Review Thyroid disease in relation to pregnancy

Lazarus, John H.; Othman, Sakinah

doi:10.1111/j.1365-2265.1991.tb01741.x

Cited by 67 publications

(37 citation statements)

References 56 publications

(31 reference statements)

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“…[116][117][118] PPT affects 4-6% of women in the years following delivery. 119 Permanent hypothyroidism is observed in ෂ25% of the women followed for several years after clinical resolution of PPT. 120 Significant differences in prevalence between ethnic groups have been reported.…”

Section: Postpartum Thyroiditis (Ppt)mentioning

confidence: 99%

CTLA-4 in autoimmune diseases – a general susceptibility gene to autoimmunity?

2000

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Section: Postpartum Thyroiditis (Ppt)mentioning

confidence: 99%

CTLA-4 in autoimmune diseases – a general susceptibility gene to autoimmunity?

2000

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“…The incidence of PPTD in the general population is 4-8% (3)(4)(5)(6). PPTD is thought to be part of the spectrum of autoimmune thyroid diseases (AITD) and is caused, in the majority of cases, by a lymphocytic thyroiditis exacerbated in the first year post partum as the result of a 'rebound' from the suppressed immune system during pregnancy (4,6).…”

Section: Introductionmentioning

confidence: 99%

“…PPTD is thought to be part of the spectrum of autoimmune thyroid diseases (AITD) and is caused, in the majority of cases, by a lymphocytic thyroiditis exacerbated in the first year post partum as the result of a 'rebound' from the suppressed immune system during pregnancy (4,6). Fifty percent of pregnant women positive for thyroid peroxidase antibodies (TPOAb, identical to microsomal antibodies (MsAb)), will develop PPTD (3)(4)(5)(6). PPTD is clinically characterized by symptoms associated with hyper-and/or hypothyroidism and depressive symptoms (4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Prediction of post partum thyroid dysfunction: can it be improved?

Kuijpens¹,

Pop

Vader³

et al. 1998

Eur J Endocrinol

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Background: Screening pregnant women for thyroid peroxidase antibodies (TPOAb) to identify those at risk for post partum thyroid dysfunction (PPTD) is controversial, mainly because of the low positive predictive value (ppv) of TPOAb. Objectives: To evaluate if the ppv of TPOAb can be enhanced, either by taking into account the time of TPOAb testing, or by combining this parameter with other putative determinants of PPTD such as smoking, family history or other autoimmune diseases. Methods: A prospective study was performed in the Kempenland region (southeastern Netherlands). Three hundred and ten unselected women were visited at 12 and 32 weeks gestation and 4, 12, 20, 28 and 36 weeks post partum. Serial thyroid stimulating hormone (TSH), free thyroxine (fT 4 ) and TPOAb testing was performed. Thyroid dysfunction (TD) was defined as abnormal TSH either in combination with abnormal fT 4 (overt TD) or without abnormal fT 4 (subclinical TD). PPTD was defined as overt TD post partum. Multivariate regression analysis was performed for determining independent risk factors for PPTD. The sensitivity and specificity of TPOAb at different time points and at different concentrations were calculated and presented in receiver operating characteristic (ROC) curves. Women who had experienced PPTD were followed for 2.5-3 years. Results: Data from 291 women were available for analysis. Serum fT 4 declined during pregnancy and returned to baseline values post partum. TD in gestation was present in 23 women (7.9%): serum TSH was transiently decreased in 13 (6 had overt gestational thyrotoxicosis (2.1%)) and increased in 10 (2 had TPOAb). Both point prevalence and concentration of TPOAb decreased during gestation and returned to baseline levels within 12 weeks post partum. TD in post partum was present in 36 women (12.4%): 21 had subclinical and 15 overt TD. Out of the 15 women with overt TD (incidence of PPTD: 5.2%) 10 were positive for TPOAb (TPOAbþ); 9 had thyrotoxicosis (4 TPOAbþ), 5 hypothyroidism (5 TPOAbþ) and 1 thyrotoxicosis followed by hypothyroidism (TPOAbþ). Independent risk factors for PPTD were TPOAb (relative risk (RR) ¼ 27.2), bottle feeding (RR ¼ 11.1) and smoking habits (ever smoked: RR ¼ 3.1; women with PPTD had smoked more cigarettes for a longer period of time). The sensitivity of TPOAb testing was highest at 12 weeks gestation (0.67). The ppv of TPOAb was 0.31-0.75 (depending on time of testing and concentration), increasing slightly to 0.38-0.80 when combined with bottle feeding or smoking habits. There appeared to be an autoimmune form of PPTD in 2/3 of cases and a nonautoimmune form; women with the autoimmune form were at risk for developing permanent hypothyroidism. Conclusions: A maximum of 2/3 of PPTD cases can be predicted from the presence of TPOAb because 1/3 remained negative for TPOAb. The most appropriate time for TPOAb testing is in the first trimester of pregnancy. The combination of TPOAb testing with anamnestic determinants of PPTD does not increase ppv substantially.

