ABSTRACT
Subacute thyroiditis (SAT) is an inflammatory disease of the thyroid gland with multiple etiologies and clinical features, often challenging to recognize. The classic presentation is the painful, granulomatous thyroiditis (DeQuervain's) characterized by diffuse swelling of the gland, usually preceded by an upper respiratory tract infection. A painless variant, also referred to as autoimmune subacute thyroiditis, has been documented and is strongly linked to postpartum state, reported following ~10% of pregnancies. It can be differentiated from the former by the presence of anti-thyroid antibodies, which classifies it as an autoimmune thyroiditis. Any spontaneous development of painful swelling of the thyroid gland warrants a complete work up that includes thyroid hormones, thyroid autoimmune panel, acute phase reactant titers, and, if available, imaging that may lead to the diagnosis of an inflammatory or infectious cause of thyroiditis.
Tiroiditis Subaguda, es una enfermedad inflamatoria de la glándula Tiroides que tiene muchas etiologías y características clínicas, y frecuentemente difícil de reconocer. La presentación clásica es: tiroiditis granu-lomatosa dolorosa caracterizada de hinchazón difusa de la glándula del Tiroides, usualmente precedida de una infección respiratoria de las vías áreas superior (como una infección viral). Existe una variante sin dolor, tam-bién referida como tiroiditis subaguda autoinmune, ha sido documentado y es muy ligada al estado postparto, en un 10% de los embarazos. La Tiroiditis postparto Puede ser diferenciada de la anterior por la presencia de anticuerpos lo que la clasifica como una tiroiditis auto-inmune. Cualquier desarrollo espontaneo de una hin-chazón dolorosa de la tiroides garantiza su evaluación de una manera formal, que incluye las hormonas del tiroides, panel tiroideo de autoinmunidad títulos de los factores que reaccionan agudamente, y si está disponible imágenes como una ultrasonografía que conlleva al di-agnóstico de una Tiroiditis inflamatoria o de origen in-feccioso.
Subject(s)
Humans , Female , Adolescent , Thyroiditis, Subacute , Goiter, Nodular , Postpartum ThyroiditisABSTRACT
It is well known that the long-term prognosis of postpartum thyroiditis (PPT) is excellent except recurrent PPT in subsequent pregnancies and risk of progression to permanent hypothyroidism in some patients. However, the prospective observation of PPT patients who have neither consecutive gestation nor any evidence of hypothyroidism were limited. We describe three patients who have history of PPT and showed repeated painless thyroiditis in the span of more than ten years. The clinical courses of repeated painless thyroiditis were the transient thyrotoxicosis, self-limited, and not related to pregnancy. Based on the clinical courses of our three patients, it is recommended to remember that transient painless thyroiditis could be repeated as a possible long-term course of the patients with history of PPT.
Subject(s)
Humans , Pregnancy , Hypothyroidism , Postpartum Period , Postpartum Thyroiditis , Prognosis , Prospective Studies , Thyroid Gland , Thyroiditis , ThyrotoxicosisSubject(s)
Humans , Female , Adult , Graves Disease/diagnostic imaging , Postpartum Thyroiditis/diagnostic imagingABSTRACT
BACKGROUND AND OBJECTIVES: In the past, subacute thyroiditis causing thyrotoxicosis included both painful and painless subgroup, but it is representative for the painful subacute thyroiditis these days. So we evaluated the clinical and laboratory characteristics of subacute thyroiditis and compared with the painless (silent) thyroiditis, and identified predictive factors of permanent hypothyroidism and recurrence. MATERIALS AND METHODS: This was a retrospective case series study analyzing clinical data of 221 consecutive patients diagnosed between 2009 and 2015. Medical records were reviewed for diagnostic route, age distribution, laboratory data, clinical course and long-term follow up outcome. RESULTS: The mean age was 48 years; female v/s male ratio 3.4:1. Median disease duration was 110 days; mean peak free T4 level was 2.9 ng/dL. 56.7% of painless thyroiditis patients were diagnosed on health checkup or routine thyroid function test with symptoms not typically associated with thyrotoxicosis. Permanent hypothyroidism was not uncommon (11/221; 5.0%). Higher peak thyroid-stimulating hormone (TSH) was associated with permanent hypothyroidism in painless thyroiditis. Lower peak TSH was associated with recurrence rate in both subacute and painless thyroiditis. In painless thyroiditis, short duration of thyrotoxicosis phase was also associated with recurrence rate. CONCLUSION: Considerable numbers of painless thyroiditis without symptoms were diagnosed on health checkup. Higher peak TSH was associated with permanent hypothyroidism in painless thyroiditis. Recurrence rate was related with lower peak TSH in both groups.
