A 39-year-old woman comes to the physician because of a progressive fatigue. She has no history of serious illness. Seven weeks before this visit, she delivered a healthy male baby without complications. Her vital signs are normal. The thyroid gland is enlarged, firm, and non-tender to palpation. Laboratory evaluation shows low serum TSH and elevated serum thyroxine (T4) and triiodothyronine (T3). Thyroid ultrasound with Doppler flow reveals a mildly enlarged gland with decreased blood flow. Which of the following is the most likely cause of this patient's symptoms?

Question

A 39-year-old woman comes to the physician because of a progressive fatigue. She has no history of serious illness. Seven weeks before this visit, she delivered a healthy male baby without complications.  Her vital signs are normal. The thyroid gland is enlarged, firm, and non-tender to palpation.   Laboratory evaluation shows low serum TSH and elevated serum thyroxine (T4) and triiodothyronine (T3).  Thyroid ultrasound with Doppler flow reveals a mildly enlarged gland with decreased blood flow.  Which of the following is the most likely cause of this patient's symptoms?

Quizplus · Accepted Answer

Eductional Objective: Postpartum thyroiditis occurs within 12 months of pregnancy and is characterized by autoimmune destruction of thyroid follicles.  It typically begins with a hyperthyroid phase due to the release of preformed thyroid hormone, followed by a hypothyroid phase due to depletion of thyroid hormone and an eventual return to a euthyroid state.  Histologic inspection demonstrates lymphocytic infiltration with the formation of germinal centers, which is similar to chronic lymphocytic (Hashimoto) thyroiditis.

A 39-Year-Old Woman Comes to the Physician Because of a Progressive