Postpartum thyroiditis

Disease Description (Causes and Symptoms)

• Definition and causes: A condition in which hyperfunction occurs in cells that secrete hormones from the pituitary gland. In most cases, it is caused by a pituitary tumor (adenoma). It presents with various clinical manifestations depending on the type of hormone that is excessively secreted (e.g., growth hormone, prolactin, adrenocorticotropic hormone [ACTH], gonadotropins, etc.).
• Brief pathophysiology: A tumor or hyperactive cells excessively secrete a specific pituitary hormone → changes in the function of target organs (thyroid gland, adrenal glands, gonads, etc.) and symptoms of direct hormone excess result. Large tumors can cause visual field defects and headaches by compressing the optic nerves.
• Main symptoms (summary by hormone):
  • Growth hormone excess: gigantism if the growth plates have not closed; acromegaly in adults (enlargement of the hands, feet, and face), joint pain, carpal tunnel syndrome, cardiovascular problems (cardiomegaly and hypertension), and abnormalities in glucose metabolism (diabetes)
  • Prolactin excess: galactorrhea, amenorrhea and infertility (women), decreased libido and erectile dysfunction (men)
  • ACTH excess (Cushing disease): central obesity, rounded face (moon face), changes in subcutaneous fat, muscle weakness, hypertension, hyperglycemia, and osteoporosis
  • Gonadotropin excess: precocious puberty (children)
  • General symptoms: fatigue, excessive sweating, facial edema, headache, and visual impairment (such as bitemporal superior quadrantanopia)

Treatment Methods

• Diagnostic-based treatment principles: Treatment is individualized according to the type of excess hormone and the size and location of the tumor.
• Medication
  • Prolactinoma: Dopamine agonists (cabergoline, bromocriptine) are first-line treatments (they suppress hormone secretion and reduce tumor size in most cases)
  • Growth hormone excess (acromegaly): Somatostatin analogs (octreotide, lanreotide), GH receptor antagonist (pegvisomant)
  • Adjunctive medications for Cushing disease (before/after surgery or when surgery is not possible): Medications that inhibit cortisol synthesis (such as mitotane); direct pituitary-targeted treatment is limited
• Surgery
  • Transsphenoidal approach (transsphenoidal surgery, TSS): The standard method for removing pituitary tumors using endoscopic or microscopic surgery through the nose (first-line treatment for most non-prolactin-secreting tumors)
  • Transcranial approach: When the tumor is large or difficult to access
• Radiation therapy
  • If complete removal by surgery is not possible or if the tumor recurs, stereotactic radiosurgery (such as Gamma Knife) or fractionated radiation therapy may be considered
• Hormone deficiency replacement
  • If decreased normal pituitary function occurs after surgery/radiation or is caused by the tumor itself, replacement with thyroid hormones, adrenocortical hormones (steroids), sex hormones, growth hormone (in specific cases), etc. may be necessary
• Lifestyle and comorbidity management
  • Active management of metabolic complications such as hypertension and diabetes, screening and treatment for sleep apnea, and evaluation of joint pain and cardiovascular risk
• Precautions (related to treatment)
  • Medication side effects (e.g., orthostatic hypotension and nausea caused by dopamine agonists, and rarely, heart valve abnormalities), cerebrospinal fluid leakage and infection after surgery, and the possibility of delayed hormone deficiencies after radiation therapy
  • If you are planning a pregnancy, the medication and surgical strategy may differ, so be sure to consult a specialist

Checklist Before an Outpatient Visit (Including Example Questions)

• Items to prepare (recommended to bring)
  • A list of currently taken medications and supplements (including doses and dosing times)
  • Previous test results (blood tests, hormone tests, MRI/CT films or reports)
  • Records of symptom changes (time of onset, progression, breastfeeding status, changes in menstrual history, changes in vision, etc.)
  • Blood pressure and blood glucose measurement records (if available)
  • Pregnancy status or pregnancy plans, and breastfeeding status
• Items that must be checked during the outpatient visit
  • Presence of visual impairment or headache, milk discharge, menstrual cycle and infertility history, changes in sexual function, and changes in growth (children)
  • Recent weight changes and symptoms of sleep apnea (snoring and daytime sleepiness)
• Information about preparing for tests
  • Hormone tests (IGF-1, GH, prolactin, ACTH, cortisol, etc.) may require preparation before testing (e.g., stopping certain medications or fasting). Follow the hospital's instructions before the outpatient visit.
• Example questions (items you can ask the doctor directly)
  • "Which levels in this hormone test are the treatment targets?"
  • "Which complications should I watch for before and after surgery?"
  • "While taking the medication, should I avoid any particular exercise, foods, or other medications?"

Examples of General Questions to Ask the Doctor

• "What are the expected effects and side effects of this medication (or surgery)?"
• "What are the target hormone levels after treatment, and how often will they be tested?"
• "What is the prognosis? What is the possibility of recurrence, and what long-term complications may occur?"
• "What should I be careful about regarding lifestyle habits (exercise, diet, and sleep)?"

Examples of Disease-Specific Questions

• Related to growth hormone excess (acromegaly/gigantism):
  • "Have my GH/IGF-1 levels reached the treatment target range? Which is more appropriate for me: a medication such as a somatostatin analog or pegvisomant?"
• Related to prolactinoma (patients of childbearing age):
  • "I am planning a pregnancy. Is it safe to stop the dopamine agonist? How will follow-up be conducted during pregnancy?"