The sonographic appearances in postpartum thyroiditis

Adams, H.; Jones, Matthew; Othman, Sakinah; Lazarus, John H.; Parkes, A. B.; Hall, R.; Phillips, David I. W.; Richards, C. J.

doi:10.1016/s0009-9260(05)80081-9

Cited by 50 publications

(22 citation statements)

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“…Ultrasonographic evaluation showed hypoechogenicity in 96% of PPT patients in the in¯ammatory phase of the disease. This is in agreement with a previous report (25). The change in thyroid echogenicity may be due to abnormal morphology and lymphocytic in®ltration.…”

Section: Discussionsupporting

confidence: 93%

Prevalence and characteristics of postpartum thyroid dysfunction in Tehran

Shahbazian

Sarvghadi

Azizi

2001

European Journal of Endocrinology

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Objective: To determine the prevalence of postpartum thyroiditis (PPT), one of the autoimmune disorders of the thyroid which usually occurs in women in the ®rst year after parturition. PPT presents with periods of transient thyrotoxicosis and hypothyroidism, in many cases resulting in permanent hypothyroidism. Design: The study involved 1040 mothers who had contacted ®ve health centers in Tehran for vaccination of their children. Methods: Signs and symptoms of hypothyroidism and thyrotoxicosis, and the presence of goiter (using the World Health Organization classi®cation), were sought. Serum T3, T4, TSH, anti-TPO and anti-Tg antibodies were measured at 3, 4.5, 6 and 9 months after parturition. In those with hypothyroidism or thyrotoxicosis and a matched group of normal women, thyroid sonography was performed. Results: The prevalance of thyroiditis was 11.4%. Hypothyroidism and thyrotoxicosis occured in 68 and 42 mothers respectively. Nine had thyrotoxicosis followed by hypothyroidism. There was one case of Graves' disease. Out of 68 hypothyroid patients, 33 women underwent treatment with levothyroxine (because of the severity of symptoms) for 12 months. Six women showed increased TSH at 6 weeks after discontinution of thyroxine. Stage II goiter (World Health Organization classi®cation) were observed in 21.8% of patients and in 6.7% of pospartum euthyroid women P , 0X001X Positive anti-TPO was found in 61.5% of patients and in 19% of the control group; positive anti-Tg was found in 58% of patients and in 6% of the control group P , 0X001X Sonographic changes were observed in 96% of the patients and in 7% of the control group P , 0X001X There was no signi®cant correlation between the occurrence of thyroiditis and parity, the age of the mother, a previous history of thyroid disease in the patient or family, breast-feeding, or the gender of the child. Conclusion:The results of this study show a high prevalence of PPT in Tehranian women. This may be due to the length and frequency of follow-up and/or the transition from low to adequate iodine intake. The major difference with respect to other studies is the low frequency of the biphasic form of PPT.

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Section: Discussionsupporting

confidence: 93%

Prevalence and characteristics of postpartum thyroid dysfunction in Tehran

Shahbazian

Sarvghadi

Azizi

2001

European Journal of Endocrinology

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“…Some authors confi rm that thyroid hypoechogenicity predates the hormonal changes in PPTD but did not prove to be a reliable prognostic factor for its development. 13 Others suggest that structural and echogenic changes might be of predictive value for the development of PPTD 14 especially when TPOAb are borderline during pregnancy. 15 Furthermore, TPOAb positivity in pregnant women is not invariably associated with prominent autoimmune pattern on thyroid US.…”

Section: Resultsmentioning

confidence: 99%

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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“…O resultado era considerado positivo no encontro de hipoecogeneidade difusa ou de múl-tiplas áreas focais com baixa ecogeneidade, dispersas em ambos os lobos da tireóide resultando em aparência heterogênea. Os aspectos sonográficos alterados seguiram os critérios descritos por Adams et al (15); alterações estruturais mínimas não foram consideradas patológicas. Constatamos glândula tireóidea aumentada em 21 pacientes (2,6%).…”

