Compare the images of the two patients. Patient 1 (left column) presented a diffuse hypoechogenicity and thyroid enlargement, while the thyroid was normal and the echogenicity index was around 15% in patient 2. Both patients had moderate degree of hyperthyoidism 6 weeks after delivery with FT4 29.1 and 28.2 pM/L, patients 1 and 2, respectively. In both cases 3 months later spontaneous hypothyroidism has developed: TSH 19.2 mIU/L, FT4 8.1 pM/L and TSH 22.9 mIU/L, FT4 7.9 pM/L, patient 1 and 2, respectively.
7 months months later the hypothyroidism was more severe in patient 1 with TSH 43.0 mIU/L, FT4 under 6 pM/L, while hypothyroidism spontaneously resolved in patient 2 with TSH 3.81 mIU/L, FT4 13,7 pM/L.
The degree of hypoechogenicity in the early post partum period has a similar role in the prognosis as anti-TPO determination. The degree of hypoechogenicity correlates well with the risk of permanent hypothyroidism.