Post-partum thyroiditis (PPT) is a common disease with important clinical sequelae. Its clinical features, association with antimicrosomal antibodies (TPOAb) and long-term prognosis are not thoroughly described in Mediterranean populations. The aims of this study were: 1) to describe clinical features of PPT in a Greek population, 2) to associate TPOAb with PPT presence, and 3) to identify long-term prognosis of PPT. 1,594 consecutive post-partum women were studied within 3 days of their delivery. Women with positive TPOAb were followed-up for one yr for clinical and biochemical evidence of PPT. Incidence of positive TPOAb was 5.2% whereas incidence of PPT was 2.4%. PPT was presented as hyperthyroidism alone (18%), hypothyroidism alone (40%) and hyperthyroidism followed by hypothyroidism (42%). A titer of 1:1600, immediately post-partum, could predict PPT with 97% sensitivity and 91% specificity. History of PPT in previous pregnancies was associated with PPT in the current pregnancy. This association did not exist with maternal age, gestation duration, parity, abortions, sex of the newborn, birth-weight or smoking. Long-term hypothyroidism developed in 21% of women. Observation and post-partum thyroid function testing, where PPT is suspected, seems to constitute the best clinical approach. There is need for long-term follow-up in PPT patients.
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Stagnaro-Green A., Roman S.H., Cobin R.H., el Harazy E., Wallenstein S., Davies T.F. A prospective study of lymphocyte-initiated immunosuppression in normal pregnancy: evidence of a T-cell etiology for post-partum thyroid dysfunction. J. Clin. Endocrinol. Metab. 1992, 74: 645–653.
Nikolai T.F., Turney S.L., Roberts R.C. Post-partum lymphocytic thyroiditis. Prevalence, clinical course, and long-term follow-up. Arch. Intern. Med. 1987, 147: 221–224.
Walfish P.G., Meyerson J., Provias J.P., Vargas M.T., Papsin F.R. Prevalence and characteristics of post-partum thyroid dysfunction: results of a survey from Toronto, Canada. J. Endocrinol. Invest. 1992, 15: 265–272.
Pop V.J., de Rooy H.A., Vader H.L., et al. Post-partum thyroid dysfunction and depression in an unselected population. N. Engl. J. Med. 1991, 324: 1815–1816.
Hayslip C.C., Fein H.G., O’Donnell V., Friedman D.S., Klein T.A., Smallridge R.C. The value of serum antimicrosomal antibody testing in screening for symptomatic post-partum thyroid dysfunction. Am. J. Obstet. Gynecol. 1988, 159: 203–209.
Tachi J., Amino N., Tamaki H., Aozasa M., Iwatani Y., Miyai K. Long-term follow-up and HLA association in patients with post-partum hypothyroidism. J. Clin. Endocrinol. Metab. 1988, 66: 480–484.
Othman S., Phillips D.I., Parkes A.B., et al. A long-term follow-up of post-partum thyroiditis. Clin. Endocrinol. (Oxf.) 1990, 32: 559–564.
Amino N., Tada H., Hidaka Y., Crapo L.M., Stagnaro Green A. Therapeutic controversy: Screening for post-partum thyroiditis. J. Clin. Endocrinol. Metab. 1999, 84: 1813–1821.
Lucas A., Pizarro E., Granada M.L., Salinas I., Foz M., Sanmarti A. Post-partum thyroiditis: epidemiology and clinical evolution in a nonselected population. Thyroid 2000, 10: 71–77.
Gerstein H.C. How common is post-partum thyroiditis? A methodologic overview of the literature. Arch. Intern. Med. 1990, 150: 1397–1400.
Sulimani R.A., Ba’Aqeel H.A., al Nuaim A.R., al Meshari A.A., Haleem K. Post partum thyroiditis in Saudi women. East Afr. Med. J. 1993, 70: 556–557.
Davies T.F. The thyroid immunology of the post-partum period. Thyroid 1999, 9: 675–684.
Lazarus J.H., Hall R., Othman S., et al. The clinical spectrum of post-partum thyroid disease. Q.J.M. 1996, 89: 429–435.
Furlanetto T.W., Premaor M.O., Caramori M.L., et al. Postpartum thyroiditis in South Brazil presenting as thyrotoxicosis: prevalence and risk factors. J. Endocrinol. Invest. 2000, 23: 496–501.
Amino N., Tada H., Hidaka Y. Autoimmune thyroid disease and pregnancy. J. Endocrinol. Invest. 1996, 19: 59–70.