Subject(s)
Female , Humans , Male , Age Distribution , Follow-Up Studies , Hypothyroidism , Medical Records , Postpartum Thyroiditis , Recurrence , Retrospective Studies , Thyroid Function Tests , Thyroid Gland , Thyroiditis , Thyroiditis, Subacute , Thyrotoxicosis , ThyrotropinABSTRACT
BACKGROUND AND OBJECTIVES: In the past, subacute thyroiditis causing thyrotoxicosis included both painful and painless subgroup, but it is representative for the painful subacute thyroiditis these days. So we evaluated the clinical and laboratory characteristics of subacute thyroiditis and compared with the painless (silent) thyroiditis, and identified predictive factors of permanent hypothyroidism and recurrence. MATERIALS AND METHODS: This was a retrospective case series study analyzing clinical data of 221 consecutive patients diagnosed between 2009 and 2015. Medical records were reviewed for diagnostic route, age distribution, laboratory data, clinical course and long-term follow up outcome. RESULTS: The mean age was 48 years; female v/s male ratio 3.4:1. Median disease duration was 110 days; mean peak free T4 level was 2.9 ng/dL. 56.7% of painless thyroiditis patients were diagnosed on health checkup or routine thyroid function test with symptoms not typically associated with thyrotoxicosis. Permanent hypothyroidism was not uncommon (11/221; 5.0%). Higher peak thyroid-stimulating hormone (TSH) was associated with permanent hypothyroidism in painless thyroiditis. Lower peak TSH was associated with recurrence rate in both subacute and painless thyroiditis. In painless thyroiditis, short duration of thyrotoxicosis phase was also associated with recurrence rate. CONCLUSION: Considerable numbers of painless thyroiditis without symptoms were diagnosed on health checkup. Higher peak TSH was associated with permanent hypothyroidism in painless thyroiditis. Recurrence rate was related with lower peak TSH in both groups.
Subject(s)
Female , Humans , Male , Age Distribution , Follow-Up Studies , Hypothyroidism , Medical Records , Postpartum Thyroiditis , Recurrence , Retrospective Studies , Thyroid Function Tests , Thyroid Gland , Thyroiditis , Thyroiditis, Subacute , Thyrotoxicosis , ThyrotropinABSTRACT
Postpartum thyroid dysfunction occurs in 5-10% of women within one year after delivery. Women with hypothyroidism antedating pregnancy are at high risk for postpartum thyroiditis and should be closely monitored during the first year post-partum. Here, we report a case of recurrent hyperthyroidism between two episodes of postpartum thyroiditis in a woman diagnosed with subclinical hypothyroidism prior to pregnancy. It is of particular interest that spontaneously remitting hyperthyroidism as a sequela of postpartum thyroiditis can occur.
Subject(s)
Female , Humans , Pregnancy , Hyperthyroidism , Hypothyroidism , Postpartum Period , Postpartum Thyroiditis , Thyroid Gland , ThyroiditisABSTRACT
The most common thyroid dysfunctions that occur after delivery are postpartum thyroiditis (PPT) and Graves' disease (GD). PPT is more likely to occur among patients who had a history of PPT or GD. For that reason, it is possible to assume that both PPT and GD occur concomitantly after delivery. Here we report two cases of atypical postpartum thyroid dysfunctions presenting the simultaneous occurrence of PPT and GD. A 31-year-old woman with history of PPT had thyrotoxicosis and hypothyroidism of PPT followed by GD with mild symptoms. The patient recovered quickly afterwards. In the second case, a 28-year-old woman with a history of GD presented with thyrotoxicosis of PPT followed by severe GD. The patient required long-term antithyroid treatment.
