Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Postpartum thyroiditis

Kenneth D Burman, MD
Section Editor
Douglas S Ross, MD
Deputy Editor
Jean E Mulder, MD


Postpartum thyroiditis is a destructive thyroiditis induced by an autoimmune mechanism within one year after parturition. Postpartum thyroiditis can also occur after spontaneous or induced abortion [1]. It usually presents in one of three ways (figure 1):

Transient hyperthyroidism alone

Transient hypothyroidism alone

Transient hyperthyroidism followed by hypothyroidism and then recovery

The clinical manifestations, diagnosis, and treatment of postpartum thyroiditis are reviewed here. Other forms of thyroiditis and the diagnosis and management of thyroid dysfunction during pregnancy are discussed separately. (See "Overview of thyroiditis" and "Overview of thyroid disease in pregnancy" and "Hyperthyroidism during pregnancy: Treatment" and "Hypothyroidism during pregnancy: Clinical manifestations, diagnosis, and treatment".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Oct 7, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Marqusee E, Hill JA, Mandel SJ. Thyroiditis after pregnancy loss. J Clin Endocrinol Metab 1997; 82:2455.
  2. Nicholson WK, Robinson KA, Smallridge RC, et al. Prevalence of postpartum thyroid dysfunction: a quantitative review. Thyroid 2006; 16:573.
  3. De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97:2543.
  4. Stagnaro-Green A. Approach to the patient with postpartum thyroiditis. J Clin Endocrinol Metab 2012; 97:334.
  5. 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; 21:1081.
  6. Caixàs A, Albareda M, García-Patterson A, et al. Postpartum thyroiditis in women with hypothyroidism antedating pregnancy? J Clin Endocrinol Metab 1999; 84:4000.
  7. Azizi F. The occurrence of permanent thyroid failure in patients with subclinical postpartum thyroiditis. Eur J Endocrinol 2005; 153:367.
  8. Tachi J, Amino N, Tamaki H, et al. Long term follow-up and HLA association in patients with postpartum hypothyroidism. J Clin Endocrinol Metab 1988; 66:480.
  9. Othman S, Phillips DI, Parkes AB, et al. A long-term follow-up of postpartum thyroiditis. Clin Endocrinol (Oxf) 1990; 32:559.
  10. Nikolai TF, Turney SL, Roberts RC. Postpartum lymphocytic thyroiditis. Prevalence, clinical course, and long-term follow-up. Arch Intern Med 1987; 147:221.
  11. Lazarus JH, Ammari F, Oretti R, et al. Clinical aspects of recurrent postpartum thyroiditis. Br J Gen Pract 1997; 47:305.
  12. Stuckey BG, Kent GN, Ward LC, et al. Postpartum thyroid dysfunction and the long-term risk of hypothyroidism: results from a 12-year follow-up study of women with and without postpartum thyroid dysfunction. Clin Endocrinol (Oxf) 2010; 73:389.
  13. Lucas A, Pizarro E, Granada ML, et al. Postpartum thyroiditis: long-term follow-up. Thyroid 2005; 15:1177.
  14. Kologlu M, Fung H, Darke C, et al. Postpartum thyroid dysfunction and HLA status. Eur J Clin Invest 1990; 20:56.
  15. Stagnaro-Green A, Roman SH, Cobin RH, et al. A prospective study of lymphocyte-initiated immunosuppression in normal pregnancy: evidence of a T-cell etiology for postpartum thyroid dysfunction. J Clin Endocrinol Metab 1992; 74:645.
  16. Lazarus JH, Hall R, Othman S, et al. The clinical spectrum of postpartum thyroid disease. QJM 1996; 89:429.
  17. Harris B, Othman S, Davies JA, et al. Association between postpartum thyroid dysfunction and thyroid antibodies and depression. BMJ 1992; 305:152.
