| Postpartum thyroiditis |
| Classification and external resources |
| ICD-10 |
O90.5 |
| DiseasesDB |
10441 |
| MeSH |
D050032 |
Postpartum thyroiditis is a phenomenon observed following pregnancy[1] and may involve hyperthyroidism, hypothyroidism or the two sequentially. It affects about 5% of all women within a year after giving birth. 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 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 & Symptoms
- 2 Prevalence
- 3 Etiology
- 4 Diagnosis
- 5 Treatment
- 6 References
- 7 External links
Signs & Symptoms
The initial phase of hyperthyroid symptoms occurs transiently about two to six months postpartum.[2] Typical symptoms include fatigue, irritability, nervousness, palpitations, and heat intolerance. Hormonal disturbances during this phase tend to occur with lower intensity compared with the hypothyroid phase.[2] 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.[2] 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.[2]
Women who test positive for thyroid antibodies may be at increased risk of developing symptoms associated with postpartum depression than women without thyroid antibodies.[3]
Prevalence
Worldwide reporting of postpartum thyroiditis cases is highly varied. This variation may be due to methodological discrepancies in assessing women for this condition.[4] Factors such as length of follow-up after delivery, diagnostic criteria, frequency of postpartum blood sampling, and thyroid hormone assay methodology[5] likely contribute to this variation. On average, 5-7% of pregnant women from most iodine-replete populations develop this condition.[4]
Women with type I diabetes mellitus have a threefold increase in the prevalence of postpartum thyroiditis than non-diabetic women in the same region.[2]
Etiology
During pregnancy, immunologic suppression occurs which induces tolerance to the presence of the fetus.[4] Without this suppression, the fetus would be rejected causing miscarriage.[4] 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:[4]
- 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
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
For most women, the hyperthyroid phase presents with very mild symptoms or is asypmtomatic; intervention is usually not required. If symptomatic cases require treatment, a short course of beta-blockers would be effective.[2]
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.[2] 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.[2] Otherwise, treatment could be discontinued after 1 year postpartum.
References
- ^ 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/er.22.5.605. PMID 11588143.
- ^ 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.
- ^ 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.
- ^ a b c d e 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
- ^ http://www.thyroidmanager.org/Chapter6/Ch-6-2.htm
- ^ 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
|
Pathology of pregnancy, childbirth and the puerperium (O, 630–679)
|
|
| Pregnancy |
|
Pregnancy with
abortive outcome
|
- Ectopic pregnancy
- Abdominal pregnancy
- Cervical pregnancy
- Interstitial pregnancy
- Ovarian pregnancy
- Molar pregnancy
- Miscarriage
|
|
|
Oedema, proteinuria and
hypertensive disorders
|
- Gestational hypertension
- Pre-eclampsia
- Eclampsia
|
|
|
Other, predominantly
related to pregnancy
|
|
Digestive system
|
- Acute fatty liver of pregnancy
- Gestational diabetes
- Hepatitis E
- Hyperemesis gravidarum
- Intrahepatic cholestasis of pregnancy
|
|
|
Integumentary system /
dermatoses of pregnancy
|
- Gestational pemphigoid
- Impetigo herpetiformis
- Intrahepatic cholestasis of pregnancy
- Linea nigra
- Prurigo gestationis
- Pruritic folliculitis of pregnancy
- Pruritic urticarial papules and plaques of pregnancy (PUPPP)
- Striae gravidarum
|
|
|
Nervous system
|
|
|
|
Blood
|
- Gestational thrombocytopenia
- Pregnancy-induced hypercoagulability
|
|
|
|
Maternal care related to the
fetus and amniotic cavity
|
- amniotic fluid
- Oligohydramnios
- Polyhydramnios
- Braxton Hicks contractions
- chorion / amnion
- Amniotic band syndrome
- Chorioamnionitis
- Chorionic hematoma
- Monoamniotic twins
- Premature rupture of membranes
- Obstetrical hemorrhage
- placenta
- Circumvallate placenta
- Monochorionic twins
- Placenta praevia
- Placental abruption
- Twin-to-twin transfusion syndrome
|
|
|
| Labor |
- Amniotic fluid embolism
- Cephalopelvic disproportion
- Dystocia
- Fetal distress
- Locked twins
- Obstetrical hemorrhage
- placenta
- Preterm birth
- Postmature birth
- Umbilical cord prolapse
- Uterine rupture
- Vasa praevia
|
|
| Puerperal |
- Breastfeeding difficulties
- Agalactia
- Fissure of the nipple
- Galactorrhea
- Breast engorgement
- Diastasis symphysis pubis
- Peripartum cardiomyopathy
- Postpartum depression
- Postpartum thyroiditis
- Puerperal fever
- Puerperal mastitis
|
|
| Other |
- Concomitant conditions
- Diabetes mellitus
- Systemic lupus erythematosus
- Thyroid disorders
- Maternal death
|
|
|
Index of obstetrics
|
|
| Description |
- Pregnancy
- Development
- Anatomy
|
|
| Disease |
- Pregnancy and childbirth
- Placenta and neonate
- Infections
- Symptoms and signs
|
|
| Treatment |
- Procedures
- Drugs
- oxytocins
- labor repressants
|
|
|
External links
- More information about remedy for thyroiditis