Subject(s)
Female , Humans , Graves Disease , Hypothyroidism , Postpartum Period , Postpartum Thyroiditis , Thyroid Gland , ThyrotoxicosisABSTRACT
A pesar de no ser frecuente, la hipofunción tiroidea no controlada en la gestante, puede traer consigo efectos deletéreos sobre la madre y el feto, fundamentalmente cuando se presenta de forma manifiesta. Si se detecta precozmente y se trata de forma adecuada con levotiroxina, los riesgos se minimizan. Las dosis a emplear serán las suficientes para alcanzar un valor de tirotropina de acuerdo con lo recomendado para cada trimestre, y que por lo general serán mayores que en la etapa preconcepcional. El bocio se tratará en algunas condiciones específicas, y lo mismo sucede con la tiroiditis posparto. Pacientes sin disfunción tiroidea, pero con anticuerpos antitiroideos positivos elevados, también serán tratadas(AU)
Despite the rareness of the uncontrolled thyroid hypofunction in the pregnant woman, it may bring deleterious effects for the mother and her fetus, mainly when it is manifested. If early detected and adequately treated with levothyroxin, the risks are minimal. The doses to be used are enough to reach a thyrotropin level in accordance with the recommendations for each pregnancy trimester and they will be generally higher than those of the preconception phase. Goiter will be treated under some specific conditions and the same is valid for the postpartum thyroiditis. The patients without thyroid dysfunction, but with high positive antithyroid antibodies, should also be treated(AU)
Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/prevention & control , Postpartum Thyroiditis/drug therapy , Goiter/complications , Hypothyroidism/complications , Thyroxine/therapeutic use , Follow-Up StudiesABSTRACT
BACKGROUND/AIMS: Graves' disease (GD) is caused by thyroid-stimulating hormone receptor (TSHR) and thyroid-stimulating immunoglobulin (TSI). We used a recently introduced, technically enhanced TSI bioassay to assess its diagnostic value and determine the cut-off in patients in high iodine intake area. METHODS: In a cross-sectional setting, we collected serum from 67 patients with untreated GD, 130 with GD under treatment, 22 with GD in remission, 42 with Hashimoto's thyroiditis, 12 with subacute thyroiditis, 20 with postpartum thyroiditis, and 93 euthyroid controls. TSI was measured using the Thyretaintrade mark bioassay, which is based on Chinese hamster ovary cells transfected with chimeric TSHR (Mc4). TSI levels are reported as a specimen-to-reference ratio percentage (SRR%). RESULTS: The TSI levels in patients with GD (either treated or not) were significantly higher than those of the remaining patients (p < 0.05). The new bioassay showed a sensitivity of 97.0% and a specificity of 95.9% with a cut-off value of 123.0 SRR% for GD. A weak correlation was found between TSI and thyrotropin-binding inhibiting immunoglobulin (TBII) (rs = 0.259, p = 0.03), but no correlation was found between TSI and tri-iodothyronine or free thyroxine. CONCLUSIONS: The Mc4-CHO bioassay showed comparable diagnostic value for GD with the conventional TBII assay. We propose a cut-off of 123.0 SRR% in areas where iodine intake is high.
Subject(s)
Adult , Animals , Cricetinae , Female , Humans , Male , Middle Aged , Biological Assay , Biomarkers/blood , CHO Cells , Case-Control Studies , Cricetulus , Cross-Sectional Studies , Genes, Reporter , Graves Disease/diagnosis , Hashimoto Disease/diagnosis , Immunoglobulins, Thyroid-Stimulating/blood , Luciferases/genetics , Postpartum Thyroiditis/diagnosis , Predictive Value of Tests , Protein Binding , Radioimmunoassay , Receptors, Thyrotropin/genetics , Recombinant Fusion Proteins/metabolism , Republic of Korea , Sensitivity and Specificity , Thyroiditis, Subacute/diagnosis , TransfectionABSTRACT
La tiroiditis posparto es un síndrome de disfunción tiroidea transitorio o permanente materno que ocurre en el primer año del nacimiento. No existen datos de la prevalencia de tiroiditis posparto en nuestro país. Objetivo: determinar la prevalencia de tiroiditis posparto en la población de pacientes mujeres usuarias de Salud Pública de nuestro país. Material y método: se realizó un estudio observacional descriptivo, incluyendo 105 pacientes cuyo parto ocurriera en los tres a 12 meses previos, excluyendo aquellas pacientes que presentaban enfermedad tiroidea conocida. Se dosificó tirotropina al total de las pacientes, repitiendo a los tres meses aquellas patológicas y dosificando anticuerpos antitiroperoxidasa. Resultados: se encontró 5,7 por ciento de tiroiditis posparto, así como 6,7 por ciento de hipotiroidismo no asociado a tiroiditis (12,4 por ciento total). La presencia de síntomas asociados a enfermedad no fue estadísticamente significativa (x²=0,431). Se estimó la curva de valores normales de TSH (Hormona Estimulante de la Tiroides) en relación con los meses posparto. Conclusiones: el concepto de la tiroiditis posparto como un desorden leve y temporal está cambiando actualmente, reconociéndose como una fase aguda en un proceso crónico de tiroiditis autoinmune con secuelas negativas a largo plazo en la madre y el hijo. La prevalencia varía entre 1,1 por ciento a 21 por ciento mundialmente, no habiendo datos previos en nuestro medio. En la población estudiada se encontró 5,7 por ciento de pacientes con enfermedad, con un total de 12,4 por ciento de hallazgos alterados, no encontrándose asociación con la presencia de síntomas clínicos. La frecuencia de esta afección determina la necesidad de valorar e implementar herramientas de screening adecuadas.
