Advertisement

Postpartum Thyroiditis and Silent Thyroiditis

  • Lakdasa D. Premawardhana
  • Onyebuchi E. Okosieme
  • John H. Lazarus
Reference work entry
Part of the Endocrinology book series (ENDOCR)

Abstract

Postpartum thyroiditis (PPT) is an autoimmune “destructive” thyroiditis that occurs in the first year following delivery and, rarely, after a miscarriage. The autoimmune nature of the disease is confirmed by the presence of thyroid peroxidase antibodies (TPOAb) in most affected women (and occasionally thyroglobulin antibodies) and immune cell infiltration of the thyroid gland. These are usually combined with the imaging characteristics of a destructive thyroiditis (low radioactive iodine or technetium uptake and ultrasound hypoechogenicity).

PPT may present in several ways – a mild and short thyrotoxic phase followed by a more symptomatic and longer hypothyroid phase occur in the biphasic form of PPT, in about 24–28% subjects. However, the thyrotoxic and hypothyroid phases may occur independently of each other, with hypothyroidism occurring alone in about 50% of cases. The thyrotoxic phase usually requires symptomatic treatment only, but the hypothyroid phase produces more severe and longer-lasting symptoms and requires thyroxine replacement in the majority. Early permanent hypothyroidism occurs in a minority of women, and a high percentage of those who are antibody positive and develop PPT develop long-term thyroid dysfunction. There is approximately a 70% chance of PPT recurring in subsequent pregnancies. The presence of TPOAb, gestational and type 1 diabetes mellitus, autoimmune thyroid disease, and previous PPT are risk factors for the development of PPT. The strategies for screening and prevention are not clear, and there is no consensus currently.

Sporadic silent thyroiditis has identical pathological and clinical features to postpartum thyroiditis but occurs sporadically, outside the postpartum setting. It is characterized by a similar destructive thyroiditis with thyrotoxic, hypothyroid, and euthyroid phases. The absence of thyroid pain or raised inflammatory markers distinguishes this form of thyroiditis from acute and subacute thyroiditis. Although silent thyroiditis is typically self-limiting, some patients have severe and recurrent episodes, and permanent hypothyroidism is seen in about 10–20% of patients.

Keywords

Sporadic thyroiditis Postpartum thyroiditis Pregnancy Thyrotoxicosis Hypothyroidism 

References

  1. ACOG. Practice Bulletin No. 148: thyroid disease in pregnancy. Obstet Gynecol. 2015;125(4):996–1005.CrossRefGoogle Scholar
  2. Adams H, Jones MC, Othman S, Lazarus JH, Parkes AB, Hall R, et al. The sonographic appearances in postpartum thyroiditis. Clin Radiol. 1992;45(5):311–5.CrossRefPubMedGoogle Scholar
  3. Adlan MA, Premawardhana LD. Thyroid peroxidase antibody and screening for postpartum thyroid dysfunction. J Thyroid Res. 2011;2011:745135.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Alvarez-Marfany M, Roman SH, Drexler AJ, Robertson C, Stagnaro-Green A. Long-term prospective study of postpartum thyroid dysfunction in women with insulin dependent diabetes mellitus. J Clin Endocrinol Metab. 1994;79(1):10–6.PubMedGoogle Scholar
  5. Andersen SL, Olsen J, Carle 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(3):1164–71.CrossRefPubMedGoogle Scholar
