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Thyroid Diseases pp 1–29Cite as

Postpartum Thyroiditis and Silent Thyroiditis

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Part of the book series: Endocrinology ((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.

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References

  • ACOG. Practice Bulletin No. 148: thyroid disease in pregnancy. Obstet Gynecol. 2015;125(4):996–1005.

    Article  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Adlan MA, Premawardhana LD. Thyroid peroxidase antibody and screening for postpartum thyroid dysfunction. J Thyroid Res. 2011;2011:745135.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Azizi F. Age as a predictor of recurrent hypothyroidism in patients with post-partum thyroid dysfunction. J Endocrinol Invest. 2004;27(11):996–1002.

    Article  CAS  PubMed  Google Scholar 

  • Azizi F. The occurrence of permanent thyroid failure in patients with subclinical postpartum thyroiditis. Eur J Endocrinol. 2005;153(3):367–71.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • 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.

    CAS  PubMed  Google Scholar 

  • Basaria S, Cooper DS. Amiodarone and the thyroid. Am J Med. 2005;118(7):706–14.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Bonds DE, Freedberg KA. Cost-effectiveness of prenatal screening for postpartum thyroiditis. J Womens Health Gend Based Med. 2001;10(7):649–58.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • Dayan CM, Daniels GH. Chronic autoimmune thyroiditis. N Engl J Med. 1996;335(2):99–107.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • 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.

    CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Galustian C, Dasgupta P. Regulatory T cells. eLS: Chichester: Wiley; 2001.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Gerstein HC. Incidence of postpartum thyroid dysfunction in patients with type I diabetes mellitus. Ann Intern Med. 1993;118(6):419–23.

    Article  CAS  PubMed  Google Scholar 

  • Hamnvik OP, Larsen PR, Marqusee E. Thyroid dysfunction from antineoplastic agents. J Natl Cancer Inst. 2011;103(21):1572–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Lazarus JH. Lithium and thyroid. Best Pract Res Clin Endocrinol Metab. 2009;23(6):723–33.

    Article  CAS  PubMed  Google Scholar 

  • Lazarus JH. The continuing saga of postpartum thyroiditis. J Clin Endocrinol Metab. 2011;96(3):614–6.

    Article  CAS  PubMed  Google Scholar 

  • Lazarus J, Premawardhana L. Postpartum thyroiditis. In: Weetman A, editor. Contemporary endocrinology – autoimmune diseases in endocrinology. Totowa: Humana Press; 2011.

    Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Lazarus JH, Parkes AB, Premawardhana LD, Harris B. Screening for postpartum thyroiditis. J Clin Endocrinol Metab. 1999;84(11):4295–6.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Liang TJ, Ghany MG. Current and future therapies for hepatitis C virus infection. N Engl J Med. 2013;368(20):1907–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Martino E, Bartalena L, Bogazzi F, Braverman LE. The effects of amiodarone on the thyroid. Endocr Rev. 2001;22(2):240–54.

    CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Miller KK, Daniels GH. Association between lithium use and thyrotoxicosis caused by silent thyroiditis. Clin Endocrinol (Oxf). 2001;55(4):501–8.

    Article  CAS  Google Scholar 

  • Mittra ES, McDougall IR. Recurrent silent thyroiditis: a report of four patients and review of the literature. Thyroid. 2007;17(7):671–5.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Morita S, Ueda Y, Yokoyama N. Painless thyroiditis induced by the cessation of betamethasone. Intern Med (Tokyo, Japan). 2001;40(8):744–6.

    Article  CAS  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nicholson WK, Robinson KA, Smallridge RC, Ladenson PW, Powe NR. Prevalence of postpartum thyroid dysfunction: a quantitative review. Thyroid. 2006;16(6):573–82.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003;348(26):2646–55.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    CAS  Google Scholar 

  • Roberton H. Lassitude, coldness, and hair changes following pregnancy, and their response to treatment with thyroid extract. Br Med J. 1948;2:93–4.

    Article  Google Scholar 

  • 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Samuels MH. Subacute, silent, and postpartum thyroiditis. Med Clin North Am. 2012;96(2):223–33.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Schumacher A, Costa SD, Zenclussen AC. Endocrine factors modulating immune responses in pregnancy. Front Immunol. 2014;5:196.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Stagnaro-Green A. Approach to the patient with postpartum thyroiditis. J Clin Endocrinol Metab. 2012;97(2):334–42.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Tajiri J, Nakashima M, Higashi K, Morita M, Umeda T, Sato T. Silent thyroiditis. Arch Intern Med. 1986;146(8):1644.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Thewjitcharoen Y, Lumlertgul N. Painless thyroiditis complicating with hypercalcemic encephalopathy. J Med Assoc Thai. 2012;95(1):119–23.

    PubMed  Google Scholar 

  • Tomer Y, Menconi F. Interferon induced thyroiditis. Best Pract Res Clin Endocrinol Metab. 2009;23(6):703–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Tsang W, Houlden RL. Amiodarone-induced thyrotoxicosis: a review. Can J Cardiol. 2009;25(7):421–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Vitug AC, Goldman JM. Silent (painless) thyroiditis. Evidence of a geographic variation in frequency. Arch Intern Med. 1985;145(3):473–5.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Whitfield P, Bagg W, Holdaway I. Concurrent Addison’s disease and silent thyroiditis. Intern Med J. 2009;39(12):e1–2.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Section of Endocrinology, Department of Medicine, YYF Hospital, Aneurin Bevan University Health Board, Ystrad Fawr Way, Caerphilly, UK

    Lakdasa D. Premawardhana

  2. Centre for Endocrine and Diabetes Sciences, C2 Link Corridor, University Hospital of Wales, Cardiff, CF14 4XN, UK

    Lakdasa D. Premawardhana

  3. Endocrine and Diabetes Department, Prince Charles Hospital, Cwm Taf University Health Board, Merthyr Tydfil, CF47 9DT, UK

    Onyebuchi E. Okosieme

  4. Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK

    Onyebuchi E. Okosieme & John H. Lazarus

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  1. Lakdasa D. Premawardhana
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  3. John H. Lazarus
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Correspondence to Lakdasa D. Premawardhana .

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Editors and Affiliations

  1. Department of Endocrinology, University of Pisa, Pisa, Italy

    Paolo Vitti

  2. Department of Endocrinology and Metaboli, Odense Univeristy Hospital, Odense, Denmark

    Laszlo Hegedus

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Premawardhana, L.D., Okosieme, O.E., Lazarus, J.H. (2016). Postpartum Thyroiditis and Silent Thyroiditis. In: Vitti, P., Hegedus, L. (eds) Thyroid Diseases. Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-319-29195-6_8-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-29195-6

  • Online ISBN: 978-3-319-29195-6

  • eBook Packages: Springer Reference MedicineReference Module Medicine

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