Subject(s)
Uruguay , Postpartum Thyroiditis , Prevalence , Cross-Sectional StudiesABSTRACT
BACKGROUND: Pregnancy affects the course of Graves' Disease (GD), and patients who initially maintain euthyroid function into their middle trimester with minimum doses of antithyroid drugs become exacerbated after delivery. Even patients who are completely cured, requiring no treatment during pregnancy, can relapse after delivery. In this study, we examined the postpartum changes in the thyroid functions of patients with GD, and attempted to determine the factors contributing to these changes. METHODS: The study subjects were recruited from pregnant women visiting our outpatient clinic for routine prenatal evaluations. 45 women previously diagnosed with GD, who had been treated and cured with hyperthyroidism, and were no longer taking any thyroid medications, were evaluated for 1 year post delivery. RESULTS: Among 45 patients, 20 (44.4%) developed thyroid disorders following delivery. Postpartum thyroiditis (PPT) developed in 8 patients (17.8%), and GD developed in 12 (26.0%). The onset of the PPT disease 3.1 +/- 1.4 months following delivery, which was significantly earlier than the 6.7 +/- 2.7 months required for the post delivery onset of GD (p=0.003). The TBII values, measured during the thyrotoxic state in each womaen, were negative in women with PPT and positive in 71.4% of women with GD (p=0.030). The duration of treatment for hyperthyroidism prior or pregnancy, the number of recurrences, and the time interval without treatment, were not associated with the development of postpartum thyroid disorders. Whereas, the mean number of past pregnancies for women who developed PPT was 3.9 +/- 2.1, and was significantly higher than the 2.2+/- 1.7 for women developing no thyroid dysfunctions (p=0.044). In 13 women their initial onset of GD occurred within one year postpartum, 7 (53.8%) having had a recurrence, which was significantly higher than in women whose disease onset occurred unrelated to delivery (5 of 32 women: 15.6%). CONCLUSION: Women with GD developed postpartum thyroid dysfunctions in 44.4% of cases. Women whose initial disease onset occurred within one year postpartum had higher recurrences of GD, and women who developed PPT had a history of higher gravidity compared to the euthyroid women postpartum. Therefore, if women with GD develop postpartum thyroid dysfunctions, the diagnosis should be made, and a treatment modality planned, following careful considerations of the patients' past obstetric history, changes in clinical manifestations and the TBII values.