  6. Azizi F. Age as a predictor of recurrent hypothyroidism in patients with post-partum thyroid dysfunction. J Endocrinol Invest. 2004;27(11):996–1002.CrossRefPubMedGoogle Scholar
  7. Azizi F. The occurrence of permanent thyroid failure in patients with subclinical postpartum thyroiditis. Eur J Endocrinol. 2005;153(3):367–71.CrossRefPubMedGoogle Scholar
  8. Barca MF, Knobel M, Tomimori E, Cardia MS, Medeiros-Neto G. Prevalence and characteristics of postpartum thyroid dysfunction in Sao Paulo, Brazil. Clin Endocrinol (Oxf). 2000;53(1):21–31.CrossRefGoogle Scholar
  9. Bartalena L, Grasso L, Brogioni S, Aghini-Lombardi F, Braverman LE, Martino E. Serum interleukin-6 in amiodarone-induced thyrotoxicosis. J Clin Endocrinol Metab. 1994;78(2):423–7.PubMedGoogle Scholar
  10. Basaria S, Cooper DS. Amiodarone and the thyroid. Am J Med. 2005;118(7):706–14.CrossRefPubMedGoogle Scholar
  11. Bech K, Hoier-Madsen M, Feldt-Rasmussen U, Jensen BM, Molsted-Pedersen L, Kuhl C. Thyroid function and autoimmune manifestations in insulin-dependent diabetes mellitus during and after pregnancy. Acta Endocrinol. 1991;124(5):534–9.PubMedCrossRefGoogle Scholar
  12. Bogazzi F, Bartalena L, Brogioni S, Mazzeo S, Vitti P, Burelli A, et al. Color flow Doppler sonography rapidly differentiates type I and type II amiodarone-induced thyrotoxicosis. Thyroid. 1997;7(4):541–5.CrossRefPubMedGoogle Scholar
  13. Bohbot NL, Young J, Orgiazzi J, Buffet C, Francois M, Bernard-Chabert B, et al. Interferon-alpha-induced hyperthyroidism: a three-stage evolution from silent thyroiditis towards Graves’ disease. Eur J Endocrinol. 2006;154(3):367–72.CrossRefPubMedGoogle Scholar
  14. Bonds DE, Freedberg KA. Cost-effectiveness of prenatal screening for postpartum thyroiditis. J Womens Health Gend Based Med. 2001;10(7):649–58.CrossRefPubMedGoogle Scholar
  15. Brix TH, Hansen PS, Kyvik KO, Hegedus L. Aggregation of thyroid autoantibodies in twins from opposite-sex pairs suggests that microchimerism may play a role in the early stages of thyroid autoimmunity. J Clin Endocrinol Metab. 2009;94(11):4439–43.CrossRefPubMedGoogle Scholar
  16. Creagh FM, Parkes AB, Lee A, Adams H, Hall R, Richards CJ, et al. The iodide perchlorate discharge test in women with previous post-partum thyroiditis: relationship to sonographic appearance and thyroid function. Clin Endocrinol (Oxf). 1994;40(6):765–8.CrossRefGoogle Scholar
  17. Dayan CM, Daniels GH. Chronic autoimmune thyroiditis. N Engl J Med. 1996;335(2):99–107.CrossRefPubMedGoogle Scholar
  18. de Groot JW, Zonnenberg BA, Plukker JT, van Der Graaf WT, Links TP. Imatinib induces hypothyroidism in patients receiving levothyroxine. Clin Pharmacol Ther. 2005;78(4):433–8.CrossRefPubMedGoogle Scholar
  19. De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(8):2543–65.CrossRefPubMedGoogle Scholar
  20. Durr S, Kindler V. Implication of indolamine 2,3 dioxygenase in the tolerance toward fetuses, tumors, and allografts. J Leukoc Biol. 2013;93(5):681–7.CrossRefPubMedGoogle Scholar
  21. Ekinci EI, Chiu WL, Lu ZX, Sikaris K, Churilov L, Bittar I, et al. A longitudinal study of thyroid autoantibodies in pregnancy: the importance of test timing. Clin Endocrinol (Oxf). 2015;82(4):604–10.CrossRefGoogle Scholar
