Postpartum Thyroiditis and Silent Thyroiditis

  • Lakdasa D. PremawardhanaEmail author
  • Onyebuchi E. Okosieme
  • John H. Lazarus
Reference work entry
Part of the Endocrinology book series (ENDOCR)


Postpartum thyroiditis (PPT) is an autoimmune “destructive” thyroiditis that occurs in the first year following delivery and, rarely, after a miscarriage. The autoimmune nature of the disease is confirmed by the presence of thyroid peroxidase antibodies (TPOAb) in most affected women (and occasionally thyroglobulin antibodies) and immune cell infiltration of the thyroid gland. These are usually combined with the imaging characteristics of a destructive thyroiditis (low radioactive iodine or technetium uptake and ultrasound hypoechogenicity).

PPT may present in several ways – a mild and short thyrotoxic phase followed by a more symptomatic and longer hypothyroid phase occur in the biphasic form of PPT, in about 24–28% subjects. However, the thyrotoxic and hypothyroid phases may occur independently of each other, with hypothyroidism occurring alone in about 50% of cases. The thyrotoxic phase usually requires symptomatic treatment only, but the hypothyroid phase produces more severe and longer-lasting symptoms and requires thyroxine replacement in the majority. Early permanent hypothyroidism occurs in a minority of women, and a high percentage of those who are antibody positive and develop PPT develop long-term thyroid dysfunction. There is approximately a 70% chance of PPT recurring in subsequent pregnancies. The presence of TPOAb, gestational and type 1 diabetes mellitus, autoimmune thyroid disease, and previous PPT are risk factors for the development of PPT. The strategies for screening and prevention are not clear, and there is no consensus currently.

Sporadic silent thyroiditis has identical pathological and clinical features to postpartum thyroiditis but occurs sporadically, outside the postpartum setting. It is characterized by a similar destructive thyroiditis with thyrotoxic, hypothyroid, and euthyroid phases. The absence of thyroid pain or raised inflammatory markers distinguishes this form of thyroiditis from acute and subacute thyroiditis. Although silent thyroiditis is typically self-limiting, some patients have severe and recurrent episodes, and permanent hypothyroidism is seen in about 10–20% of patients.


Sporadic thyroiditis Postpartum thyroiditis Pregnancy Thyrotoxicosis Hypothyroidism 


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Lakdasa D. Premawardhana
    • 1
    • 2
    Email author
  • Onyebuchi E. Okosieme
    • 3
    • 4
  • John H. Lazarus
    • 4
  1. 1.Section of Endocrinology, Department of MedicineYYF Hospital, Aneurin Bevan University Health BoardCaerphillyUK
  2. 2.Centre for Endocrine and Diabetes Sciences, C2 Link CorridorUniversity Hospital of WalesCardiffUK
  3. 3.Endocrine and Diabetes DepartmentPrince Charles Hospital, Cwm Taf University Health BoardMerthyr TydfilUK
  4. 4.Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of MedicineCardiff UniversityCardiffUK

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