Article thumbnail

A Patient with Postpartum Hypopituitarism (Sheehan's Syndrome) Developed Postpartum Autoimmune Thyroiditis (Transient Thyrotoxicosis and Hypothyroidism): A Case Report and Review of the Literature

By Nobuyuki Takasu and Yoshirou Nakayama


A 36-year-old woman with postpartum hypopituitarism (Sheehan's syndrome: SS) developed postpartum autoimmune thyroiditis (PPAT). She delivered a baby by Caesarean section (620 mL blood loss). At 1 month post partum, she developed thyrotoxicosis due to painless thyroiditis (autoimmune destructive thyroiditis). She was positive for antithyroid antibodies. Postpartum and hypoadrenalism-induced exacerbation of autoimmune thyroiditis caused the thyrotoxicosis due to autoimmune destructive thyroiditis. ACTH was undetectable. She had ACTH deficiency and secondary hypoadrenalism. Hydrocortisone was started. At 6 months post partum, she was referred to us with hypothyroidism. Thyroxine was administered. She had thyrotoxicosis at 1-2 months post partum and then hypothyroidism. She was diagnosed with PPAT. She had hypopituitarism, ACTH deficiency (secondary hypoadrenalism), low prolactin with agalactia, and low LH with failure to resume regular menses. She had empty sella on MRI. She was diagnosed with SS. Three cases with SS have been reported to develop PPAT. Postpartum immunological rebounds and hypoadrenalism-induced immunological alterations (or a combination of the two) might have been responsible for the PPAT

Topics: Case Report
Publisher: SAGE-Hindawi Access to Research
OAI identifier:
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles


  1. (2008). a p l u n ,C .F r a t i l a ,A .F e r e n c z ie ta l . ,“ S e q u e n t i a lp i t u i t a r y MR imaging in Sheehan syndrome: report of 2 cases,”
  2. a r u y a m a ,M .K a t o ,O .M i z u n o ,K .K a t a o k a ,a n dS . Matsuki, “Transient thyrotoxicosis occurred after cessation of steroid therapy in a patient with autoimmune thyroiditis and rheumatoid arthritis,”
  3. (1991). a s a k i ,O .O h n i s h i ,T .O k u d e r a ,a n dM .O k u m u r a ,“ S i m u l -taneous occurrence of transient resolving thyrotoxicosis due to painless thyroiditis, hypopituitarism and diabetes insipidus following pituitary apoplexy,”
  4. (2008). Antihypothalamus and anti-pituitary antibodies may contribute to perpetuate the hypopituitarism in patients with Sheehan’s syndrome,”
  5. (2003). C o o p e r ,“ H y p e r t h y r o i d i s m ,
  6. Corticosteroid-mediated immunoregulation in man,”
  7. (1993). Development of autoimmune thyroid dysfunction after bilateral adrenalectomy in a patient with Carney’s complex and after removal of ACTH-producing pituitary adenoma in a patient with Cushing’s disease,”
  8. (1990). Exacerbation of autoimmune thyroid dysfunction after unilateral adrenalectomy in patients with Cushing’s syndrome due to an adrenocortical adenoma,” The New England
  9. (1969). I r v i n e ,D .R .C u l l e n ,a n dK .I .K i r k h a m ,“ S h e e h a n ’ ss y n -drome associated with thyrotoxicosis and diabetes mellitus,”
  10. (1977). J.GinsbergandP.G.Walfish,“Postpartumtransientthyrotoxicosis with painless thyroiditis,”
  11. (1982). m i n o ,H .M o r i ,a n dY .I w a t a n i ,“ H i g hp r e v a l e n c eo f transient post-partum thyrotoxicosis and hypothyroidism,” TheNewEnglandJournal ofMedicine,vol.306,no.14,pp.849– 852,
  12. (1997). Painless thyroiditis developed in a patient with Sheehan’s syndrome,”
  13. (2002). Pituitary autoimmunity in patients with Sheehan’s syndrome,”
  14. (2001). Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatalcare,”
  15. (2010). Pregnancy and pituitary disorders,”
  16. S h e e h a n ,“ P o s t p a r t u mn e c r o s i so ft h ep i t u i t a r y , ”Journal ofPathologyandBacteriology,
  17. (1992). Simultaneous occurrence of postpartum hypopituitarism (Sheehan’s syndrome) and transient resolving thyrotoxicosis due to postpartum painless thyroiditis,”
  18. (1989). Spontaneous recovery of rats from experimental allergic encephalomyelitis is dependent on regulation of the immune system by endogenous adrenal corticosteroids,”
  19. (2007). t m a c a ,F .T a n r i v e r d i ,C .G o k c e ,K .U n l u h i z a r c i ,a n dF . Kelestimur, “Do we still need the TRH stimulation test?”
  20. (1988). Yamauchi et al.,“Antipituitary antibodies in patients with the primary empty sella syndrome,”