The Incidence of Gestational Hyperthyroidism and Postpartum Thyroiditis in Treated Patients with Graves' Disease

Tagami, Tetsuya; Hagiwara, Hanae; Kimura, Takashi; Usui, Takeshi; Shimatsu, Akira; Naruse, Mitsuhide

doi:10.1089/thy.2007.0003

Cited by 106 publications

(22 citation statements)

References 21 publications

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“…Tagami et al evaluated the serum hCG values and FT 3 /FT 4 ratios of pregnant GD patients and found that the hCG values were higher and FT 3 /FT 4 ratios were lower in the GTT group than in the non-GTT group [9]. Our results in the present study were consistent with the findings in that report.…”

Section: Disclosure Statementsupporting

confidence: 92%

Serum human chorionic gonadotropin levels and thyroid hormone levels in gestational transient thyrotoxicosis: Is the serum hCG level useful for differentiating between active Graves’ disease and GTT?

et al. 2015

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Section: Disclosure Statementsupporting

confidence: 92%

Serum human chorionic gonadotropin levels and thyroid hormone levels in gestational transient thyrotoxicosis: Is the serum hCG level useful for differentiating between active Graves’ disease and GTT?

et al. 2015

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“…17,18 Consequently, a history of autoimmune thyroid disorder particularly Hashimoto thyroiditis, Graves' disease or previous PPT is a predisposing factor leading to a higher risk of developing PPTD (56.1-68%; 44% and 70% respectively). [19][20][21][22] In accordance with this data, we also found an increased incidence of PPTD among women with AITD antedating pregnancy.…”

Section: Resultssupporting

confidence: 86%

Risk Factors for Postpartum Thyroid Dysfunction in Euthyroid Women Prior to Pregnancy

et al. 2017

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Citation: Nonchev BI, Argatska AV, Pehlivanov BK, Orbetzova MM. Risk factors for postpartum thyroid dysfunction in euthyroid women prior to pregnancy. 2017;59(2):190-196. doi: 10.1515/folmed-2017-0027 Background: Thyroid dysfunction is common during the postpartum and the predisposing factors for its development are considered specifi c for the population studied. The aim of this study was to evaluate the risk factors for the occurrence of postpartum thyroid dysfunction (PPTD) in euthyroid women prior to pregnancy. Materials and methods: Forty-fi ve women with PPTD and 55 age-matched euthyroid postpartum women from Plovdiv, Bulgaria were included in the study. TSH, FT4, FT3, TPOAb, TgAb, TRAb were measured and ultrasound evaluation of the thyroid was performed in the fi rst trimester of pregnancy and during the postpartum. Results: The study found higher risk of developing PPTD in women with family history of thyroid disease (OR 4.42; 95% CI 1.87,10.43), smokers (OR 4.01; 95% CI 1.72,9.35), personal history of autoimmune thyroid disease (OR 5.37; 95% CI 1.15,28.53), positive TPOAb (OR 18.12; 95% CI 4.93,66.65) and thyroid US hypoechogenicity during early pregnancy (OR 6.39; 95% CI 2.53,16.12) and those who needed levothyroxine during pregnancy (OR 3.69; 95% CI 1.28,10.61). BMI before pregnancy was signifi cantly lower in women with PPTD than in euthyroid postpartum women (22.80±0.55 vs 26.25±0.97, p=0.013). The multivariate logistic regression analysis identifi ed as most important independent risk factors for PPTD occurrence the TPOAb positivity during early pregnancy, family history of thyroid disease, smoking and lower BMI before pregnancy. Conclusion: Our data suggest that in the population studied several factors are associated with an increased risk of PPTD and screening for thyroid disorders among those women can be benefi cial. Folia Medica BACKGROUND

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“…Women with other autoimmune disorders have an increased risk of PPT. Specifically, the prevalence of PPT is 25% with Type 1 diabetes mellitus (276,277), 25% with chronic viral hepatitis (278), 14% with systemic lupus erythematosus (279), and 44% with a prior history of Graves' disease (280). Individuals who had PPT in a prior episode and who returned to the euthyroid state have a 70% chance of developing PPT in a subsequent pregnancy (281).…”