Subject(s)
Female , Humans , Pregnancy , Ambulatory Care Facilities , Antithyroid Agents , Diagnosis , Graves Disease , Gravidity , Hyperthyroidism , Postpartum Period , Postpartum Thyroiditis , Pregnant Women , Recurrence , Thyroid GlandABSTRACT
BACKGROUND: It is known that pregnancy markedly influences the clinical course of autoimmune thyroid diseases. In the postpartum period, various kinds of autoimmune thyroid dysfunctions can be observed. Thyroid dysfunction is found in 5.5-7.1% of postpartum women in the general population. Among those who show thyroid dysfunction after delivery, some will develop Graves' disease and others will develop postpartum thyroiditis. It is also known that patients with Graves' disease may manifest thyrotoxicosis in the postpartum period because of postpartum thyroiditis or relapse of the Graves' disease itself. We evaluated the clinical features of postpartum thyrotoxicosis in Graves' disease patients to find diagnostic indices that could be used in differentiating between postpartum thyroiditis and relapse of Graves' disease. METHOD: We reviewed the cases with postpartum thyrotoxicosis in patients that had a history of Graves' disease between 1995 and 2000. The diagnosis of postpartum thyroiditis had been made by means of a 99mTc thyroid scan or by the observation of a typical triphasic thyroid function change, in cases where a 99mTc thyroid scan was not possible because of breast feeding. We measured the serum TSH, free T4, free T3, TSH binding inhibiting immunoglobulin (TBII), anti-thyroid peroxidase (TPO) antibody, and anti- thyroglobulin (Tg) antibody serially from the time of the diagnosis of Graves' disease to the time of postpartum thyroid dysfunction. RESULTS: Eleven patients, 5 patients in the postpartum thyroiditis (PPT group) and 6 patients with relapse of the Graves' disease (GD group), were identified. The mean values of TBII of two groups at the time of diagnosis of Graves' disease were 40.9+/-4.8 IU/mL (PPT group), 58.9+/-23.5 IU/mL (GD group) respectively, which were insignificant. The mean values of TBII of the two groups at early pregnancy were 3.2+/-1.9 IU/mL (PPT group), 41.6+/-22.6 IU/mL (GD group) and this difference was statistically significant (p=0.009). The mean values of TBII of the two groups at the time of postpartum thyrotoxicosis were 1.9+/-1.6 IU/mL (PPT group), 51.5+/-23.2 IU/mL (GD group) which were also statistically significant (p=0.003). The mean values of anti-TPO antibody, anti-Tg antibody, disease duration, and treatment duration between the two groups were not significantly different. The onsets of thyroid dysfunction after delivery in the two groups were 2.6+/-2.0 (PPT group), 4.0+/-3.9 (GD group) months which were statistically insignificant. CONCLUSION: These data suggest that the measurement of TBII at the time of the postpartum thyrotoxic period, could help to differentiate postpartum thyroiditis from a relapse of Graves' disease in those patients that have a history of Graves' disease especially when thyroid scan is not possible because of breast feeding.
Subject(s)
Humans , Pregnancy , Breast Feeding , Diagnosis , Graves Disease , Immunoglobulins , Peroxidase , Postpartum Period , Postpartum Thyroiditis , Receptors, Thyrotropin , Recurrence , Thyroglobulin , Thyroid Diseases , Thyroid Gland , ThyrotoxicosisABSTRACT
BACKGROUND: Postpartum thyroiditis is an autoimmune thyroid dysfunction that occurs in the first year after a delivery. Although a postpartum thyroid dysfunction after a full-term pregnancy is well described, little is known about its association with an abortion. The purpose of this study was to investigate the clinical and laboratory findings in thyroid dysfunction that develops after abortion and to investigate the differences in the clinical course according to the types of abortion. METHODS: Thirty patients who were proven to have thyroid dysfunction after either spontaneous or an elective abortion were studied. We analyzed their past history, the type of abortion, their clinical features, the laboratory findings and the courses of the disease. RESULTS: Seventeen patients were hypothyroid and 13 were thyrotoxic at the time of the initial thyroid function evaluation. In the thyrotoxic group, the T3 and free T4 were significantly higher but the TSH was lower than in the hypothyroid group. The titers of antimicrosomal and antithyroglobulin antibody were not different between the two groups. In the thyrotoxic group, 3 cases showed normal values, 2 cases were hypothyroid and the remaining 8 cases were persistently thyrotoxic during the 2 months of observation. TSH receptor antibodies were absent in all of the transient thyrotoxic patients, but they were present in 83.3% of the persistent thyrotoxic patients. The clinical manifestations of the thyroid dysfunction were not different according to the type of abortion. CONCLUSION: Reproductive-age women who have an abnormal thyroid function require careful history taking with respect to their history of regarding parturition or abortion in order to evaluate the possibility of a transient thyroid dysfunction after the abortion.