  22. Elenkov IJ, Wilder RL, Bakalov VK, Link AA, Dimitrov MA, Fisher S, et al. IL-12, TNF-alpha, and hormonal changes during late pregnancy and early postpartum: implications for autoimmune disease activity during these times. J Clin Endocrinol Metab. 2001;86(10):4933–8.PubMedGoogle Scholar
  23. Erlebacher A, Vencato D, Price KA, Zhang D, Glimcher LH. Constraints in antigen presentation severely restrict T cell recognition of the allogeneic fetus. J Clin Invest. 2007;117(5):1399–411.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Feldt-Rasmussen U, Høier-Madsen M, Rasmussen NG, Hegedüs L, Hornnes P. Anti-thyroid peroxidase antibodies during pregnancy and postpartum. Relation to postpartum thyroiditis. Autoimmunity. 1990;6(3):211–4.CrossRefPubMedGoogle Scholar
  25. Fung HY, Kologlu M, Collison K, John R, Richards CJ, Hall R, et al. Postpartum thyroid dysfunction in Mid Glamorgan. Br Med J (Clin Res Ed). 1988;296(6617):241–4.CrossRefGoogle Scholar
  26. Gallas PR, Stolk RP, Bakker K, Endert E, Wiersinga WM. Thyroid dysfunction during pregnancy and in the first postpartum year in women with diabetes mellitus type 1. Eur J Endocrinol. 2002;147(4):443–51.CrossRefPubMedGoogle Scholar
  27. Galustian C, Dasgupta P. Regulatory T cells. eLS: Chichester: Wiley; 2001.Google Scholar
  28. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18(6):988–1028.CrossRefPubMedGoogle Scholar
  29. Gerstein HC. Incidence of postpartum thyroid dysfunction in patients with type I diabetes mellitus. Ann Intern Med. 1993;118(6):419–23.CrossRefPubMedGoogle Scholar
  30. Hamnvik OP, Larsen PR, Marqusee E. Thyroid dysfunction from antineoplastic agents. J Natl Cancer Inst. 2011;103(21):1572–87.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Hegedüs L, Bonnema SJ, Winther KH. Selenium in the treatment of thyroid diseases: an element in search of the relevant indications? Eur Thyroid J. 2016;5(3):149–51.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Hunt JS, Vassmer D, Ferguson TA, Miller L. Fas ligand is positioned in mouse uterus and placenta to prevent trafficking of activated leukocytes between the mother and the conceptus. J Immunol. 1997;158(9):4122–8.PubMedGoogle Scholar
  33. Ide A, Amino N, Kang S, Yoshioka W, Kudo T, Nishihara E, et al. Differentiation of postpartum Graves’ thyrotoxicosis from postpartum destructive thyrotoxicosis using antithyrotropin receptor antibodies and thyroid blood flow. Thyroid. 2014;24(6):1027–31.CrossRefPubMedGoogle Scholar
  34. Ishii H, Takei M, Sato Y, Ito T, Ito K, Sakai Y, et al. A case of severe and recurrent painless thyroiditis requiring thyroidectomy. Med Princ Pract. 2013;22(4):408–10.CrossRefPubMedGoogle Scholar
  35. Ito K, Akita Y, Ishida N, Kasugai C, Tamada Y, Watanabe D. Painless thyroiditis in drug-induced hypersensitivity syndrome with prolonged reactivation of herpesviruses. Int J Dermatol. 2013;52(4):475–7.CrossRefPubMedGoogle Scholar
  36. Jansson R, Bernander S, Karlsson A, Levin K, Nilsson G. Autoimmune thyroid dysfunction in the postpartum period. J Clin Endocrinol Metab. 1984;58(4):681–7.CrossRefPubMedGoogle Scholar
  37. Kamijo K. Study on cutoff value setting for differential diagnosis between Graves’ disease and painless thyroiditis using the TRAb (Elecsys TRAb) measurement via the fully automated electrochemiluminescence immunoassay system. Endocr J. 2010;57(10):895–902.CrossRefPubMedGoogle Scholar
