Endocrine Abstracts

A 25 year-old female was referred to endocrinology outpatients from her general practitioner (GP) in view of abnormal thyroid function tests (TFTs). She gave a 2 week history of increasing lethargy limiting her daily activities, loose stools and palpitations. She denied changes in appetite or weight and no neck pain or swelling. No recent history of illness. She has no past medical history and was not on any regular medications. She gave birth to her first child 6 weeks ago. Pregnancy was uneventful. She is a non-smoker. On physical examination, her blood pressure was 125mmHg over 65mmHg and heart rate of 85 beats per minute, regular. Neck examination revealed a smooth non-tender goiter with no cervical lymphadenopathy. Rest of physical examination was unremarkable. TFTs taken 5 days ago by her GP showed suppressed thyroid stimulating hormone (TSH) at a level of 0.016µIU/mL (reference range 0.3-3) with elevated free thyroxine (T4) and triiodothyronine (T3) at a level of 42.12 pmol/l(11-18) and 11.3 pmol/l(3.5-6.5) respectively. Previous TFTs during her pregnancy were normal. Thyroid antibodies were taken and showed a negative TSH receptor antibody with a positive anti-thyroid perosidase antibody (80IU/ml, reference range 0.0-50.0). Thyroid scintigraphy scan showed an enlarged smooth thyroid gland with decreased tracer uptake. A diagnosis of postpartum thyroiditis was made. She was started on propranolol 40 mg three times a day and a ’’watch and wait’’ approach was applied. The patient was reviewed 1 month after and she noticed an improvement in her energy levels. She also noticed decreased in her palpitations. Biochemically, there was evidence of subclinical hypothyrodisim with T4 and T3 at a level of 15.42 pmol/land 4.2 pmol/lrespectively and elevated TSH at 6.68µIU/ml. Propranolol was stopped. During her visits, the patient remained well and felt back to her normal self. Also reported regular menses after 4 months from her delivery. TFTs continued to improve and euthyroidism was achieved 8 months postpartum. No thyroid hormone replacement was started as she was always asymptomatic and with no over hypothyrodism biochemically.