This sounds like postpartum thyroiditis. This condition typically resolves itself within 18 months (if your wife is having symptoms she can go on thyroid medication -
Oops! I posted before I was finished lol. In some cases of postpartum thyroiditis hypothyroidism is permanent though.
With TPOab that high, I'd say your wife has Hashimoto's and the condition will not resolve on its own. These results are neither "really bad" nor "really good"... Hashimoto's is an autoimmune condition in which the body erroneously sees the thyroid as foreign and produces antibodies to destroy it. It's the # 1 cause of hypothyroidism in the developed world.
Most people who have Hashimoto's are on replacement thyroid hormones for life.
With TSH at 45.89, was your wife started on a replacement thyroid hormone and has there been a thyroid ultrasound done to determine whether or not she has nodules on her thyroid? Nodules are very common with Hashimoto's, but it's important to keep in mind that < 5% of all thyroid nodules turn out to be cancerous.
Were there any other tests ordered, such as Free T4 and Free T3? If Free T4 and Free T3 were tested, please post those results, with reference ranges. If they weren't tested, do make sure they get tested next time, and every time, your wife has a TSH test. TSH is pituitary hormone, not a thyroid hormone and only provides a small portion of the picture of what's happening...
"Although most women with postpartum thyroiditis are euthyroid by 1 yr postpartum, long-term follow-up reveals an increased prevalence of permanent hypothyroidism. Prospective studies have shown a prevalence rate of hypothyroidism of 23% and 29% at 3.5 to 8.7 yr postpartum (28, 29). Progression to permanent hypothyroidism was more common in women who presented with higher TSH levels and higher titers of thyroid peroxidase antibodies in the hypothyroid phase of postpartum thyroiditis (12). The development of permanent hypothyroidism provides further evidence that postpartum thyroiditis is the clinical presentation of preexisting subclinical Hashimoto’s disease (28)."
Postpartum Thyroiditis - The Journal of Clinical Endocrinology & Metabolism, Volume 87, Issue 9, 1 September 2002