
- presence of high titers of anti-TG anti-thyroid antibodies in the patient
Postpartum thyroiditis: symptoms and course
Postpartum thyroiditis usually has two phases. The first of them is the hyperthyroidism phase, during which the following may appear:
- irritability and severe nervousness
- tachycardia (increased heart rate)
- increased sweating and heat intolerance
- feeling tired
- moisture and warmth of the skin
- muscle tremors
- weight loss
The hyperthyroidism phase of postpartum thyroiditis is usually mild, so that neither the patient, nor even the doctor, may suspect that she has had any thyroid gland dysfunction. More onerous and more severe symptoms appear in the opposite phase of the disease, i.e. the phase of hypothyroidism. It occurs immediately after the onset of the hyperthyroidism phase, or it occurs after a short period of time when the thyroid gland is not abnormal. Symptoms that may appear in the hypothyroidism phase of postpartum thyroiditis are:
- concentration disorders
- dry skin
- cold intolerance
- constipation
- feeling of lack of energy
- weight gain
- constant feeling of fatigue
- memory problems
- puffiness
Postpartum thyroiditis can also be monophasic, i.e. patients may experience either hyperthyroidism alone or hypothyroidism only.
It can also lead to a four-stage course of the disease, where after the hyperthyroidism phase there is aeuthyroid phase(temporary balance of the thyroid hormone balance), followed by a hypothyroid phase and then euthyroid phase again.
Postpartum thyroiditis: diagnosis
In the diagnosis of postpartum thyroiditis, the patient's symptoms and the results of laboratory tests are important. Usually, the first test to be performed is to assess the level of thyroid stimulating hormone (TSH) in the blood.
In progressits values may be low (such are found in the hyperthyroidism phase of postpartum thyroiditis) or high (observed during the hypothyroidism phase). It should be emphasized that the patient with the disease in question may have a normal level of TSH - this does not mean that she does not have the disease, because it may happen when the hyperthyroid phase gradually changes to the hypothyroidism phase. in patients with suspected postpartum thyroiditis, the concentration of free hormones of this gland (T3 and T4) is assessed. Their high values are noted in the hyperactive phase, and low in the hypothyroid phase.
The determination of anti-thyroid antibodies (anti-thyroglobulin - anti-TG and anti-thyroid-peroxidase - anti-TPO) is also useful - if their titers are positive, then in the presence of other abnormalities (such as the presence of the symptoms described above and the amount of thyroid hormones exceeding normal limits) it is possible to diagnose postpartum thyroiditis.
Postpartum thyroiditis: treatment
Postpartum thyroiditis does not require treatment in every patient - this especially applies to those patients whose symptoms are not severe and whose laboratory deviations are not significant. In a situation where the symptoms are clearly expressed, it is possible to use:
- in the phase of hyperthyroidism, drugs that reduce the conversion of the thyroid T4 into more active T3 in the body - for this purpose, propranolol is used, belonging to the group of beta-blockers
- levothyroxine preparations, which are the basic method of treating the hypothyroid phase
The most important thing is to treat patients who are in a state of hypothyroidism. The duration of therapy is varied, usually 6-12 months. After some time, the doctor (based on the results of hormonal tests) may try to discontinue levothyroxine, but during this period the patient must initially be under his constant supervision and have regular (every few weeks) hormonal tests. Only after making sure that the thyroid hormone balance is stabilized, it is possible to completely stop taking thyroid hormone supplementation.
Postpartum thyroiditis: prognosis
Thyroid dysfunction after childbirth is most often a transient condition - in most patients the thyroid gland functions return to normal over time. However, special attention should be given topatients who developed hypothyroidism. This is due to the fact that among the entire group of such patients, according to statistics, one in five of them develops chronic hypothyroidism.
Thyroid tests
Thyroid examinations can be divided into two parts - examining the level of hormones produced by the thyroid gland and imaging examinations, the most popular of which is ultrasound. Our expert - endocrinologist Marta Kunkel from Medicover Hospital tells what these thyroid tests look like and what they show.