Puerperium: postpartum thyroiditis: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Puerperium: postpartum thyroiditis

Sample item

A woman 3 months postpartum reports palpitations, irritability and weight loss. She has a painless small goitre, a low TSH, raised free T4 and positive anti-TPO antibodies. Radioiodine uptake is low. What is the best initial treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Beta blocker for symptoms, with monitoring for later hypothyroidism

Postpartum thyroiditis is an autoimmune destructive thyroiditis in which a transient thyrotoxic phase at 1 to 4 months is followed by hypothyroidism, then often recovery. Low radioiodine uptake distinguishes it from Graves disease, and antithyroid drugs are not effective as the hormone is leaking, not being overproduced. Beta blockers control symptoms, and thyroxine is given if hypothyroidism develops.

Option by option

  • A. Carbimazole for 18 months

    Antithyroid drugs are ineffective in destructive thyroiditis.

  • B. Beta blocker for symptoms, with monitoring for later hypothyroidism (correct)

    Correct. Symptomatic beta blockade is appropriate, with follow-up for the hypothyroid phase.

  • C. Radioiodine ablation

    Radioiodine would not take up in a thyroid with low uptake and is contraindicated in lactation.

  • D. Total thyroidectomy

    Surgery is unnecessary for a self-limiting condition.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Beta blocker for symptoms, with monitoring for later hypothyroidism. Postpartum thyroiditis is an autoimmune destructive thyroiditis in which a transient thyrotoxic phase at 1 to 4 months is followed by hypothyroidism, then often recovery.

Why is "Carbimazole for 18 months" not the answer?

Antithyroid drugs are ineffective in destructive thyroiditis.

Why is "Radioiodine ablation" not the answer?

Radioiodine would not take up in a thyroid with low uptake and is contraindicated in lactation.

Why is "Total thyroidectomy" not the answer?

Surgery is unnecessary for a self-limiting condition.

What concept does this question test?

It tests Puerperium: postpartum thyroiditis in OBG. Low radioiodine uptake distinguishes it from Graves disease, and antithyroid drugs are not effective as the hormone is leaking, not being overproduced. Beta blockers control symptoms, and thyroxine is given if hypothyroidism develops.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Puerperium: postpartum thyroiditis?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.