Section: Question 73: What Is the Prevalence Of Ppt?mentioning

confidence: 99%

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Alexander

Pearce

Brent

et al. 2017

Thyroid

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2,716

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INTRODUCTION Pregnancy has a profound impact on the thyroid gland and thyroid function. The gland increases 10% in size during pregnancy in iodine-replete countries and by 20%-40% in areas of iodine deficiency. Production of thyroxine (T 4 ) and triiodothyronine (T 3 ) increases by 50%, along with a 50% increase in the daily iodine requirement. These physiological changes may result in hypothyroidism in the later stages of pregnancy in iodine-deficient women who were euthyroid in the first trimester. The range of thyrotropin (TSH), under the impact of placental human chorionic gonadotropin (hCG), is decreased throughout pregnancy with the lower normal TSH level in the first trimester being poorly defined and an upper limit of 2.5 mIU/L. Ten percent to 20% of all pregnant women in the first trimester of pregnancy are thyroid peroxidase (TPO) or thyroglobulin (Tg) antibody positive and euthyroid. Sixteen percent of the women who are euthyroid and positive for TPO or Tg antibody in the first trimester will develop a TSH that exceeds 4.0 mIU/L by the third trimester, and 33%-50% of women who are positive for TPO or Tg antibody in the first trimester will develop postpartum thyroiditis. In essence, pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency, and postpartum thyroiditis in women with underlying Hashimoto's disease who were euthyroid prior to conception.Knowledge regarding the interaction between the thyroid and pregnancy/the postpartum period is advancing at a rapid pace. Only recently has a TSH of 2.5 mIU/L been accepted as the upper limit of normal for TSH in the first trimester. This has important implications in regards to interpretation of the literature as well as a critical impact for the clinical diagnosis of hypothyroidism. Although it is well accepted that overt hypothyroidism and overt hyperthyroidism have a deleterious impact on pregnancy, studies are now focusing on the potential impact of subclinical hypothyroidism and subclinical hyperthyroidism on maternal and fetal health, the association between miscarriage and preterm delivery in euthyroid women positive for TPO and/or Tg antibody, and the prevalence and long-term impact of postpartum thyroiditis. Recently completed prospective randomized studies have begun to produce critically needed data on the impact of treating thyroid disease on the mother, fetus, and the future intellect of the unborn child.It is in this context that the American Thyroid Association (ATA) charged a task force with developing clinical guidelines on the diagnosis and treatment of thyroid disease during pregnancy and the postpartum. The task force consisted of international experts in the field of thyroid disease and pregnancy, and included representatives from the ATA, Asia and Oceania Thyroid Association, Latin American Thyroid Society, American College of Obstetricians and Gynecologists, and the Midwives Alliance of North America. Inclusion of thyroidologists, obstetricians, and midwives ...

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The Incidence of Gestational Hyperthyroidism and Postpartum Thyroiditis in Treated Patients with Graves' Disease

Cited by 106 publications

References 21 publications

Serum human chorionic gonadotropin levels and thyroid hormone levels in gestational transient thyrotoxicosis: Is the serum hCG level useful for differentiating between active Graves’ disease and GTT?

Serum human chorionic gonadotropin levels and thyroid hormone levels in gestational transient thyrotoxicosis: Is the serum hCG level useful for differentiating between active Graves’ disease and GTT?

Risk Factors for Postpartum Thyroid Dysfunction in Euthyroid Women Prior to Pregnancy

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

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The Incidence of Gestational Hyperthyroidism and Postpartum Thyroiditis in Treated Patients with Graves' Disease

Cited by 106 publications

References 21 publications

Serum human chorionic gonadotropin levels and thyroid hormone levels in gestational transient thyrotoxicosis: Is the serum hCG level useful for differentiating between active Graves&rsquo; disease and GTT?

Serum human chorionic gonadotropin levels and thyroid hormone levels in gestational transient thyrotoxicosis: Is the serum hCG level useful for differentiating between active Graves&rsquo; disease and GTT?

Risk Factors for Postpartum Thyroid Dysfunction in Euthyroid Women Prior to Pregnancy

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Contact Info

Product

Resources

About

Serum human chorionic gonadotropin levels and thyroid hormone levels in gestational transient thyrotoxicosis: Is the serum hCG level useful for differentiating between active Graves’ disease and GTT?

Serum human chorionic gonadotropin levels and thyroid hormone levels in gestational transient thyrotoxicosis: Is the serum hCG level useful for differentiating between active Graves’ disease and GTT?