Thyroiditis (single hyperthyroid blood result) including post partum thyroiditis

• A single result indicating thyrotoxicosis may indicate thyroiditis which is often a self-limiting condition.
• If there are significant thyrotoxic symptoms (tremor, tachycardia, feeling hot etc), beta-blockers such as Propranolol 20-40mg 2-3 times a day or 80mg modified release once daily or Nadolol 80mg od (in the absence of contraindication such as asthma) may be used to help relieve symptoms. please avoid cardio-selective B-blockers such as bisoprolol as these are less effective in thyrotoxicosis
• After 1 month please check TSH, FT4, TT3 If not already done, when repeating bloods, please also check thyroid peroxidise (TPO) and Thyrotropin receptor antibodies (TRAB).
• If the repeat TFTs show a worsening pattern appointment please commence:
  • Carbimazole 20-40mg once daily with the usual BNF warnings.
  • Due to the small risk of agranulocytosis, the importance of checking a full blood count in the event of significant sore throat, unexplained fever or mouth ulcers must be stressed.
  • Please check a baseline FBC and LFT when commencing Carbimazole; accepting mild neutropenia (no action other than repeat monitoring unless neutrophils less than 1.0 x10^9/l) and mild LFT derangements (no action other than repeat monitoring unless ALT >2 times upper limit of normal) can occur in a significant proportion due to hyperthyroidism itself.

We aim to see most people with a new diagnosis of thyroiditis around 6 weeks after the initial finding. The tests and results above will help guide our treatment plan and allow efficient use of clinic appointments

Patient information leaflets can be found on the British Thyroid Foundation website (http://www.btf-thyroid.org/).

• post-partum thyroiditis is the most likely cause of thyroid dysfunction in the first year after delivery.
• Post-partum thyroiditis can go through phases of mild subclinical or overt hyperthyroidism, subclinical or overt hypothyroidism in the first year and the majority may well return back to normal without therapy.
• Usually TFTs are monitored 6-8weekly until stable.
• After 1 month please check TSH, FT4, TT3 If not already done, when repeating bloods, please also check thyroid peroxidise (TPO) and Thyrotropin receptor antibodies (TRAB).
• If bloods indicate thyrotoxicosis we would usually only recommend beta blockers if she is symptomatic. If breastfeeding, a lower dose (e.g. Propranolol 20mg three times daily) could be used.
• For overt hypothyroidism we would recommend commencement of Levothyroxine although as this may be temporary, this can be discontinued after a year (with monitoring of TFTs) unless further pregnancies are planned.
• In patients with positive thyroid antibodies annual monitoring of thyroid functions would be needed due to the higher risk of subsequent hypothyroidism.

We aim to see most people with a new diagnosis of post partum thyroiditis around 6 weeks after the initial finding. The tests and results above will help guide our treatment plan and allow efficient use of clinic appointments

Patient information leaflets can be found on the British Thyroid Foundation website (http://www.btf-thyroid.org/). There are leaflets on a number of topics related to over-active thyroids.