thyroid troubles post pregnency

[DrR]

A 28-year-old woman is the biological mother of a healthy three-week-old boy. Ever since the birth of her son, she has been very anxious and has noticed a mild tremor. She also has daily palpitations and states that she is very fatigued. Which of the following is her most probable diagnosis?
A. De Quervain's thyroiditis
B. Grave's disease
C. Hashimoto's thyroiditis
D. Riedel thyroiditis
E. Subacute lymphocytic thyroiditis

please kindly give explaination

[swimguy23]

Originally Posted by DrR

A 28-year-old woman is the biological mother of a healthy three-week-old boy. Ever since the birth of her son, she has been very anxious and has noticed a mild tremor. She also has daily palpitations and states that she is very fatigued. Which of the following is her most probable diagnosis?
A. De Quervain's thyroiditis
B. Grave's disease
C. Hashimoto's thyroiditis
D. Riedel thyroiditis
E. Subacute lymphocytic thyroiditis

please kindly give explaination

E associated with HLA DR3 and DR5, more common in women, especially post partum. its autoimmune with high t3 and t4 , low TSH. the symptoms are usually mild

[DrR]

Originally Posted by swimguy23

E associated with HLA DR3 and DR5, more common in women, especially post partum. its autoimmune with high t3 and t4 , low TSH. the symptoms are usually mild

agree that E is more common in women. Although overall is not GRAVES more commen? EVen grave's will be to precipititate after child berth. and it has been only three wiks since delivery, thats why seems like a mild case. what according to you is going aginst graves diagnosis. plz let me to know. thanks for reply.

[swimguy23]

Originally Posted by DrR

agree that E is more common in women. Although overall is not GRAVES more commen? EVen grave's will be to precipititate after child berth. and it has been only three wiks since delivery, thats why seems like a mild case. what according to you is going aginst graves diagnosis. plz let me to know. thanks for reply.

since you questioned.....i looked it up
http://www.emedicine.com/med/topic2276.htm

keep in mind grave's disease more than likely would have presented prior in her life, and the time frame would suggest E
there would be no reason to choose grave's disease based on that history....keep in mind especially with questions like this and on the USMLE they give you textbook examples.

a question on grave's disease would more likely mention low TSH, high T3/T4, exopthalmous, female, palpitations, carotid bruits, etc

[DrR]

thanks, that was enlightning!

assumingly, if there was a choice f) subacute postpartum thyroiditis. Now will this become the answer to the same question?

[swimguy23]

Originally Posted by DrR

thanks, that was enlightning!

assumingly, if there was a choice f) subacute postpartum thyroiditis. Now will this become the answer to the same question?

with my experience with Step 1.....they had ONLY 1 answer that was correct. Another answer where you were like hmmmm and this was your distractor, then the rest ranged to youve got to be kidding.....without a very specific test, lab value, etc that differentiates the two you would not see both based on that history. also the interesting thing about subacute postpartum thyroiditis is its ultimate clinical manifestation of hypothyroidism

[DrR]

ok, got it. thanks so much.

[swimguy23]

Originally Posted by DrR

ok, got it. thanks so much.

no prob.....remember USMLE tests your knowledge, not their ability to trick you

[lyuda_m@yahoo.com]

I think than correct answer is E.
Grave's disease is devepmenting in pregnant women. BUT

• Subacute lymphocytic or silent thyroiditis and postpartum thyroiditis are associated with autoimmune thyroiditis. Silent thyroiditis occurs twice as often in women than in men.

• Postpartum thyroiditis occurs 1-6 months after giving birth. If a woman has postpartum thyroiditis with one baby, all other pregnancies are likely to be associated with this condition.