Postpartum thyroid dysfunction is a destructive thyroiditis with similar pathogenetic features to Hashimotos thyroiditis.The disease is very common with a prevalence of 5-9% of unselected postpartum women. Typically there is a transient hyperthyroid phase that is followed by a phase of hypothyroidism. Permanent hypothyroidism occurs in as much as 30% of cases after 3 years, and in 50% at 7–10 years. The hyperthyroid phase will not usually require treatment but, rarely, propanolol may be used for symptom control in severe cases. The hypothyroid phase should be treated with thyroxine if patients are symptomatic, planning to get pregnant, or if TSH levels are above 10 mU/L. Long-term follow up is necessary due to the risk of permanent hypothyroidism.Nearly all the women with Postpartum thyroid dysfunction have anti-thyroid peroxidase antibodies. This marker can be a useful screening test in early pregnancy as 50% of women with antibodies will develop thyroid dysfunction postpartum. In addition, some but not all studies have shown an association between Postpartum thyroid dysfunction and depression so that thyroid function should be checked postpartum in women with mood changes. == References ==
Diagnosis
Diagnosis is based on clinical history and examination. Examination is clinical, via anterior rhinoscopy and fibreoptic, using nasendoscopy. A CT scan can be used to confirm the diagnosis and review disease extent. Treatment
Treatment of atrophic rhinitis can be either medical or surgical. Medical measures include:

Nasal irrigation using normal saline
Nasal irrigation and removal of crusts using alkaline nasal solutions. 25% glucose in glycerine can be applied to the nasal mucosa to inhibit the growth of proteolytic organisms which produce foul smell. Local antibiotics, such as chloromycetine. Vitamin D2 . Estradiol spray for regeneration of seromucinous glands and vascularization of mucosa. Systemic streptomycin (1g/day) against Klebsiella organisms. Oral potassium iodide for liquefaction of secretion. Placental extract injected in the submucosa. Rifampicin 600 mg once daily for 12 weeks.Surgical interventions include:

Youngs operation. Modified Youngs operation. Narrowing of nasal cavities, submucosal injection of Teflon paste (Williams operation), section and medial displacement of the lateral wall of the nose. Transposition of parotid duct to maxillary sinus or nasal mucosa (Wittmacks operation)
Complete inversion of mucoperiosteum of maxillary antrum to create a neoturbinate (Raghav Sharans operation)
Repeated Stellate ganglion block (Sardanas operation)
Vestibuloplasty

History
This disorder was known since the time of ancient Egypt, almost 4,000 years ago, and descriptions of it are found in the historical medical papyri. In the Edwin Smith Papyrus (1700 BC) it was prescribed a treatment based on wine and breast milk to cure this disease. The ancient Greek and Indian civilizations were aware of atrophic rhinitis. See also
Empty nose syndrome

References


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