  38. Kokandi AA, Parkes AB, Premawardhana LD, John R, Lazarus JH. Association of postpartum thyroid dysfunction with antepartum hormonal and immunological changes. J Clin Endocrinol Metab. 2003;88(3):1126–32.CrossRefPubMedGoogle Scholar
  39. Krouse RS, Royal RE, Heywood G, Weintraub BD, White DE, Steinberg SM, et al. Thyroid dysfunction in 281 patients with metastatic melanoma or renal carcinoma treated with interleukin-2 alone. J Immunother Emphasis Tumor Immunol. 1995;18(4):272–8.CrossRefPubMedGoogle Scholar
  40. Kuijpens JL, Pop VJ, Vader HL, Drexhage HA, Wiersinga WM. Prediction of post partum thyroid dysfunction: can it be improved? Eur J Endocrinol. 1998;139(1):36–43.CrossRefPubMedGoogle Scholar
  41. Kuijpens JL, Vader HL, Drexhage HA, Wiersinga WM, van Son MJ, Pop VJ. Thyroid peroxidase antibodies during gestation are a marker for subsequent depression postpartum. Eur J Endocrinol. 2001;145(5):579–84.CrossRefPubMedGoogle Scholar
  42. La Rocca C, Carbone F, Longobardi S, Matarese G. The immunology of pregnancy: regulatory T cells control maternal immune tolerance toward the fetus. Immunol Lett. 2014;162(1 Pt A):41–8.CrossRefPubMedGoogle Scholar
  43. Lazarus JH. Lithium and thyroid. Best Pract Res Clin Endocrinol Metab. 2009;23(6):723–33.CrossRefPubMedGoogle Scholar
  44. Lazarus JH. The continuing saga of postpartum thyroiditis. J Clin Endocrinol Metab. 2011;96(3):614–6.CrossRefPubMedGoogle Scholar
  45. Lazarus J, Premawardhana L. Postpartum thyroiditis. In: Weetman A, editor. Contemporary endocrinology – autoimmune diseases in endocrinology. Totowa: Humana Press; 2011.Google Scholar
  46. Lazarus JH, Hall R, Othman S, Parkes AB, Richards CJ, McCulloch B, et al. The clinical spectrum of postpartum thyroid disease. QJM. 1996;89(6):429–35.CrossRefPubMedGoogle Scholar
  47. Lazarus JH, Ammari F, Oretti R, Parkes AB, Richards CJ, Harris B. Clinical aspects of recurrent postpartum thyroiditis. Br J Gen Pract. 1997;47(418):305–8.PubMedPubMedCentralGoogle Scholar
  48. Lazarus JH, Parkes AB, Premawardhana LD, Harris B. Screening for postpartum thyroiditis. J Clin Endocrinol Metab. 1999;84(11):4295–6.CrossRefPubMedGoogle Scholar
  49. Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3(2):76–94.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Leide-Svegborn S, Ahlgren L, Johansson L, Mattsson S. Excretion of radionuclides in human breast milk after nuclear medicine examinations. Biokinetic and dosimetric data and recommendations on breastfeeding interruption. Eur J Nucl Med Mol Imaging. 2016;43(5):808–21.CrossRefPubMedGoogle Scholar
  51. Liang TJ, Ghany MG. Current and future therapies for hepatitis C virus infection. N Engl J Med. 2013;368(20):1907–17.CrossRefPubMedPubMedCentralGoogle Scholar
  52. Maleki N, Tavosi Z. Evaluation of thyroid dysfunction and autoimmunity in gestational diabetes mellitus and its relationship with postpartum thyroiditis. Diabet Med. 2015;32(2):206–12.CrossRefPubMedGoogle Scholar
  53. Mariotti S, Martino E, Cupini C, Lari R, Giani C, Baschieri L, et al. Low serum thyroglobulin as a clue to the diagnosis of thyrotoxicosis factitia. N Engl J Med. 1982;307(7):410–2.CrossRefPubMedGoogle Scholar
  54. Martino E, Bartalena L, Bogazzi F, Braverman LE. The effects of amiodarone on the thyroid. Endocr Rev. 2001;22(2):240–54.PubMedGoogle Scholar
