Subclinical Thyroid Disease
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Management of postpartum thyrotoxicosis.
Current Opinion in Endocrinology & Diabetes. 12(6):471-476, December 2005.
Azizi, Fereidoun a; Braverman, Lewis E b
Abstract:
Purpose of review: In the months following delivery, thyrotoxicosis occurs frequently. The timely recognition of the etiology and proper clinical management is important and improves the quality of life of both mother and her child. This article reviews recent literature defining the proper diagnosis and management of postpartum thyrotoxicosis.
Recent findings: During pregnancy, a variety of immune changes in systemic immune responses and localized mechanisms for protection of the placenta occur. Following delivery, there is exacerbation of immune reactivity, and during this period, autoimmune thyroid disorders may begin, recur, or exacerbate. Graves' disease and postpartum thyroiditis are two major causes of thyrotoxicosis during the postpartum period. Increased thyroidal uptake, high thyroxine/triiodothyronine ratio, and positive thyrotropin receptor-stimulating antibody results could differentiate Graves' disease from postpartum thyroiditis. The patient's thyrotoxic phase of postpartum thyroiditis lasts a few weeks and does not require treatment. Antithyroid drugs are the mainstay of treatment for postpartum Graves' disease. Many investigations have concluded that both methimazole and propylthiouracil do not cause any alterations in thyroid function and the physical and mental development of infants breast-fed by lactating hyperthyroid mothers.
Summary: Both methimazole and propylthiouracil could be safely administered in moderately high doses during lactation. It is now clear that treatment of breastfeeding thyrotoxic mothers using antithyroid medication has no detrimental effects on the thyroid function and physical and intellectual development of their children.
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