08-18-2014, 08:10 PM
The presentation of postpartum weight loss, nervousness, tachycardia, and menorrhagia is consistent with postpartum thyroiditis, and symptoms can be treated with propranolol. Postpartum thyroiditis is an autoimmune thyroiditis occurring within 6 months of delivery and likely secondary to the accumulation of fetal cells in the maternal thyroid during pregnancy. Usually treatment is unnecessary, as most symptoms are mild, although occasionally β-blockers should be used for symptomatic patients until their triiodothyronine and thyroxine levels normalize.
A is not correct. 6% chose this.
Although a recent delivery may have resulted in acute blood loss and postpartum anemia, anemia is unlikely to have led to the additional symptoms of weight loss and anxiety. Menorrhagia may be a cause of anemia, but is unlikely at this point.
B is not correct. 3% chose this.
Although postpartum depression may present with anxiety and weight loss, there is nothing in the history to suggest postpartum depression. If postpartum depression were suspected, a selective serotonin reuptake inhibitor might be effective therapy. There is an association, although unclear, between postpartum depression and postpartum thyroiditis.
C is not correct. 16% chose this.
Postpartum thyroiditis can result in transient hypothyroidism alone, transient hyperthyroidism alone, or transient hyperthyroidism followed by transient hypothyroidism. This patient presents with symptoms of hyperthyroidism that are bordering on thyrotoxicosis, and levothyroxine would be contraindicated since it would exacerbate her symptoms. There might be a period while a patient is transiently hypothyroid during which levothyroxine may be necessary.
D is not correct. 2% chose this.
Postpartum bipolar disorder is a possibility, but because she does not have symptoms of mania or previous mental health problems, this diagnosis is unlikely. In patients with postpartum bipolar disorder, lithium and care by a psychiatrist would be appropriate management.