  55. Maruyama H, Kato M, Mizuno O, Kataoka K, Matsuki S. Transient thyrotoxicosis occurred after cessation of steroid therapy in a patient with autoimmune thyroiditis and rheumatoid arthritis. Endocrinol Jpn. 1982;29(5):583–8.CrossRefPubMedGoogle Scholar
  56. Mattsson S, Johansson L, Leide Svegborn S, Liniecki J, Nosske D, Riklund KA, et al. Radiation dose to patients from radiopharmaceuticals: a compendium of current information related to frequently used substances. Ann ICRP. 2015;44(2 Suppl):7–321.CrossRefPubMedGoogle Scholar
  57. Miller KK, Daniels GH. Association between lithium use and thyrotoxicosis caused by silent thyroiditis. Clin Endocrinol (Oxf). 2001;55(4):501–8.CrossRefGoogle Scholar
  58. Mittra ES, McDougall IR. Recurrent silent thyroiditis: a report of four patients and review of the literature. Thyroid. 2007;17(7):671–5.CrossRefPubMedGoogle Scholar
  59. Mizokami T, Itoh Y, Sato Y, Nunoi K, Okamura K. Isolated adrenocorticotropin deficiency associated with painless thyroiditis: a case report and review of the literature. Kurume Med J. 2012;59(3–4):71–7.CrossRefPubMedGoogle Scholar
  60. Mizukami Y, Michigishi T, Hashimoto T, Tonami N, Hisada K, Matsubara F, et al. Silent thyroiditis: a histologic and immunohistochemical study. Hum Pathol. 1988;19(4):423–31.CrossRefPubMedGoogle Scholar
  61. Morita S, Ueda Y, Yokoyama N. Painless thyroiditis induced by the cessation of betamethasone. Intern Med (Tokyo, Japan). 2001;40(8):744–6.CrossRefGoogle Scholar
  62. Negro R, Greco G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. The influence of selenium supplementation on postpartum thyroid status in pregnant women with thyroid peroxidase autoantibodies. J Clin Endocrinol Metab. 2007;92(4):1263–8.CrossRefPubMedGoogle Scholar
  63. Negro R, Attanasio R, Grimaldi F, Guglielmi R, Papini E. A 2015 Italian Survey of Clinical Practice Patterns in the Management of Graves’ Disease: comparison with European and North American Surveys. Eur Thyroid J. 2016;5(2):112–9.CrossRefPubMedPubMedCentralGoogle Scholar
  64. Nicholson WK, Robinson KA, Smallridge RC, Ladenson PW, Powe NR. Prevalence of postpartum thyroid dysfunction: a quantitative review. Thyroid. 2006;16(6):573–82.CrossRefPubMedGoogle Scholar
  65. Nikolai TF, Brosseau J, Kettrick MA, Roberts R, Beltaos E. Lymphocytic thyroiditis with spontaneously resolving hyperthyroidism (silent thyroiditis). Arch Intern Med. 1980;140(4):478–82.CrossRefPubMedGoogle Scholar
  66. Nikolai TF, Coombs GJ, McKenzie AK. Lymphocytic thyroiditis with spontaneously resolving hyperthyroidism and subacute thyroiditis. Long-term follow-up. Arch Intern Med. 1981;141(11):1455–8.CrossRefPubMedGoogle Scholar
  67. Nikolai TF, Turney SL, Roberts RC. Postpartum lymphocytic thyroiditis. Prevalence, clinical course, and long-term follow-up. Arch Intern Med. 1987;147(2):221–4.CrossRefPubMedGoogle Scholar
  68. Nygaard B, Knudsen JH, Hegedus L, Scient AV, Hansen JE. Thyrotropin receptor antibodies and Graves’ disease, a side-effect of 131I treatment in patients with nontoxic goiter. J Clin Endocrinol Metab. 1997;82(9):2926–30.PubMedGoogle Scholar
  69. Oh SB, Ahn J, Oh MY, Choi BG, Kang JH, Jeon YK, et al. Thyrotoxic periodic paralysis associated with transient thyrotoxicosis due to painless thyroiditis. J Korean Med Sci. 2012;27(7):822–6.CrossRefPubMedPubMedCentralGoogle Scholar
