Hypothyroidism is one of the most common sequelae of Sheehan syndrome. Patients affected by this condition usually present with symptoms within weeks to months, but may present several years after postpartum hemorrhage. Rarely, the duration to onset of disease beyond 30 years has been reported in the literature. A 78-year-old woman presented with the complaint of fatigue for 2 months. Her physical examination was unremarkable. She was diagnosed with depression and started on fluoxetine. She returned to the clinic 3 weeks later with no improvement in her symptoms. Laboratory work revealed a normal thyroid stimulating hormone with a low free T4 and a low total T4. Additional investigations showed low serum follicle stimulating hormone, luteinizing hormone, and cortisol levels. Adrenocorticotropic hormone stimulation test was normal. A magnetic resonance imaging of the brain revealed a partially empty sella. On further questioning, the patient revealed that at the age of 27, after the delivery of her last child, she remained amenorrhic and failed to lactate. She recalled having excessive bleeding that required multiple blood transfusions. Based on her clinical presentation and history, she was diagnosed with delayed onset central hypothyroidism secondary to Sheehan syndrome and started on thyroid hormone supplement. As illustrated above, Sheehan syndrome can present several years postpartum. Appropriate history taking and relevant diagnostic workup is necessary to diagnose the condition.
*Resident, Internal Medicine Residency Program; and †Assistant Professor, College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL.
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Chief Editor's Note: This article is the 7th of 18 that will be published in 2008 for which a total of up to 18 AMA PRA Category 1 Credits™ can be earned. Instructions for how credits can be earned precede the CME Examination at the back of this issue