Pop V.J., de Rooy H.A., Vader H.L., van der Heide D., van Son M.M., Komproe I.H. Microsomal antibodies during gestation in relation to post-partum thyroid dysfunction and depression. Acta Endocrinol. (Copenh.) 1993, 129: 26–30.
Hidaka Y., Tamaki H., Iwatani Y., Tada H., Mitsuda N., Amino N. Prediction of post-partum Graves’ thyrotoxicosis by measurement of thyroid stimulating antibody in early pregnancy. Clin. Endocrinol. (Oxf.) 1994, 41: 15–20.
Nohr S., Jorgensen A., Pedersen K., Laurberg P. post-partum thyroid dysfunction in pregnant thyroid peroxidase antibody-positive women living in an area with mild to moderate iodine deficiency: is iodine supplementation safe? J. Clin. Endocrinol. Metab. 2000, 85: 3191–3198.
Solomon B.L., Fein H.G., Smallridge R.C. Usefulness of antimicrosomal antibody titers in the diagnosis and treatment of post-partum thyroiditis. J. Fam. Pract. 1993, 36: 177–182.
Lervang H., Pryds O., Ostergaard K. Thyroid dysfunction after delivery: incidence and clinical course. Acta Med. Scand. 1987, 222: 369–374.
Parkes A., Adams H., Othman S., Hall R., John S., Lazarus J. The role of complement in the pathogenesis of postpartum thyroiditis: ultrasound echogenicity and the degree of complement-induced thyroid damage. Thyroid 1996, 6: 177–182.
Kuijpens J., de Hann-Meulman M., Vader H., Pop V., Wiersinga W., Drexhage H. Cell-mediated immunity and post-partum thyroid dysfunction: a possibility for the prediction of the disease? J. Clin. Endocrinol. Metab. 1988, 83: 1959–1966.
Bech K., Hertel J., Rasmussen N.G., et al. Effect of maternal thyroid autoantibodies and post-partum thyroiditis on the fetus and neonate. Acta Endocrinol. (Copenh.) 1991, 125: 146–149.
Jansson R., Bernander S., Karlsson A., Levin K., Nilsson G. Autoimmune thyroid dysfunction in the post-partum period. J. Clin. Endocrinol. Metab. 1984, 58: 681–687.
Amino N., Mori H., Iwatani Y., et al. High prevalence of transient post-partum thyrotoxicosis and hypothyroidism. N. Engl. J. Med. 1982, 306: 849–852.
Ericsson U.B., Lindgarde F. Effects of cigarette smoking on thyroid function and the prevalence of goitre, thyrotoxicosis and autoimmune thyroiditis. J. Intern. Med. 1991, 229: 67–71.
Lazarus J.H., Ammari F., Oretti R., Parkes A.B., Richards C.J., Harris B. Clinical aspects of recurrent post-partum thyroiditis. Br. J. Gen. Pract. 1997, 47: 305–308.
Premawardhana L.D., Parkes A.B., Ammari F., et al. postpartum thyroiditis and long-term thyroid status: prognostic influence of thyroid peroxidase antibodies and ultrasound echogenicity. J. Clin. Endocrinol. Metab. 2000, 85: 71–75.
Luboshitzky R., Qupti G., Ishai A., Dharan M. Transient cold nodule of the thyroid due to localized post-partum thyroiditis. Eur. J. Endocrinol. 1998, 138: 562–564.
Momotani N., Noh J., Ishikawa N., Ito K. Relationship between silent thyroiditis and recurrent Graves’ disease in the post-partum period. J. Clin. Endocrinol. Metab. 1994, 79: 285–289.
Bech K., Hoier Madsen M., Feldt Rasmussen U., Jensen B.M., Molsted Pedersen L., Kuhl C. Thyroid function and autoimmune manifestations in insulin-dependent diabetes mellitus during and after pregnancy. Acta Endocrinol. (Copenh.) 1991, 124: 534–539.
Majima T., Takamatsu J., Isotani H., et al. Insulin-dependent diabetes mellitus in which glycemic control was improved during pregnancy but deteriorated after delivery with the occurrence of post-partum thyrotoxicosis: a case report. Diabetes Res. Clin. Pract. 1991, 13: 207–211.
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Kita, M., Goulis, D.G. & Avramides, A. Post-partum thyroiditis in a Mediterranean population: A prospective study of a large cohort of thyroid antibody positive women at the time of delivery. J Endocrinol Invest 25, 513–519 (2002). https://doi.org/10.1007/BF03345493