The biochemical and clinical course of postpartum thyroid dysfunction: the treatment decision.
OBJECTIVE
To follow the clinical and biochemical course of a cohort of women who had postpartum thyroid dysfunction (PPTD) at 6 months postpartum and to examine the treatment practices of general practitioners and endocrinologists in the setting of PPTD.


METHODS
Prospective longitudinal study.


METHODS
Metropolitan, Perth, Australia.


METHODS
Eighty-six Caucasian women who were identified to have PPTD at 6 months postpartum in a cross-sectional study of 748 women.


METHODS
Characteristics of the clinical and biochemical course of PPTD and documentation of the treatment practices and factors influencing treatment of PPTD by general practitioners and endocrinologists.


RESULTS
Sixteen of 86 women (19%) were receiving treatment at 9 months postpartum and by 30 months postpartum 27% of women had received treatment for PPTD. Fifty-one percent of those not treated were biochemically euthyroid at 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-nine percent of endocrinologists and 73% of general practitioners reported that they required clinical signs or symptoms before initiating treatment for hypothyroid PPTD.


CONCLUSIONS
In a cohort of women with postpartum thyroid dysfunction, a quarter received treatment. Elevated TSH in untreated women does not completely return to the normal median. The role of clinical assessment in treatment decision-making differs between primary care physicians and endocrinologists. A case is made for the early Institution of permanent thyroxine replacement in women with postpartum thyroid dysfunction, elevated TSH and positive thyroid antibodies.
Stuckey
B G
BG
Keogh Institute for Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia. bstuckey@cyllene.uwa.edu.au
Kent
G N
GN
Allen
J R
JR
D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005194:Family Practice; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy / Q000378:metabolism*; D008163:Luminescent Measurements; D018579:Patient Selection; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000188:drug therapy / Q000378:metabolism*; D018709:Statistics, Nonparametric; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood / Q000627:therapeutic use; D013997:Time Factors
D013972:Thyrotropin; D013974:Thyroxine