Subject(s)
Female , Humans , Pregnancy , Antibodies , Parturition , Postpartum Period , Postpartum Thyroiditis , Receptors, Thyrotropin , Reference Values , Thyroid GlandABSTRACT
BACKGROUND: Postpartum thyroiditis(PPT) is one of syndromes of thyroid dysfunction that occurs in the first year after parturition. Reported incidence of PPT is 3.9-8.2% of postpartum women in several studies from different countries. The fact that 52-100% of patients with PPT have thyroid autoantibodies, and that lymphocytic infiltration of thyroid gland is the characteristic pathological feature of PPT suggest that PPT is an autoimmune disease. High iodine intake in short term period is known to aggrevate the experimental autoimmune thyroiditis. This study was performed to investigate the incidence and clinical features of PPT in Korean postpartum women who usually ingest excessive amount of idine in immediate postpartum period and to investigate the predictive value of thyroid autoantibodies in the development of PPT in them. METHOD: Between March 1996 and February 1997, 99 women without previous history of any thyroid disease who delivered babies at Boramae hospital were enrolled. Thyroid function parameters(T3, T4, free T4, TSH), thyroid autoantibodies(anti-microsomal antibody, anti-thyroglobulin antibody) and urinary iodine excretion were measured prospectively before and 1, 3 months after delivery. Dietary iodine intake during postpartum period was evaluated by questionnaire, and clinical parameters were followed up. RESULTS: During 3 months of observation, PPT developed in 8.1%(8/99) of postpartum women. Five cases had typical course having thyrotoxic phase and the other 3 cases had hypothyroid phase without toxic phase. However, only one of those required thyroid hormone replacement therapy in the latter group. There were no differences in age, baseline thyroid function parameters, parity, percent cases with family history of thyroid disease between those developed PPT (n=8) and those did not develop PPT(n=91). Duration of high iodine intake(3.8 +- 0.5 wk. vs. 3.7 +- 0.8 wk., p>0.05), total ingested amount of high iodine diet(77 +- 28 vs. 79 +- 24 bowels of miyokguk, p)0.05), and the urinary iodine excretion(1.9 +- 1.4 mg/g creatinine vs. 3.7 +- 3.7mg/g creatinine, p0.05) at 1 month postpartum were not different between two groups. Of 99 total subjects, anti-microsomal antibody(AMA) was present in 13.1%(13/99) before delivery in their sera. Positive predictive value of the presence of AMA before delivery in predicting the development of PPT was 30.8%. CONCLUSION: The fact that incidence of PPT in normal Korean postpartum women who usually have high iodine intake in immediate postpartum period is not higher than those of other countries, and that there was no difference in the amount of iodine intake between those developed PPT and those did not suggest that high iodine intake in immediate postpartum period do not influence on the incidence of PPT. The presence of AMA before delivery had low specificity in prediction of development of PPT, so the measurement of AMA seems not to be a useful screening test.
Subject(s)
Female , Humans , Autoantibodies , Autoimmune Diseases , Creatinine , Hormone Replacement Therapy , Incidence , Iodine , Mass Screening , Parity , Parturition , Postpartum Period , Postpartum Thyroiditis , Prospective Studies , Surveys and Questionnaires , Sensitivity and Specificity , Thyroid Diseases , Thyroid Gland , Thyroiditis, AutoimmuneABSTRACT
Postpartum thyroiditis is a common but frequently unrecognized disorder, affecting approximately 5% of women during the first 12 months after delivery. It is characterized by transient hyperthyroidism occurring about 14 weeks postpartum followed by transient hypothyroidism at 19 weeks postpartum. Our aim is to investigate the prevalence of positive antimicrosomal antibody in women 3 months postpartum and an association of antimicrosomal antibody with symptomatic and biochemical thyroid disorders. We used data collected from 205 women who visited Dankook University Hospital in 3 months postpartum, Our results showed that the rate of positive antithyroid microsomal antibody was 12.7% in women 3 months postpartum and the prevalence of biochemical hyperthyroidism and biochemical hypothyroidism with positive antithyroid microsomal antibody women 3 months postpartum were 26.9% and 19.2%, respectively. The prevalence of postpartum biochemical thyroid dysfuncion 3 months postpartum was 13.7%. There was no relationship between any of the following factors and thyroid antibody status: fetal distress, birth weight and infant sex, matemal age, experiences and mode of delivery, previous medical disease(such as pstrointestinal and psychotic diseases), experiences of previous abortions, gestational age and past history of thyroid diseases.
