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Postpartum Thyroiditis, Profuse Ssweating, T4 Normal, TSH High, Bilateral Nodules. Meaning?

Posted on Tue, 22 May 2012

Question: Can an ultrasound confirm postpartum thyroiditis vs. a full blown diagnosis of hypo/hyper thyroidism? I am 32, 6'1'' and am 6 months postpartum. At around 2 mo. postpartum, I would sweat profusely in my sleep. It suddenly stopped. At about 4 mo. postpartum, I got routine labwork done. My TSH was 9.56 and my Thyroxine Free T4 was in the normal range. My MD said TSH was high, but not worried because T4 was normal. Took labs again a month and a half later to see if TSH had changed. Got results back and it was now 9.72 and T4 normal. Had ultrasound today and results say my thyroid is of normal size. I have multiple tiny bilateral nodules, some cystic and some mixed cystic and solid. Some with XXXXXXX flow and some without. What does this mean? Should I be worried?

Answered by Dr. Dr. Rakhi Tayal (1 hour later)

Hello.

Thanks for your query.
You should not be worried of the present findings as post partum thyroiditis is a temporary condition AsT4 is normal, there is nothing to worry much, but follow up with your physician for serial TSH, complete blood count and ESR.

There is no specific finding seen on USG in thyroiditis except for a slightly decreased size of the gland with diffusely decreased echogenecity.
Just by seeing the Ultrasound images it is very difficult to comment about the cause of thyroiditis or to comment on its function- hyper or hypo thyroidism.
Secondly, TSH levels depend on the activity of the pituitary gland or hypothalamus and not on the thyroid gland.

Thyroid gland secretes T3 and T4.Multiple nodular appearance of thyroid gland is a normal appearance and is not related to any pathology.

Hope I have answered your query. I will be available if you have any further queries.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (43 minutes later)

So based on everything, you think that I have post partum thyroiditis rather than hypothyroidism? What could be the reason for elevated levels of TSH? Is something wrong with my pitituary gland? If it is PPT, when should I expect it to resolve itself? Are there any natural vitamin supplements that you would recommend that support healthy thyroid function? What is ESR?

Answered by Dr. Dr. Rakhi Tayal (6 hours later)

Hello XXXXXXX

Thanks for writing back.

Based on the history, it seems more likely to be post partum thyroiditis rather than hypothyroidism.

Raised TSH level is the first indication of decreased thyroid hormone synthesis. It does not necessarily mean that something is wrong with your pituitary or hypothalamus.

PPT usually takes 4 to 6 weeks to resolve on its own.

You may use iodised salt and other sea foods high in iodine content to bring your thyroid function back to normal.

ESR ('Erythrocyte Sedimentation Rate') is a non specific marker of inflammation. It is found raised in multiple conditions such as anemia, pregnancy, infections and so on.

Hope I have answered your query. I will be available if you have any further queries.

Wish you an early recovery.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (1 hour later)

Lastly, would elevated TSH levels alone cause symptoms of hypothyroidism? Can stress cause these problems? If nothing changed and TSH levels stayed elevated, would I have to take meds if I am asymptomatic? At what TSH level are meds typically prescribed?

Answered by Dr. Dr. Rakhi Tayal (55 minutes later)

Hello XXXXXXX

Thanks for writing back.

Only raised TSH levels do not normally cause the symptoms of hypothyroidism. It is indicative of only sub-clinical hypothyroidism.

Yes, stress definitely produces an effect on the hormonal secretions of our body.

If you are asymptomatic and your T3 and T4 levels are decreased then you will have to take the treatment. Otherwise it depends on the clinical assessment of the clinician treating you whether to start the treatment or not.

Hope I have answered your query. I will be available if you have any further queries.
Wish you an early recovery.
Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar