A Patient with Postpartum Hypopituitarism (Sheehan's Syndrome) Developed Postpartum Autoimmune Thyroiditis (Transient Thyrotoxicosis and Hypothyroidism): A Case Report and Review of the Literature
Figure 1
The clinical course of a patient with postpartum hypopituitarism (Sheehan’s syndrome: SS), who developed postpartum autoimmune thyroiditis (PPAT) (transient thyrotoxicosis and hypothyroidism). A 36-year-old woman delivered a full-term baby by Caesarean section (Delivery). At 1 month post partum, she visited a doctor with thyrotoxicosis (Toxico). She was negative for TRAb. However, she was positive for TPOAb and TGAb. TPOAb- and TGAb-titers increased after delivery. Her serum thyroglobulin was 72 μg/L (normal < 32 μg/L). Radioactive iodine uptake was 0.5%/24 hr (normal 10–40%). She had thyrotoxicosis (Toxico) due to painless thyroiditis (autoimmune destructive thyroiditis). Her ACTH was less than 0.4 pmol/L, and her cortisol was less than 5.5 nmol/L. She had ACTH deficiency and secondary hypoadrenalism; 20 mg hydrocortisone (HC) was started. The thyrotoxicosis subsided spontaneously. At 4 months post partum, she developed hypothyroidism (hypothyroidism) with TSH 6.6 mIU/L. At 6 months post partum, she was referred to us with easy fatigability and agalactia. She had hypothyroidism with TSH 16.8 mIU/L. She had thyrotoxicosis (Toxico) at 1-2 months post partum and then hypothyroidism (hypothyroidism) (PPAT). At 7 months, thyroxine (T4) was started. She had hypopituitarism and empty sella on MRI (SS). She is now taking 75 μg T4 and 20 mg HC daily. Normal reference ranges: TSH 0.4–4.20 mIU/L, free T3 (free triiodothyronine) 3.5–6.6 nmol/L, and free T4 (free thyroxine) 11.6–21.9 pmol/L.