Subject(s)
Female , Humans , Infant , Abortion, Induced , Birth Weight , Fetal Distress , Gestational Age , Hyperthyroidism , Hypothyroidism , Postpartum Period , Postpartum Thyroiditis , Prevalence , Thyroid Diseases , Thyroid GlandABSTRACT
BACKGROUND: Excessive iodine intake increases the occurrence of autoimmune thyroid disorders by enhancing immunogenecity of iodine-rich thyroglobulin, In Korea, most of postpartum women take a large amount of iodine-rich seaweed. Although the excessive iodine intake may affect the thyroid function, only a few reports were available concering iodine intake, especially on postpartum period. METHODS: A prospective study was undertaken in 146 of normal delivered postpartum women. Dietary intake and urinary excretion of iodine, serum T3, T4, TSH, anti-TPO Ab and anti-Tg Ab were measured before and 1, 6, 12 and 24 weeks after delivery. Iodine intake was analyzed by one-to-one interview using 24hr recall and food frequency questionnaire. RESULTS: 1. PPT was occurred in 6 (10.3%) postparturn women, It presented as hypothyroidism alone in 1 (16.7%), transient thyrotoxicosis followed by hypothyroidisrn in 3 (50.0%), and thyrotoxicosis alone in 2 (33.3%) of the follwed-up patients. 2. During pregnancy, no difference was found in age, serum T3, T4 and TSH between PPT and normal thyroid function group. 3. In PPT group, anti-TPO and anti-Tg Ab were significantly higher than those of normal thyroid function group during pregnancy, and their sensitivity for PPT was 40% and 33%, respectively. But there was no correlation between dietary iodine intake and the titer of thyroid auto-antibodies. 4. There was no correlation between pre and post-partum dietary iodine intake and occurrence of PPT. CONCLUSION: In Korea, the incidence of PPT was slightly higher than other nations. The sensitivity of thyroid auto-antibodies was too low to use for prediction of PPT. Pre and post-partum iodine intake had no effect on the occurrence of PPT and post-partum thyroid function.
Subject(s)
Female , Humans , Pregnancy , Hypothyroidism , Incidence , Iodine , Korea , Postpartum Period , Postpartum Thyroiditis , Prospective Studies , Surveys and Questionnaires , Seaweed , Thyroglobulin , Thyroid Gland , ThyrotoxicosisABSTRACT
Background: Postpartum thyroiditis is a painless, destructive lymphocytic inflammation of the thyroid gland that occurs during the postpartum period and is associated with a high prevalence of serum thyroid autoantibodies. Clinical symptoms and laboratory fi#ndings of postpartum thyroiditis vary widely during the course of illness and the final outcome of this disease remains unpredictive in some patients. The purpose of this study is to investigate the clinical course and the predictors of the outcome of the disease. Methods: Thirty-eight patients proven to have postpartum thyroiditis at the Ewha Womans University Hospital were studied. We analyzed their clinical features, laboratory findings and duration of recovery to characterize the course of the disease. Results: Their mean age was 29.0±3.3 years and the time of diagnosis was 4.9±1.9 months after delivery. The prevailed months of delivery were November through January in this study. Twenty six patients were hypothyroid and 12 were thyrotoxic at initial thyroid function. The positive rates of antithyroglobulin and anitmicrosomal antibodies were 92%, 67% in the hypothyroid group and 75%, 67% in th thyrotoxic group respectively. TSH receptor antibodies were negative in all patients. In the hypothyroid group the titers of antimicrosomal antibodies were significantly higer than the thyrotoxic group. The titers of antimicrosomal antibodies were positively correlated with serum TSH and negatively correlated with serum T4. In all patients, the titers in thyroid function tests returned to the normal range without long-term hypothyroidism. Conclusion: The titers of antimicrosomal antibodies were significantly higher in the hypothyroid group than the thyrotoxic group. Thus the titers of antimicrosomal antibodies can help guide the physician in the care of patients with postpartum thyroiditis who will probably be hypothyroid. In this study, we were surprised that all patients became euthyroid without permanent hypothyroidism.