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Answer 3
  1. Initiate ß-blocker therapy. The combination of low serum TSH, elevated FT4, positive TPO antibodies, and low RAIU is consistent with the hyperthyroid phase of postpartum thyroiditis. Most women with postpartum thyroiditis do not require treatment. Because the hyperthyroid phase of postpartum thyroiditis is caused by the release of preformed thyroid hormone from a destructive inflammation of the thyroid, thionamides, which block thyroid hormone synthesis, would not be an effective treatment. 131I ablation would also be ineffective because radioiodine would not be incorporated into the thyroid gland because of low uptake. However, ß-blockers can be given to alleviate symptoms of hyperthyroidism that are caused by increased ß-adrenergic tone (eg, palpitations, anxiety, heat intolerance, tachycardia).6 If there are no contraindications to their use, ß-blockers can be started in most patients at the time hyperthyroidism is diagnosed, even prior to RAIU. As thyroid inflammation resolves, a transient period of hypothyroidism can be seen as thyroid follicles regenerate. If this condition occurs, symptomatic hypothyroidism can be treated with daily levothyroxine.

    6. Geffner DL, Hershman JM. Beta-adrenergic blockade for the treatment of hyperthyroidism. Am J Med 1192;93:61–8.

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