The hypothyroid phase of postpartum thyroiditis does not always require treatment — but certain clinical situations clearly call for intervention. When a woman is symptomatic, currently breastfeeding, or actively trying to conceive, a structured therapeutic approach is indicated.
This protocol applies to women in the hypothyroid phase of postpartum thyroiditis who meet one or more of the following criteria: symptomatic hypothyroidism, currently breastfeeding, or actively attempting pregnancy.
Thyroid hormone replacement therapy is the recommended intervention in this scenario. The complete protocol outlines the specific agent, clinical indications, and a defined plan for eventual reassessment of whether therapy can be discontinued.
DOI: 10.1089/thy.2016.0457
In women with significant symptoms, those currently lactating or women who are actively attempting pregnancy, treatment should be started.
LT4 should be considered for women with symptomatic hypothyroidism due to PPT.
LT4 should also be started in hypothyroid women who are attempting pregnancy or who are breastfeeding.
LT4 treatment should be considered during the hypothyroid phase of PPT if the patient is mildly symptomatic, or recommended if the patient is considering another conception.
If LT4 is initiated for PPT, discontinuation of therapy should be attempted after 12 months.
Guiding principles are to maintain a euthyroid state in women who are attempting pregnancy or pregnant.
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