Oyibo Samson O, Green Olivia S, Laliwala Nabeel M, Sagi Satyanarayana V
Department of Diabetes and Endocrinology, Peterborough City Hospital, Peterborough, UK.
Nightingale Medical Centre, Peterborough, UK.
Endocrinol Diabetes Metab Case Rep. 2021 Jul 19;2021(21-0069):EDM210069. doi: 10.1530/EDM-21-0069.
Hypothyroidism occurring in the postpartum period can be due to pituitary or hypothalamic disease as in Sheehan's syndrome and postpartum autoimmune hypophysitis or due to a primary thyroid disease as in postpartum thyroiditis. It is important that the correct diagnosis is ascertained because hypothalamic or pituitary disorders are often associated with other pituitary hormone deficiencies, especially life-threatening adrenal insufficiency or adrenal crisis. A combination of various symptoms and biochemical markers, especially serum thyroid-stimulating hormone levels dictate the initial diagnostic pathway. We present a case of a woman who presented with a 2-month history of tiredness and neck discomfort following delivery. A thyroid function test demonstrated results, which we initially interpreted as central hypothyroidism. Follow-up results indicated that this was in fact the transition period between the thyrotoxic phase and hypothyroid phases of postpartum thyroiditis. This case highlights the potential for diagnostic confusion between central hypothyroidism and postpartum thyroiditis.
Postpartum thyroiditis affects one in twenty mothers within 12 months of delivery. The majority of patients have transient thyrotoxicosis only, some have transient hypothyroidism only, and the rest has a triphasic pattern (thyrotoxic, hypothyroid then a euthyroid phase). During the transition from the thyrotoxic phase to hypothyroid phase, when serum TSH is still suppressed, the biochemical results can resemble that of central hypothyroidism. If central hypothyroidism is suspected, then urgent diagnostic investigations should be carried out along with the assessment of adrenal function. There is a potential for diagnostic confusion between postpartum central hypothyroidism and postpartum thyroiditis; however, the obstetric history, clinical symptoms, and signs (headaches, breastfeeding, goitre, etc.) and serum adrenocorticotropic levels should help with the differential diagnosis.
产后发生的甲状腺功能减退可能是由于垂体或下丘脑疾病，如席汉综合征和产后自身免疫性垂体炎，也可能是由于原发性甲状腺疾病，如产后甲状腺炎。确定正确的诊断很重要，因为下丘脑或垂体疾病常与其他垂体激素缺乏有关，尤其是危及生命的肾上腺功能不全或肾上腺危象。各种症状和生化指标的组合，尤其是血清促甲状腺激素水平决定了初始诊断途径。我们报告一例产后出现2个月疲劳和颈部不适病史的女性病例。甲状腺功能检查结果最初被我们解读为中枢性甲状腺功能减退。后续结果表明，这实际上是产后甲状腺炎甲状腺毒症期和甲状腺功能减退期之间的过渡期。该病例突出了中枢性甲状腺功能减退和产后甲状腺炎之间诊断混淆的可能性。
产后甲状腺炎在分娩后12个月内影响每二十名母亲中的一名。大多数患者仅出现短暂的甲状腺毒症，一些患者仅出现短暂的甲状腺功能减退，其余患者呈现三相模式（甲状腺毒症、甲状腺功能减退然后是甲状腺功能正常期）。在从甲状腺毒症期过渡到甲状腺功能减退期时，当血清促甲状腺激素仍被抑制时，生化结果可能类似于中枢性甲状腺功能减退。如果怀疑中枢性甲状腺功能减退，则应在评估肾上腺功能的同时进行紧急诊断检查。产后中枢性甲状腺功能减退和产后甲状腺炎之间存在诊断混淆的可能性；然而，产科病史、临床症状和体征（头痛、母乳喂养、甲状腺肿等）以及血清促肾上腺皮质激素水平应有助于鉴别诊断。
