Abstract
Postpartum thyroiditis (PPT) is an autoimmune destructive thyroiditis that occurs in some women during the postpartum period. Its immune perturbations have been partially worked out, but at the present time only TPOAb positivity is a reliable marker of this process. Groups at increased risk of developing PPT are well known. Nevertheless there is no consensus about screening for this disorder, which unfortunately causes considerable morbidity, at a physiologically, emotionally and socially vulnerable time. Nor are there effective strategies to prevent PPT in individuals at high risk. Treatment is empirical and largely symptomatic except in the hypothyroid phase when thyroxine may be required.
Keywords
Postpartum thyroiditis Postpartum Graves’ disease Risk factors ScreeningReferences
- 1.De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, Eastman CJ, Lazarus JH, Luton D, Mandel SJ, Mestman J, Rovet J, Sullivan S. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97:2543–65.CrossRefGoogle Scholar
- 2.Premawardhana LD, Parkes AB, Ammari F, John R, Darke C, Adams H, Lazarus JH. Postpartum thyroiditis and long-term thyroid status: prognostic influence of thyroid peroxidase antibodies and ultrasound echogenicity. J Clin Endocrinol Metab. 2000;85:71–5.CrossRefGoogle Scholar
- 3.Nicholson WK, Robinson KA, Smallridge RC, Ladenson PW, Powe NR. Prevalence of postpartum thyroid dysfunction: a quantitative review. Thyroid. 2006;16:573–82.CrossRefGoogle Scholar
- 4.Stagnaro-Green A, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Negro R. High rate of persistent hypothyroidism in a large-scale prospective study of postpartum thyroiditis in southern Italy. J Clin Endocrinol Metab. 2011a;96:652–7.CrossRefGoogle Scholar
- 5.Premawardhana LD, Parkes AB, John R, Harris B, Lazarus JH. Thyroid peroxidase antibodies in early pregnancy: utility for prediction of postpartum thyroid dysfunction and implications for screening. Thyroid. 2004;14:610–5.CrossRefGoogle Scholar
- 6.Tagami T, Hagiwara H, Kimura T, Usui T, Shimatsu A, Naruse M. The incidence of gestational hyperthyroidism and postpartum thyroiditis in treated patients with Graves’ disease. Thyroid. 2007;17:767–72.CrossRefGoogle Scholar
- 7.Galofré JC, Haber RS, Mitchell AA, Pessah R, Davies TF. Increased postpartum thyroxine replacement in Hashimoto’s thyroiditis. Thyroid. 2010;20(8):901.CrossRefGoogle Scholar
- 8.Dhanoa L, Dresang LT. Should women be screened for postpartum hypothyroidism. Evid Based Pract. 2013;16:13.Google Scholar
- 9.Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, Nixon A, Pearce EN, Soldin OP, Sullivan S, Wiersinga W, American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011b;21:1081–125.CrossRefGoogle Scholar
- 10.Taylor PN, Okosieme OE, Premawardhana L, Lazarus JH. Should all women be screened for thyroid dysfunction in pregnancy? Women’s Health (Lond Engl). 2015;11:295–307.CrossRefGoogle Scholar
- 11.Vila L, Velasco I, González S, Morales F, Sánchez E, Torrejón S, Soldevila B, Stagnaro-Green A, Puig-Domingo M. Controversies in endocrinology: on the need for universal thyroid screening in pregnant women. Eur J Endocrinol. 2013;170:R17–30.CrossRefGoogle Scholar
- 12.Premawardhana LD. Universal screening for hypothyroidism in pregnancy: time for a paradigm shift? Endocrine. 2015;48:9–11.CrossRefGoogle Scholar
- 13.Dosiou C, Barnes J, Schwartz A, Negro R, Crapo L, Stagnaro-Green A. Cost-effectiveness of universal and risk-based screening for autoimmune thyroid disease in pregnant women. J Clin Endocrinol Metab. 2012;97:1536–46.CrossRefGoogle Scholar
- 14.Stagnaro-Green A. Approach to the patient with postpartum thyroiditis. J Clin Endocrinol Metab. 2012;97:334–42.CrossRefGoogle Scholar
- 15.Linding S, Andersen J, Olsen J, Carlé A, Laurberg P. Hyperthyroidism incidence fluctuates widely in and around pregnancy and is at variance with some other autoimmune diseases: a Danish population-based study. J Clin Endocrinol Metab. 2015;100:1164–71.CrossRefGoogle Scholar
- 16.Ide A, Amino N, Kang S, et al. Differentiation of postpartum Graves’ thyrotoxicosis from postpartum destructive thyrotoxicosis using antithyrotropin receptor antibodies and thyroid blood flow. Thyroid. 2014;24:1027–31.CrossRefGoogle Scholar
- 17.Mestman JH. The incidence of Graves’ hyperthyroidism increases in early pregnancy and the late postpartum period. Clin Thyroidol. 2015;27:112–4.CrossRefGoogle Scholar
- 18.Groer M, Jevitt C. Symptoms and signs associated with postpartum thyroiditis. J Thyroid Res. 2014;2014:531969.CrossRefGoogle Scholar
- 19.Pearce EN. Thyroid disorders during pregnancy and postpartum. Best Pract Res Clin Obstet Gynaecol. 2015;29:700–6.CrossRefGoogle Scholar
- 20.Tozzoli R, Bergnasco M, Giavarina D, et al. TSH receptor autoantibody immunoassay in patients with Graves’ disease: improvement of diagnostic accuracy over different generations of methods. Systematic review and meta-analysis. Autoimmun Rev. 2012;12:107–13.CrossRefGoogle Scholar
- 21.Mestman JH. What are the best approaches for diagnosing the etiology of hyperthyroidism in the 12 months following delivery? Clin Thyroidol. 2014;26:238–40.CrossRefGoogle Scholar
- 22.Sergi M, Tomlinson G, Feig DS. Changes suggestive of post-partum thyroiditis in women with established hypothyroidism: incidence and predictors. Clin Endocrinol. 2015;83:389–93.CrossRefGoogle Scholar
- 23.Drutel A, Archembaud F, Caron P. Selenium and the thyroid gland; more good news for clinicians. Clin Endocrinol. 2013;78:155–64.CrossRefGoogle Scholar
- 24.Yoshihara A, Noh JY, Watanabe N, et al. Lower incidence of postpartum thyrotoxicosis in women with Graves disease treated by radioiodine therapy than by subtotal thyroidectomy or with antithyroid drugs. Clin Nucl Med. 2014;39:326–9.CrossRefGoogle Scholar
- 25.Maleki N, Tavosi Z. Evaluation of thyroid dysfunction and autoimmunity in gestational diabetes mellitus and its relationship with postpartum thyroiditis. Diabet Med. 2015;32:206–12.CrossRefGoogle Scholar
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