Section: Avaliação Da Função Tireóideaunclassified

“…O recurso da ultra-sonografia tem demonstrado ecogeneidade difusa ou multifocal reduzida, refletindo a morfologia anormal, consistente com infiltração linfocitária da tireóide (15).…”

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Aspectos ultra-sonográficos e prevalência da tireoidite pós-parto em gestantes sem disfunção tireóidea atendidas em hospital público de São Paulo

Barca

Knobel

Tomimori

et al. 2001

Arq Bras Endocrinol Metab

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RESUMOAvaliamos prospectivamente a função, as imagens ultra-sonográficas e a auto-imunidade tireóidea em grupo racial heterogêneo de 800 mulheres grávidas, primíparas ou multíparas (1 a 7 gestações prévias) atendidas em hospital universitário de São Paulo durante o pré-natal. Quarenta e seis pacientes foram excluídas do estudo por apresentarem diagnóstico confirmado de doença tireóidea anterior; das 754 restantes, 386 abandonaram o seguimento antes ou após o parto. Assim, a coorte avaliada no puerpério constituiu-se de 368 puérperas, examinadas aos 3, 6, 12 meses e no 2º ano pós-parto. Embora 29 pacientes tenham tido aumento transitório daqueles anticorpos antitireóideos, caracterizando reação de auto-imunidade, estes progressivamente declinaram ou tornaram-se negativos durante o puerpério. Entretanto, nenhuma destas evoluiu com disfunção tireóidea durante o acompanhamento. Quarenta e nove pacientes (13,3%) desenvolveram progressivamente alterações funcionais da tireóide (principalmente hipotireoidismo), provavelmente devido à TPP. Além disso, a continuação do seguimento mostrou que em 18 a 24 meses, 42 mostraram níveis séricos de anti-TPO mais elevados, em comparação aos valores do primeiro ano. Os fatores de risco para o desenvolvimento da TPP, presentes durante a gravidez, foram: (1) níveis relativamente baixos de anti-TPO, entre 60 e 100U/mL [risco relativo ou odds ratio de 3,1] e (2) alterações estruturais ultrasonográficas da tireóide no primeiro trimestre [odds ratio de 6,4]. Concluí-mos que a prevalência de TPP em hospital público de São Paulo foi de 13,3%, considerando as 368 pacientes seguidas. Em 29 puérperas foi diagnosticada forma transitória de reação tireóidea auto-imune, caracterizada por elevação dos níveis séricos de anti-TPO, que posteriormente regrediram. ABSTRACTWe evaluated thyroid function, ultrasound images and presence of autoantibodies in a mixed racial group of 800 unselected primiparous or multiparous (1-7 previous pregnancies) pregnant women attended in a public hospital in the city of São Paulo. Forty-six patients were excluded from the study because of a confirmed diagnosis of a thyroid condition. Thus, a total of 754 women were available for further studies in the postpartum period. A relatively large number of those patients (n= 386) were lost or unavailable to follow-up either before or after delivery. A cohort of 386 puerperal healthy women was followed-up regularly at 3, 6, 12 and 24 months during the postpartum period, with regular thyroid function tests, random urine iodine measurements, assays for serum autoantibodies against thyroid antigens and imaging by ultrasound. Twenty-nine patients had a transient rise of anti-TPO-Ab characterizing an autoimmune reaction. These antibodies titres progressively declined or became negative. Moreover none of these patients have evidence for altered thyroid function during the 18-24 months of follow-up. Forty-nine patients (13.3%) changed their thyroid status, mainly to hypothyroidism, indicating perspectivas

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The sonographic appearances in postpartum thyroiditis

Cited by 50 publications

References 11 publications

Prevalence and characteristics of postpartum thyroid dysfunction in Tehran

Prevalence and characteristics of postpartum thyroid dysfunction in Tehran

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

Aspectos ultra-sonográficos e prevalência da tireoidite pós-parto em gestantes sem disfunção tireóidea atendidas em hospital público de São Paulo

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