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Postpartum thyroiditis

April 18, 2024

Postpartum thyroiditis refers to thyroid dysfunction occurring in the first 12 months after pregnancy[1] and may involve hyperthyroidism, hypothyroidism or the two sequentially. According to the National Institute of Health, postpartum thyroiditis affects about 8% of pregnancies.[2] There are, however, different rates reported globally. This is likely due to the differing amounts of average postpartum follow times around the world, and due to humans' own innate differences. For example, in Bangkok, Thailand the rate is 1.1%, but in Brazil it is 13.3%.[2] The first phase is typically hyperthyroidism. Then, the thyroid either returns to normal or a woman develops hypothyroidism. Of those women who experience hypothyroidism associated with postpartum thyroiditis, one in five will develop permanent hypothyroidism requiring lifelong treatment.

Postpartum thyroiditis
SpecialtyObstetrics 

Postpartum thyroiditis is believed to result from the modifications to the immune system necessary in pregnancy, and histologically is a subacute lymphocytic thyroiditis. The process is normally self-limiting, but when conventional antibodies are found there is a high chance of this proceeding to permanent hypothyroidism. Postpartum thyroiditis is a member of the group of thyroiditis conditions known as resolving thyroiditis.

Signs and symptoms edit

The initial phase of hyperthyroid symptoms occurs transiently about two to six months postpartum.[3] Typical symptoms include irritability, nervousness, palpitations, and heat intolerance. Hormonal disturbances during this phase tend to occur with lower intensity compared with the hypothyroid phase.[3] As a result, the hyperthyroid phase may pass undetected. The second phase of hypothyroid symptoms is also transient and can occur anytime within the three- to twelve-month period postpartum.[3] Women in this phase experience low energy, poor memory, impaired concentration, carelessness, dry skin, cold intolerance, and general aches and pains. After one year postpartum, euthyroid function resumes. Any case with hypothyroid symptoms extending beyond one year postpartum is not considered postpartum thyroiditis.[3]

Women who test positive for thyroid antibodies may be at increased risk of developing symptoms associated with postpartum depression than women without thyroid antibodies.[4]

Cause edit

During pregnancy, immunologic suppression occurs which induces tolerance to the presence of the fetus.[5] Without this suppression, the fetus would be rejected causing miscarriage.[5] As a result, following delivery, the immune system rebounds causing levels of thyroids antibodies to rise in susceptible women.[6]

Specifically, the immunohistological features of susceptible women are indicated by:[5]

Diagnosis edit

This condition is commonly undiagnosed by physicians due to either unfamiliarity with the disease, the subtlety of symptoms, or the attribution of the symptoms to the stresses of having a newborn.[6] Usual screening begins with assessing the thyroid stimulating hormone (TSH) level. A suppressed TSH could represent the hyperthyroid phase, but warrants further testing to investigate for possible Graves' disease.[6] A normal TSH with persistent symptoms could represent the shift between phases and requires repeat testing 4–6 weeks later; an elevated TSH at this time could indicate the hypothyroid phase.[6]

Treatment edit

For most women, the hyperthyroid phase presents with very mild symptoms or is asymptomatic; intervention is usually not required. If symptomatic cases require treatment, a short course of beta-blockers would be effective.[3]

Assessing treatment for the hypothyroid is more complex. Women with symptoms or a very high TSH level, or both, are usually prescribed a course of levothyroxine.[3] Asymptomatic women with slightly elevated TSH levels who are planning subsequent pregnancies, should consider a course of treatment until completion of the family to avoid possible developmental complications in future children.[3] Otherwise, treatment could be discontinued after one year postpartum.[citation needed]

Prevalence edit

Women with type I diabetes mellitus have a threefold increase in the prevalence of postpartum thyroiditis than non-diabetic women in the same region.[3]

According to Johns Hopkins, 3 in 100 women develop postpartum thyroiditis. Some risk factors include antithyroid antibodies, type 1 diabetes, history of thyroid problems, and family history of thyroid problems. According to the National Institute of Health, postpartum thyroiditis is especially common in Pakistan because it is an iodine-deficient country.[citation needed]

