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Postpartum Silent Thyroiditis

Last updated Dec. 18, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Postpartum Silent Thyroiditis is an autoimmune thyroid disorder. It is a subtype of subacute thyroiditis that affects women in the period following pregnancy, which is also known as the postpartum period.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Postpartum Lymphocytic Thyroiditis
  • Post-Partum Silent Thyroiditis
  • Silent Lymphocytic Postpartum Thyroiditis

What is Postpartum Silent Thyroiditis? (Definition/Background Information)

  • Subacute Thyroiditis is disorder of the thyroid gland. It is a variant of Hashimoto’s disease. There are many subtypes of subacute thyroiditis and they include the following:
    • Silent Thyroiditis
    • Postpartum Silent Thyroiditis
  • Postpartum Silent Thyroiditis is an autoimmune thyroid disorder. It is a subtype of subacute thyroiditis that affects women in the period following pregnancy, which is also known as the postpartum period
  • Postpartum Silent Thyroiditis is termed ‘silent’, because the thyroid gland is painless in spite of the inflammation or enlargement of the gland
  • A previous episode of Postpartum Silent Thyroiditis and a family history of the condition are the common risk factors associated with it. Presently, the cause of Postpartum Silent Thyroiditis is unknown
  • In majority of the cases, the signs and symptoms of Postpartum Silent Thyroiditis are mild, and hence, the condition can go unnoticed or undiagnosed
  • The disorder usually results in hyperthyroidism (increased functioning of thyroid gland) followed by hypothyroidism (decreased functioning of the gland), before coming to a state of normally functioning thyroid
  • The common signs and symptoms of Postpartum Silent Thyroiditis include weight loss, increased sweating, fatigue, irritability, and nervousness
  • A majority of cases of Postpartum Silent Thyroiditis are self-limiting and may not require any treatment. However, regular follow-up checkups and blood tests to assess thyroid hormone levels need to be undertaken
  • The signs and symptoms of the condition usually resolve within 3 months. The prognosis of Postpartum Silent Thyroiditis is generally excellent, though it can recur in subsequent pregnancies

Who gets Postpartum Silent Thyroiditis? (Age and Sex Distribution)

  • Postpartum Silent Thyroiditis is observed in 5-10% of women in the postpartum stage (period following delivery)
  • Individuals of all racial and ethnic groups can be affected

What are the Risk Factors for Postpartum Silent Thyroiditis? (Predisposing Factors)

The risk factors associated with Postpartum Silent Thyroiditis include:

  • Family history of the condition
  • Previous episode of Postpartum Silent Thyroiditis; i.e., during a previous pregnancy
  • Pregnancy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Postpartum Silent Thyroiditis? (Etiology)

  • The exact cause of Postpartum Silent Thyroiditis is unknown
  • It is believed to develop due to an immune attack against the thyroid gland due to hyperactivity of the individual’s own immune system; it is an autoimmune disorder

What are the Signs and Symptoms of Postpartum Silent Thyroiditis?

The signs and symptoms usually occur 12-16 weeks after postpartum stage. Frequently, the signs and symptoms are mild. The postpartum stage is defined as the following:

  • After delivery of a baby
  • After a miscarriage
  • Post termination of pregnancy

In the beginning of Postpartum Silent Thyroiditis, it causes hyperthyroid signs and symptoms. This state is known as the hyperthyroid state. As the condition progresses, it causes hypothyroid signs and symptoms, a state known as hypothyroid state.

Hyperthyroidism symptoms usually last for 3 months or less. The associated signs and symptoms of hyperthyroidism may include:

  • Sleeping difficulties including insomnia
  • Excess sweating and intolerance to heat
  • Increased to excessive hunger
  • Irritation, restlessness, and nervousness
  • Protrusion of the eyes
  • Menstrual abnormalities; menstruation may be irregular or short
  • Abnormal heartbeat rate including rapid heart rate
  • Sudden weight loss

As the condition progresses, it leads to hypothyroidism, and the signs and symptoms associated with this condition may include:

  • Enlarged or swollen thyroid gland; small or shrunken thyroid gland (late in the disease)
  • Difficulty concentrating or thinking
  • Fatigue and tiredness
  • Dry skin
  • Hair loss, which may be in excess while showering
  • Constipation or difficult bowel movements
  • Weight gain that may be slow and gradual
  • Heavy and irregular periods (in women)
  • Abnormal sensitivity to cold; the affected individuals may not tolerate cold very well

How is Postpartum Silent Thyroiditis Diagnosed?

Postpartum Silent Thyroiditis can be diagnosed with a simple physical examination and a thorough medical history. Some of the signs and symptoms noted may include:

  • An enlarged thyroid gland
  • Elevated heart rate
  • Shaking hands 

Majority times, no tests are required to diagnose the condition. However, the following diagnostic tests may be ordered, when necessary:

  • Blood test to assess increase in levels of thyroid hormones T3 and T4
  • Radioactive iodine uptake

A differential diagnosis to eliminate the following conditions must be undertaken:

  • Grave’s disease
  • External intake of thyroid medication
  • TSH-secreting pituitary tumor

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Postpartum Silent Thyroiditis?

Postpartum Silent Thyroiditis is a generally self-limiting condition. However, sometimes, the thyroid function does not completely come back to normal levels. In such individuals, hypothyroidism may persist permanently.

Some potential complications associated with hypothyroidism include:

  • Infertility
  • Heart diseases
  • Increased risk of infection

How is Postpartum Silent Thyroiditis Treated?

In many cases, Postpartum Silent Thyroiditis is a self-limiting condition that resolves on its own. If treatment is provided, then it is based upon the presenting symptoms:

  • Beta-blockers are known to relieve an elevated heart rate and excessive sweating
  • Sometimes, thyroid hormone replacement is needed, if symptoms of hypothyroidism persist
  • Follow-up care with screening and check-ups are important at regular intervals

Note:

  • No surgery is required and surgery should be avoided
  • No radioactive iodine treatment is necessary
  • During the hyperthyroid stage, anti-thyroid drugs are not necessary

How can Postpartum Silent Thyroiditis be Prevented?

  • The exact cause of Postpartum Silent Thyroiditis is not known, and hence currently, there is no known preventive method reported for the condition
  • Screening of thyroid function during and after pregnancy can avoid the development of severe signs and symptoms. Hence, thyroid function tests during and after pregnancy, are important for early diagnosis of the condition

What is the Prognosis of Postpartum Silent Thyroiditis? (Outcomes/Resolutions)

  • In majority of cases, the prognosis of Postpartum Silent Thyroiditis is excellent; the condition resolves spontaneously on its own
  • As the condition resolves on its own, in a majority of individuals, the thyroid gland function comes back to normalcy (euthyroid state)
  • However, a close follow-up is necessary with 6 month intervals, and during the follow-up visits, the thyroid hormone levels in blood should be checked
  • The disorder commonly recurs during subsequent pregnancies

Additional and Relevant Useful Information for Postpartum Silent Thyroiditis:

Postpartum Silent Thyroiditis should not be confused with de Quervain's subacute thyroiditis.

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: April 24, 2016
Last updated: Dec. 18, 2018