The occurrence of permanent thyroid failure in patients with subclinical postpartum thyroiditis

Azizi, Fereidoun

doi:10.1530/eje.1.01976

Cited by 54 publications

(28 citation statements)

References 19 publications

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“…The impact of PPT on long-term thyroid function has been evaluated in six studies (284,(293)(294)(295)(296)(297). The data demonstrate that within 1 year, 10%-20% of women who were euthyroid following their initial hypothyroid phase of PPT develop permanent hypothyroidism.…”

Section: And Recommendation 69mentioning

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

2,059

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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Section: And Recommendation 69mentioning

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

2,059

2,716

View full text Add to dashboard Cite

show abstract

“…In addition, in the Othman's study it was also shown that there was no significant association between family history of thyroid disease and permanent hyperthyroidism. 9 In Shahbazian's study also no relationship was determined between postpartum thyroiditis and personal or family history of thyroid disease. 23 In this study, two patients (11.8%) of women having postpartum thyroiditis had history of abortion, whereas 15 patients (88.2%) didn't have.…”

Section: Discussionmentioning

confidence: 91%

“…9 Freidrich et al claimed that the greater number of pregnancy increases the risk of growth of thyroid autoantibodies. However, in another study run by Walsh in 2005, in Australia, unlike the previous study it was expressed that higher number of pregnancy doesn't raise the risk of thyroid dysfunction, though the study Othman showed that more cases of pregnancy can be associated with greater incidence of permanent hypothyroidism after pregnancy.…”

Section: Discussionmentioning

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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“…Nach 1 Jahr hat sich die Stoffwechsellage bei ca. 80% der Patientinnen normalisiert; bei 30-50% der Patientinnen entwickelt sich jedoch längerfristig eine Schilddrüsenun-terfunktion [28,29]. Bei Frauen mit Zustand nach Postpartum-Thyreoiditis wird deshalb eine jährliche TSH-Bestimmung empfohlen, um rechtzeitig eine primäre Hypothyreose zu entdecken [1].…”

Section: Klinik Und Diagnostikunclassified

Schilddrüsenentzündungen in Schwangerschaft und Stillzeit

Harbeck

Lehnert

Mönig

2009

Gynäkologische Endokrinologie

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Schilddrüsenentzündungen in Schwangerschaft und Stillzeit Leitthema Der Oberbegriff Thyreoiditis umfasst alle entzündlichen Verände-rungen der Schilddrüse. Eine für die Praxis hilfreiche Einteilung, die auch die unterschiedlichen Ätiologien berücksichtigt, grenzt die schmerzhaften von den schmerzlosen Formen ab (. Abb. 1). Gemeinsames Merkmal aller Schilddrüsenentzündungen ist, dass sie zu einer passageren Hyperthyreose führen können, die nicht durch eine echte Überproduktion von Schilddrüsenhormonen, sondern durch die Freisetzung präformierter Hormone infolge einer Zelldestruktion gekennzeichnet ist. Auch ein Über-gang in eine transiente oder auch permanente Hypothyreose ist möglich. Die rechtzeitige Erkennung und adäquate Therapie von Schilddrüsenentzündungen ist in der Schwangerschaft von besonderer Bedeutung, da eine nicht erkannte oder falsch behandelte Thyreoiditis einen negativen Einfluss auf den Verlauf der Schwangerschaft haben kann. Insbesondere die Abgrenzung von einer Hyperthyreose im Rahmen eines M. Basedow oder eines autonomen Adenoms ist wichtig, weil diese Erkrankungen im Gegensatz zur Thyreoiditis mit Thyreostatika behandelt werden (s. unten). Ebenso wichtig ist die Vermeidung einer hypothyreoten Stoffwechsellage, da diese mit einer erhöhten Inzidenz von Fehl-und Frühgeburten [1] sowie mit Einschränkungen der intellektuellen Entwicklung während Kindheit und Schulzeit assoziiert ist [2, 3]. Eine Hypothyreose sollte daher mög-lichst bereits vor Eintritt einer Schwangerschaft adäquat substituiert und die erforderliche Erhaltungsdosis frühzeitig in der Schwangerschaft an den erhöhten Bedarf angepasst werden [4]. Eine transiente Hyperthyreose im Rahmen einer Thyreoiditis wird aufgrund der fehlenden Überproduktion von Schilddrüsenhormonen nicht thyreostatisch, sondern, falls erforderlich, symptomatisch (z. B. mit β-Rezeptorenblockern) therapiert. Es sind bislang keine signifikant teratogenen Effekte von Propranolol auf den Menschen beschrieben worden [5]. Die Gabe von Propranolol in der Spätschwangerschaft führt möglicher-weise zu einer milden neonatalen Hypoglykämie und Bradykardie, die sich aber nach der Geburt innerhalb von 48 h zurückbilden. Die Gabe von Propranolol ist auch in der Stillzeit möglich. Bei hyperthyreoter Stoffwechsellage der Mutter besteht ein erhöhtes Risiko für eine Frühgeburt, eine intrauterine Wachstumshemmung, ein niedriges Thyreoiditis Schmerzhaft Schmerzlos Subkutane Thyreoiditis (de Quervain) Akute eitrige Thyreoiditis Strahlenthyreoiditis Hashimoto-Thyreoiditis Postparum-Thyreoiditis "Silent Thyroiditis" Medikamentös indizierte bröse Thyreoiditis (Riedel) Abb. 1 8 Einteilung der Thyreoiditiden Redaktion A. Schröer, Lübeck K. Diedrich, Lübeck M. Ludwig, Hamburg 224 | Gynäkologische Endokrinologie 4 · 2009 Geburtsgewicht, Herzinsuffizienz, Prä-eklampsie oder intrauterinen Fruchttod [6]. Die Prävalenz einer manifesten Hypothyreose in der Schwangerschaft beträgt 0,3-0,5%. Die Prävalenz einer latenten Hypothyreose beträgt 2-3%, wobei die Autoimmunthyreoiditis die Hauptursache ein...

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The occurrence of permanent thyroid failure in patients with subclinical postpartum thyroiditis

Cited by 54 publications

References 19 publications

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

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

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

Schilddrüsenentzündungen in Schwangerschaft und Stillzeit

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