References edit

  1. ^ Muller AF, Drexhage HA, Berghout A (October 2001). "Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care". Endocr. Rev. 22 (5): 605–30. doi:10.1210/edrv.22.5.0441. PMID 11588143.
  2. ^ a b Keely, Erin Joanne (March 2011). "Postpartum thyroiditis: an autoimmune thyroid disorder which predicts future thyroid health". Obstetric Medicine. 4 (1): 7–11. doi:10.1258/om.2010.100041. ISSN 1753-495X. PMC 4989649. PMID 27579088.
  3. ^ a b c d e f g h Stagnaro-Green, A. (2004). "Postpartum thyroiditis". Best Practice & Research Clinical Endocrinology & Metabolism. 18 (2): 303–316. doi:10.1016/j.beem.2004.03.008. PMID 15157842.
  4. ^ Bokhari, R.; Bhatara, V.S.; Bandettini, F.; McMillan, J.M. (1998). "Postpartum psychosis and postpartum thyroiditis". Psychoneuroendocrinology. 23 (6): 643–650. doi:10.1016/S0306-4530(98)00034-1. PMID 9802134. S2CID 28530447.
  5. ^ a b c Premawardhana, L.D.K.E., Parkes, A.B., & Lazarus, J.H. (2004). Thyroiditis, postpartum. In Editor-in-Chief: Luciano Martini (Ed.), Encyclopedia of endocrine diseases (pp. 509–514). New York: Elsevier. doi:10.1016/B0-12-475570-4/01299-3
  6. ^ a b c d Stagnaro-Green, A. (2000). Recognizing, understanding, and treating postpartum thyroiditis. Endocrinology & Metabolism Clinics of North America, 29(2), 417–430. doi:10.1016/S0889-8529(05)70140-7

Further reading edit

  • "Postpartum Thyroiditis." Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/postpartum-thyroiditis. Afzal, Rafia. "Thyroid disorders in pregnancy: An overview of literature from Pakistan." Indian journal of endocrinology and metabolism vol. 17,5 (2013): 943–5. doi:10.4103/2230-8210.117202