  70. Okosieme OE, Parkes AB, McCullough B, Doukidis D, Morgan BP, Richards CJ, et al. Complement activation in postpartum thyroiditis. QJM. 2002;95(3):173–9.CrossRefPubMedGoogle Scholar
  71. Othman S, Phillips DI, Parkes AB, Richards CJ, Harris B, Fung H, et al. A long-term follow-up of postpartum thyroiditis. Clin Endocrinol (Oxf). 1990;32(5):559–64.CrossRefGoogle Scholar
  72. Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003;348(26):2646–55.CrossRefPubMedGoogle Scholar
  73. Premawardhana LD, Parkes AB, Ammari F, John R, Darke C, Adams H, et al. Postpartum thyroiditis and long-term thyroid status: prognostic influence of thyroid peroxidase antibodies and ultrasound echogenicity. J Clin Endocrinol Metab. 2000;85(1):71–5.CrossRefPubMedGoogle Scholar
  74. 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(8):610–5.CrossRefPubMedGoogle Scholar
  75. Rasmussen NG, Hornnes PJ, Hegedus L. Ultrasonographically determined thyroid size in pregnancy and post partum: the goitrogenic effect of pregnancy. Am J Obstet Gynecol. 1989a;160(5 Pt 1):1216–20.CrossRefPubMedGoogle Scholar
  76. Rasmussen NG, Hansen JM, Hegedus L. Frequency of thyroiditis and postpartum thyroiditis in a 10-year consecutive hyperthyroid Danish population. Thyroidology/APRIM. 1989b;1(3):143–7.Google Scholar
  77. Roberton H. Lassitude, coldness, and hair changes following pregnancy, and their response to treatment with thyroid extract. Br Med J. 1948;2:93–4.CrossRefGoogle Scholar
  78. Rouas-Freiss N, Goncalves RM, Menier C, Dausset J, Carosella ED. Direct evidence to support the role of HLA-G in protecting the fetus from maternal uterine natural killer cytolysis. Proc Natl Acad Sci U S A. 1997;94(21):11520–5.CrossRefPubMedPubMedCentralGoogle Scholar
  79. Samuels MH. Subacute, silent, and postpartum thyroiditis. Med Clin North Am. 2012;96(2):223–33.CrossRefPubMedGoogle Scholar
  80. Sasaki H, Ohnishi O, Okudera T, Okumura M. Simultaneous occurrence of transient resolving thyrotoxicosis due to painless thyroiditis, hypopituitarism and diabetes insipidus following pituitary apoplexy. Postgrad Med J. 1991;67(783):75–7.CrossRefPubMedPubMedCentralGoogle Scholar
  81. Sato S, Endo K, Iizaka T, Saiki R, Iwaku K, Sato S, et al. A case of painless thyroiditis in a very early stage of pregnancy. Intern Med (Tokyo, Japan). 2012;51(5):475–7.CrossRefGoogle Scholar
  82. Schumacher A, Costa SD, Zenclussen AC. Endocrine factors modulating immune responses in pregnancy. Front Immunol. 2014;5:196.CrossRefPubMedPubMedCentralGoogle Scholar
  83. Schwartz F, Bergmann N, Zerahn B, Faber J. Incidence rate of symptomatic painless thyroiditis presenting with thyrotoxicosis in Denmark as evaluated by consecutive thyroid scintigraphies. Scand J Clin Lab Invest. 2013;73(3):240–4.CrossRefPubMedGoogle Scholar
  84. Sergi M, Tomlinson G, Feig DS. Changes suggestive of post-partum thyroiditis in women with established hypothyroidism: incidence and predictors. Clin Endocrinol (Oxf). 2015;83(3):389–93.CrossRefGoogle Scholar
  85. Smallridge RC, Clark T. Sawin historical vignette: what do criminology, Harry Houdini, and King George V have in common with postpartum thyroid dysfunction? Thyroid. 2014;24(12):1752–8.CrossRefPubMedGoogle Scholar
  86. Stagnaro-Green A. Approach to the patient with postpartum thyroiditis. J Clin Endocrinol Metab. 2012;97(2):334–42.CrossRefPubMedGoogle Scholar
