Postpartum thyroiditis and hypothalamo-hypophysial insufficiency in the same woman with successive pregnancies: a case report

Abstract

Objective. Although the incidence of postpartum autoimmune disorders of endocrine glands are not rare, the presence of two different entities in the same patient with two different pregnancies is uncommon.

Methods. We present a 35-year-old woman whose story starts with her first pregnancy when she was 29 years old, she had the diagnosis of postpartum thyroiditis with hypothyroidism. We followed up the patient when she had her second pregnancy.

Results. When she was being followed up with levothyroxine replacement, 5 years later she had her second delivery after which she had complaints of polydipsia, polyuria, weight loss and had the diagnosis of central diabetes insipitus and she has started desmopressin treatment and 17 months later the delivery she again applied with amenorrhea, continuation of lactation later she noticed oligomenorrhea, and her gonadotropin levels were found to be low as well as her TSH levels, although the L-thyroxine treatment dose was not changed. Dynamic tests of hypophysis revealed hypophyseal insufficiency and repeated hypophyseal MRI was in concordance with lymphocytic hypophysitis which explains the pattern of endocrinological abnormalities after the second delivery.

Conclusion. This case signals role of autoimmune mechanisms underlying the endocrinopathies seen after successive pregnancies of the same patient.

Keywords:

• Postpartum
• postpartum thyroiditis
• hypophysitis
• postpartum hypophysitis
• lymphocytic hypophysitis

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.