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“…[11][12][13][14][15][16][17] Signs and symptoms of hyperthyroidism include fatigue, weight loss, heart palpitations, heat intolerance, anxiety, restlessness and tachycardia.…”

Section: Introductionmentioning

confidence: 99%

“…11 Some studies have also shown that hypothyroidism can also be associated with postpartum depression. 17,18 In addition, postpartum hypothyroidism can lead to a reduction in the volume of breast milk. 19 Considering the importance of postpartum thyroiditis and its complications this study was conducted to investigate the prevalence of postpartum thyroiditis in women with gestational diabetes.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of postpartum thyroiditis in women with gestational diabetes mellitus in Ardabil: North West of Iran

2016

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INTRODUCTIONGestational diabetes is the most common metabolic disorder during pregnancy that can cause serious complications for both mother and fetus.1 Therefore, identifying risk factors for gestational diabetes is of high importance, because by knowing these factors screening programs can be conducted for susceptible women. Additionally, maternal and fetal complications can be prevented by early diagnosis and proper control of blood glucose levels.2 Although, impaired glucose tolerance disappears after delivery in these patients; more than 70% of the patients are diagnosed with type 2 diabetes after 10 years.3,4 Postpartum thyroiditis is a destructive thyroiditis that can be induced one year after pregnancy via autoimmune mechanisms. Postpartum thyroiditis can also occur after spontaneous or induced abortion.5 This complication can occur in one the following three forms: transient hyperthyroidism, transient hypothyroidism, or hyperthyroidism followed by hypothyroidism, and then return to the normal state.The global incidence rate of postpartum thyroiditis varies from 1% to 17%. [6][7][8] The higher values (up to 25%) have been reported for women with type 1 diabetes, values higher than this (42%) have been observed in women with a previous history of postpartum thyroiditis, and the values ranging from 40 to 60% have been recorded for women with normal thyroid function during pregnancy but positive antiTPO.6,7 Most women within one year after delivery return to euthyroid state, however, some remain hypothyroid forever. 9-10Manifestation of ABSTRACT Background: Gestational diabetes is the most common metabolic disorder during pregnancy and postpartum thyroiditis is a destructive thyroiditis that can cause serious complications for the mother and her child. The purpose of this study was to determine the prevalence of postpartum thyroiditis in women with gestational diabetes. Methods: In this cross-sectional study, 86 cases satisfy inclusion criteria and gestational diabetes mellitus (GDM) and were evaluated for postpartum thyroiditis with thyroid stimulating hormone (TSH), T4, anti-TPO, T3RU tests. The groups with and without thyroiditis were compared and data was analyzed by statistical methods. Results: There were 17 patients (19.8%) with postpartum thyroiditis, of whom 4 patients (23.5%) had hyperthyroidism, 9 patients (52.9%) were in the age group of 21 to 30 years, and 9 patients (52.9%) had a family history of diabetes. Five patients (29.4%) with high anti-TPO level (P=0.022) and mean TSH and anti-TPO respectively, 2.8 (4.8) and 17.2 (35.9). Conclusions: The results showed that higher level of anti TPO titer and family history of diabetes can be associated with a higher rate of postpartum thyroiditis, so it is recommended that postpartum thyroiditis to be examined in women with gestational diabetes who have these mentioned items.

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Review Thyroid disease in relation to pregnancy

Cited by 67 publications

References 56 publications

CTLA-4 in autoimmune diseases – a general susceptibility gene to autoimmunity?

CTLA-4 in autoimmune diseases – a general susceptibility gene to autoimmunity?

Prediction of post partum thyroid dysfunction: can it be improved?

Prevalence of postpartum thyroiditis in women with gestational diabetes mellitus in Ardabil: North West of Iran

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