  87. Stagnaro-Green A, Roman SH, Cobin RH, el-Harazy E, Wallenstein S, Davies TF. A prospective study of lymphocyte-initiated immunosuppression in normal pregnancy: evidence of a T-cell etiology for postpartum thyroid dysfunction. J Clin Endocrinol Metab. 1992;74(3):645–53.PubMedGoogle Scholar
  88. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21(10):1081–125.CrossRefPubMedPubMedCentralGoogle Scholar
  89. Tachi J, Amino N, Tamaki H, Aozasa M, Iwatani Y, Miyai K. Long term follow-up and HLA association in patients with postpartum hypothyroidism. J Clin Endocrinol Metab. 1988;66(3):480–4.CrossRefPubMedGoogle Scholar
  90. Tajiri J, Nakashima M, Higashi K, Morita M, Umeda T, Sato T. Silent thyroiditis. Arch Intern Med. 1986;146(8):1644.CrossRefPubMedGoogle Scholar
  91. Takasu N, Komiya I, Nagasawa Y, Asawa T, Yamada T. Exacerbation of autoimmune thyroid dysfunction after unilateral adrenalectomy in patients with Cushing’s syndrome due to an adrenocortical adenoma. N Engl J Med. 1990;322(24):1708–12.CrossRefPubMedGoogle Scholar
  92. Thewjitcharoen Y, Lumlertgul N. Painless thyroiditis complicating with hypercalcemic encephalopathy. J Med Assoc Thai. 2012;95(1):119–23.PubMedGoogle Scholar
  93. Tomer Y, Menconi F. Interferon induced thyroiditis. Best Pract Res Clin Endocrinol Metab. 2009;23(6):703–12.CrossRefPubMedPubMedCentralGoogle Scholar
  94. Tozzoli R, Bagnasco M, Giavarina D, Bizzaro N. 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(2):107–13.CrossRefPubMedGoogle Scholar
  95. Tsang W, Houlden RL. Amiodarone-induced thyrotoxicosis: a review. Can J Cardiol. 2009;25(7):421–4.CrossRefPubMedPubMedCentralGoogle Scholar
  96. Vila L, Velasco I, Gonzalez S, Morales F, Sanchez E, Lailla JM, et al. Detection of thyroid dysfunction in pregnant women: universal screening is justified. Endocrinol Nutr. 2012;59(9):547–60.CrossRefPubMedGoogle Scholar
  97. Vitug AC, Goldman JM. Silent (painless) thyroiditis. Evidence of a geographic variation in frequency. Arch Intern Med. 1985;145(3):473–5.CrossRefPubMedGoogle Scholar
  98. Walfish PG, Meyerson J, Provias JP, Vargas MT, Papsin FR. Prevalence and characteristics of post-partum thyroid dysfunction: results of a survey from Toronto, Canada. J Endocrinol Invest. 1992;15(4):265–72.CrossRefPubMedGoogle Scholar
  99. Whitfield P, Bagg W, Holdaway I. Concurrent Addison’s disease and silent thyroiditis. Intern Med J. 2009;39(12):e1–2.CrossRefPubMedGoogle Scholar
  100. Xu C, Mao D, Holers VM, Palanca B, Cheng AM, Molina H. A critical role for murine complement regulator crry in fetomaternal tolerance. Science (New York, NY). 2000;287(5452):498–501.CrossRefGoogle Scholar
  101. Yoshihara A, Noh JY, Watanabe N, Iwaku K, Kobayashi S, Suzuki M, 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(4):326–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Lakdasa D. Premawardhana
    • 1
    • 2
  • Onyebuchi E. Okosieme
    • 3
    • 4
  • John H. Lazarus
    • 4
  1. 1.Section of Endocrinology, Department of MedicineYYF Hospital, Aneurin Bevan University Health BoardCaerphillyUK
  2. 2.Centre for Endocrine and Diabetes Sciences, C2 Link CorridorUniversity Hospital of WalesCardiffUK
  3. 3.Endocrine and Diabetes DepartmentPrince Charles Hospital, Cwm Taf University Health BoardMerthyr TydfilUK
  4. 4.Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of MedicineCardiff UniversityCardiffUK

Personalised recommendations