The biochemical and clinical course of postpartum thyroid dysfunction: thetreatment decision

OBJECTIVE To follow the clinical and biochemical course of a cohort of wome n who had postpartum thyroid dysfunction (PPTD) at 6 months postpartum and to examine the treatment practices of general practitioners and endocrinolo gists in the setting of PPTD. DESIGN Prospective longitudinal study. SETTING Metropolitan, Perth, Australia. PARTICIPANTS Eighty-six Caucasian women who were identified to have PPTD at 6 months postpartum in a cross-sectional study of 748 women. MAIN OUTCOME MEASURES Characteristics of the clinical and biochemical cours e of PPTD and documentation of the treatment practices and factors influenc ing treatment of PPTD by general practitioners and endocrinologists. RESULTS Sixteen of 86 women (19%) were receiving treatment at 9 months post partum and by 30 months postpartum 27% of women had received treatment for PPTD. Fifty-one percent of those not treated were biochemically euthyroid a t 9 months, although, for those with hypothyroid biochemistry at 6 months, the median TSH at 18 months was at the upper limit of the reference range. Thyroid peroxidase antibody titre fell over the 2 years of follow-up. There was no significant change in clinical parameters over the study, Forty-nin e percent of endocrinologists and 73% of general practitioners reported tha t they required clinical signs or symptoms before initiating treatment for hypothyroid PPTD. CONCLUSIONS In a cohort of women with postpartum thyroid dysfunction, a qua rter received treatment. Elevated TSH in untreated women does not completel y return to the normal median. The role of clinical assessment in treatment decision-making differs between primary care physicians and endocrinologis ts. A case is made for the early Institution of permanent thyroxine replace ment in women with postpartum thyroid dysfunction, elevated TSH and positiv e thyroid antibodies.