A 27 year-old woman presents to the clinic complaining of fatigue and constipation. She also notes recent cold intolerance and dry skin. Her obstetric history is significant for a full term vaginal delivery 6 months ago. Her past medical history is unremarkable except for fine tremors and mild palpitations 3 months ago that resolved spontaneously. On examination, her temperature is 97.3 F, her pulse is 54/min, her blood pressure is 120/80 and her thyroid gland is enlarged and not tender. Her thyroid panel shows low T4 and elevated TSH.
What is the most likely effective treatment of this condition?
A-Supportive treatment until it resolves
C-Surgery and life-long levothyroxine
D-Begin methimazole therapy
E-Begin radioactive iodine
This is a case of postpartum thyroiditis which is characterized by initial hyperthyroidism (fine tremors and mild palpitations 3 month ago) followed by hypothyroidism. This patient is stable and she just needs supportive treatment until it resolves spontaneously as in most cases. Levothyroxine for 1-3 months can be used in severe cases.
The correct answer is A