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Journal of Endocrinological Investigation

Erschienen in:

01.08.2022 | Short Review

An update on thyroid disorders in the postpartum period

verfasst von: C. C-H. Peng, E. N. Pearce

Erschienen in: Journal of Endocrinological Investigation | Ausgabe 8/2022

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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.

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Titel: An update on thyroid disorders in the postpartum period
verfasst von: C. C-H. Peng
E. N. Pearce
Publikationsdatum: 01.08.2022
Verlag: Springer International Publishing
Erschienen in: Journal of Endocrinological Investigation / Ausgabe 8/2022
Elektronische ISSN: 1720-8386
DOI: https://doi.org/10.1007/s40618-022-01762-1

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