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Postpartum thyroiditis — DRCOG MCQ

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HardPostnatalPostpartum thyroiditisDRCOG

Four months postpartum, a 34-year-old with previous Graves disease has palpitations, tremor, suppressed TSH and raised free T4. She is breastfeeding. Which test best helps distinguish recurrent Graves disease from the thyrotoxic phase of postpartum thyroiditis?

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Correct answer: A — TSH-receptor antibody measurement alongside clinical assessment

The best answer is “TSH-receptor antibody measurement alongside clinical assessment”. TSH-receptor antibodies support recurrent Graves disease and are especially relevant with her history. Postpartum thyroiditis often has negative TRAb and a transient course. Radioiodine uptake is problematic during breastfeeding and is not the first discriminator here; management also depends on symptoms, severity and follow-up thyroid function.

Reference: RCOG Green-top Guideline No. 76: Thyroid Disorders in Pregnancy: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/management-of-thyroid-disorders-in-pregnancy-no-76/