  18. Lazarus JH, Othman S. Thyroid disease in relation to pregnancy. Clin Endocrinol (Oxf) 1991; 34:91.
  19. Kent GN, Stuckey BG, Allen JR, et al. Postpartum thyroid dysfunction: clinical assessment and relationship to psychiatric affective morbidity. Clin Endocrinol (Oxf) 1999; 51:429.
  20. Lucas A, Pizarro E, Granada ML, et al. Postpartum thyroid dysfunction and postpartum depression: are they two linked disorders? Clin Endocrinol (Oxf) 2001; 55:809.
  21. Miyake A, Tahara M, Koike K, Tanizawa O. Decrease in neonatal suckled milk volume in diabetic women. Eur J Obstet Gynecol Reprod Biol 1989; 33:49.
  22. Gerstein HC. How common is postpartum thyroiditis? A methodologic overview of the literature. Arch Intern Med 1990; 150:1397.
  23. Mizukami Y, Michigishi T, Nonomura A, et al. Postpartum thyroiditis. A clinical, histologic, and immunopathologic study of 15 cases. Am J Clin Pathol 1993; 100:200.
  24. Ide A, Amino N, Kang S, et al. Differentiation of postpartum Graves' thyrotoxicosis from postpartum destructive thyrotoxicosis using antithyrotropin receptor antibodies and thyroid blood flow. Thyroid 2014; 24:1027.
  25. Izumi Y, Hidaka Y, Tada H, et al. Simple and practical parameters for differentiation between destruction-induced thyrotoxicosis and Graves' thyrotoxicosis. Clin Endocrinol (Oxf) 2002; 57:51.
  26. Patel MC, Guneratne N, Haq N, et al. Peripartum hypopituitarism and lymphocytic hypophysitis. QJM 1995; 88:571.
  27. Landek-Salgado MA, Gutenberg A, Lupi I, et al. Pregnancy, postpartum autoimmune thyroiditis, and autoimmune hypophysitis: intimate relationships. Autoimmun Rev 2010; 9:153.
  28. Unlühizarci K, Bayram F, Colak R, et al. Distinct radiological and clinical appearance of lymphocytic hypophysitis. J Clin Endocrinol Metab 2001; 86:1861.
  29. Amino N, Tada H, Hidaka Y, et al. Therapeutic controversy: Screening for postpartum thyroiditis. J Clin Endocrinol Metab 1999; 84:1813.
  30. Premawardhana LD, Parkes AB, John R, et al. Thyroid peroxidase antibodies in early pregnancy: utility for prediction of postpartum thyroid dysfunction and implications for screening. Thyroid 2004; 14:610.
  31. Kämpe O, Jansson R, Karlsson FA. Effects of L-thyroxine and iodide on the development of autoimmune postpartum thyroiditis. J Clin Endocrinol Metab 1990; 70:1014.
  32. Nøhr SB, Jørgensen A, Pedersen KM, Laurberg P. Postpartum thyroid dysfunction in pregnant thyroid peroxidase antibody-positive women living in an area with mild to moderate iodine deficiency: is iodine supplementation safe? J Clin Endocrinol Metab 2000; 85:3191.
  33. Mazokopakis EE, Papadakis JA, Papadomanolaki MG, et al. Effects of 12 months treatment with L-selenomethionine on serum anti-TPO Levels in Patients with Hashimoto's thyroiditis. Thyroid 2007; 17:609.
  34. Negro R, Greco G, Mangieri T, et al. The influence of selenium supplementation on postpartum thyroid status in pregnant women with thyroid peroxidase autoantibodies. J Clin Endocrinol Metab 2007; 92:1263.
  35. Beardmore KS, Morris JM, Gallery ED. Excretion of antihypertensive medication into human breast milk: a systematic review. Hypertens Pregnancy 2002; 21:85.
  36. Premawardhana LD, Parkes AB, Ammari F, et al. Postpartum thyroiditis and long-term thyroid status: prognostic influence of thyroid peroxidase antibodies and ultrasound echogenicity. J Clin Endocrinol Metab 2000; 85:71.