April 18, 2024
postpartum, thyroiditis, refers, thyroid, dysfunction, occurring, first, months, after, pregnancy, involve, hyperthyroidism, hypothyroidism, sequentially, according, national, institute, health, postpartum, thyroiditis, affects, about, pregnancies, there, howe. Postpartum thyroiditis refers to thyroid dysfunction occurring in the first 12 months after pregnancy 1 and may involve hyperthyroidism hypothyroidism or the two sequentially According to the National Institute of Health postpartum thyroiditis affects about 8 of pregnancies 2 There are however different rates reported globally This is likely due to the differing amounts of average postpartum follow times around the world and due to humans own innate differences For example in Bangkok Thailand the rate is 1 1 but in Brazil it is 13 3 2 The first phase is typically hyperthyroidism Then the thyroid either returns to normal or a woman develops hypothyroidism Of those women who experience hypothyroidism associated with postpartum thyroiditis one in five will develop permanent hypothyroidism requiring lifelong treatment Postpartum thyroiditisSpecialtyObstetrics Postpartum thyroiditis is believed to result from the modifications to the immune system necessary in pregnancy and histologically is a subacute lymphocytic thyroiditis The process is normally self limiting but when conventional antibodies are found there is a high chance of this proceeding to permanent hypothyroidism Postpartum thyroiditis is a member of the group of thyroiditis conditions known as resolving thyroiditis Contents 1 Signs and symptoms 2 Cause 3 Diagnosis 4 Treatment 5 Prevalence 6 References 7 Further readingSigns and symptoms editThe initial phase of hyperthyroid symptoms occurs transiently about two to six months postpartum 3 Typical symptoms include irritability nervousness palpitations and heat intolerance Hormonal disturbances during this phase tend to occur with lower intensity compared with the hypothyroid phase 3 As a result the hyperthyroid phase may pass undetected The second phase of hypothyroid symptoms is also transient and can occur anytime within the three to twelve month period postpartum 3 Women in this phase experience low energy poor memory impaired concentration carelessness dry skin cold intolerance and general aches and pains After one year postpartum euthyroid function resumes Any case with hypothyroid symptoms extending beyond one year postpartum is not considered postpartum thyroiditis 3 Women who test positive for thyroid antibodies may be at increased risk of developing symptoms associated with postpartum depression than women without thyroid antibodies 4 Cause editDuring pregnancy immunologic suppression occurs which induces tolerance to the presence of the fetus 5 Without this suppression the fetus would be rejected causing miscarriage 5 As a result following delivery the immune system rebounds causing levels of thyroids antibodies to rise in susceptible women 6 Specifically the immunohistological features of susceptible women are indicated by 5 antibodies to thyroglobulin TgAb antibodies to thyroid peroxidase TPOAb increase in TPOAb subclasses IgG1 IgG3 lymphocyte infiltration and follicle formation within thyroid gland Hashimoto s thyroiditis T cell changes increased CD4 CD8 ratio TSH receptor antibodies TSH R Abs Diagnosis editThis condition is commonly undiagnosed by physicians due to either unfamiliarity with the disease the subtlety of symptoms or the attribution of the symptoms to the stresses of having a newborn 6 Usual screening begins with assessing the thyroid stimulating hormone TSH level A suppressed TSH could represent the hyperthyroid phase but warrants further testing to investigate for possible Graves disease 6 A normal TSH with persistent symptoms could represent the shift between phases and requires repeat testing 4 6 weeks later an elevated TSH at this time could indicate the hypothyroid phase 6 Treatment editFor most women the hyperthyroid phase presents with very mild symptoms or is asymptomatic intervention is usually not required If symptomatic cases require treatment a short course of beta blockers would be effective 3 Assessing treatment for the hypothyroid is more complex Women with symptoms or a very high TSH level or both are usually prescribed a course of levothyroxine 3 Asymptomatic women with slightly elevated TSH levels who are planning subsequent pregnancies should consider a course of treatment until completion of the family to avoid possible developmental complications in future children 3 Otherwise treatment could be discontinued after one year postpartum citation needed Prevalence editWomen with type I diabetes mellitus have a threefold increase in the prevalence of postpartum thyroiditis than non diabetic women in the same region 3 According to Johns Hopkins 3 in 100 women develop postpartum thyroiditis Some risk factors include antithyroid antibodies type 1 diabetes history of thyroid problems and family history of thyroid problems According to the National Institute of Health postpartum thyroiditis is especially common in Pakistan because it is an iodine deficient country citation needed References edit Muller AF Drexhage HA Berghout A October 2001 Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age recent insights and consequences for antenatal and postnatal care Endocr Rev 22 5 605 30 doi 10 1210 edrv 22 5 0441 PMID 11588143 a b Keely Erin Joanne March 2011 Postpartum thyroiditis an autoimmune thyroid disorder which predicts future thyroid health Obstetric Medicine 4 1 7 11 doi 10 1258 om 2010 100041 ISSN 1753 495X PMC 4989649 PMID 27579088 a b c d e f g h Stagnaro Green A 2004 Postpartum thyroiditis Best Practice amp Research Clinical Endocrinology amp Metabolism 18 2 303 316 doi 10 1016 j beem 2004 03 008 PMID 15157842 Bokhari R Bhatara V S Bandettini F McMillan J M 1998 Postpartum psychosis and postpartum thyroiditis Psychoneuroendocrinology 23 6 643 650 doi 10 1016 S0306 4530 98 00034 1 PMID 9802134 S2CID 28530447 a b c Premawardhana L D K E Parkes A B amp Lazarus J H 2004 Thyroiditis postpartum In Editor in Chief Luciano Martini Ed Encyclopedia of endocrine diseases pp 509 514 New York Elsevier doi 10 1016 B0 12 475570 4 01299 3 a b c d Stagnaro Green A 2000 Recognizing understanding and treating postpartum thyroiditis Endocrinology amp Metabolism Clinics of North America 29 2 417 430 doi 10 1016 S0889 8529 05 70140 7Further reading edit Postpartum Thyroiditis Johns Hopkins Medicine www hopkinsmedicine org health conditions and diseases postpartum thyroiditis Afzal Rafia Thyroid disorders in pregnancy An overview of literature from Pakistan Indian journal of endocrinology and metabolism vol 17 5 2013 943 5 doi 10 4103 2230 8210 117202 Retrieved from https en wikipedia org w index php title Postpartum thyroiditis amp oldid 1097473901, wikipedia, wiki, book, books, library,

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