First investigation 6 months after delivery (first and second rows of images)

Clinical presentation: a 22-year-old woman was referred for an evaluation of a newly discovered hypothyroidism. She had fatigue and hair loss. She has been delivered 6 months before present investigation.

Palpation: the thyroids were enlarged and firm.

Functional state: hypothyroidism with TSH 47.7 mIU/L.

Ultrasonography: the thyroids were hypoechogenic without any nodule. The vascularization was increased.

Cytology resulted in Hashimoto's thyroiditis.

Clinical diagnosis: hypothyroidism, post partum thyroiditis.

We did not administer replacement therapy.

Second examination 3 months later (3rd row of images)

Clinical presentation: the complaints of the patient had decreased.

Palpation: no abnormality.

Functional state: euthyroidism with TSH-level 3.60 mIU/L, FT4 13.1 pM/L.

Ultrasonography: the degree of hypoechogenicity and the previously increased vascularization have decreased, as did the size of the thyroid.

We suggested follow-up examination with yearly TSH determination, in the case of pregnancy at once.

Comment:

It is well-known that post partum state is practically the only one when even severe hypothyroidism may spontaneously normalize. The increased vascularization in a hyperthyroid state has little relevance. It may be observed in active hormone-producing disorders and in destructive process of autoimmune thyroiditis, as well.