Prognosis

Most patients recover normal thyroid function, while about 6% remain permanently hypothyroid and one third have persistent goitre or thyroid peroxidase (TPO) antibodies.[35] Recurrent episodes are common postnatally (69%), but may also occur in up to 11% of patients with sporadic disease.[35][39]

Recurrent painless thyroiditis

Women who experience postnatal thyroiditis have a high risk of developing recurrent postnatal thyroiditis in subsequent pregnancies (69%).[19]

Up to 11% of patients with sporadic painless thyroiditis will have recurrent thyroiditis.[35] Although it is rarely done, such patients may elect to have their thyroid gland ablated with radioiodine or surgically removed between episodes when they are euthyroid.[36][37]

Hashimoto's (chronic lymphocytic) thyroiditis with hypothyroidism

Patients who have had painless thyroiditis are more likely to develop permanent hypothyroidism in the future. In one study half of the women with postnatal thyroiditis and persistent TPO antibodies who had recovered thyroid function developed permanent hypothyroidism after 7 years.[40] In a 12-year follow-up study of women with postnatal thyroid dysfunction, 38% of women developed permanent hypothyroidism compared with only 4% of controls.[41]

Graves' disease

Rarely, patients with a history of painless thyroiditis go on to develop Graves' disease. If a patient develops recurrent hyperthyroidism, thyroid-stimulating hormone (TSH)-receptor antibodies should be measured, or 4-, 6-, or 24-hour radioiodine uptake should be repeated and other assessments of the aetiology of the thyrotoxicosis should be carried out.

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