Autoimmune Abnormalities of Postpartum Thyroid Diseases

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2017 Jul 29

PMID 28751877

Citations 7

Authors

Flavia Di Bari

Roberta Granese

Maria Le Donne

Roberto Vita

Salvatore Benvenga

Affiliations

Soon will be listed here.

Abstract

The year following parturition is a critical time for the appearance or exacerbation of autoimmune diseases, including autoimmune thyroid disease. The vast majority of postpartum thyroid disease consists of postpartum thyroiditis (PPT) and the minority by Graves' disease and non-autoimmune thyroiditis. PPT has a worldwide prevalence ranging from 1 to 22% and averaging 5% based on a review published in 2012. Several factors confer risk for the development of PPT. Typically, the clinical course of PPT is characterized by three phases: thyrotoxic, hypothyroid, and euthyroid phase. Approximately half of PPT women will have permanent hypothyroidism. The best humoral marker for predictivity, already during the first trimester of gestation, is considered positivity for thyroperoxidase autoantibodies (TPOAb), though only one-third to half of such TPOAb-positive pregnant women will develop PPT. Nutraceuticals (such as selenium) or omega-3-fatty acid supplements seem to have a role in prevention of PPT. In a recent study on pregnant women with stable dietary habits, we found that the fish consumers had lower rates of positivity (and lower serum levels) of both TPOAb and thyroglobulin Ab compared to meat eaters. Finally, we remind the reader of other diseases that can be observed in the postpartum period, either autoimmune or non-autoimmune, thyroid or non-thyroid.

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References

Elefsiniotis I, Vezali E, Pantazis K, Saroglou G . Post-partum thyroiditis in women with chronic viral hepatitis. J Clin Virol. 2008; 41(4):318-9. DOI: 10.1016/j.jcv.2007.12.010. View

Drucker D, Shumak S, Angel A . Schmidt's syndrome presenting with intrauterine growth retardation and postpartum addisonian crisis. Am J Obstet Gynecol. 1984; 149(2):229-30. DOI: 10.1016/0002-9378(84)90206-0. View

Amino N, Mori H, Iwatani Y, TANIZAWA O, Kawashima M, Tsuge I . High prevalence of transient post-partum thyrotoxicosis and hypothyroidism. N Engl J Med. 1982; 306(14):849-52. DOI: 10.1056/NEJM198204083061405. View

Misaki T, Miyamoto S, Kasagi K, Mori T, Konishi J . Serial occurrence of two types of postpartum thyroid disorders. Usefulness of Tc-99m pertechnetate uptake. Clin Nucl Med. 1996; 21(6):460-2. DOI: 10.1097/00003072-199606000-00005. View

Walfish P, Meyerson J, Provias J, Vargas M, Papsin F . Prevalence and characteristics of post-partum thyroid dysfunction: results of a survey from Toronto, Canada. J Endocrinol Invest. 1992; 15(4):265-72. DOI: 10.1007/BF03348726. View

Komatsu M, Kobayashi S, Ito N, Miyakawa M, Senga O, Sugenoya A . [A case of postpartum silent thyroiditis misapprehended as malignant lymphoma of the thyroid]. Nihon Geka Gakkai Zasshi. 1993; 94(6):645-7. View

Benvenga S, Vigo M, Metro D, Granese R, Vita R, Le Donne M . Type of fish consumed and thyroid autoimmunity in pregnancy and postpartum. Endocrine. 2015; 52(1):120-9. DOI: 10.1007/s12020-015-0698-3. View

Watanobe H, Kawabe H . Painless thyroiditis developed in a patient with Sheehan's syndrome. J Endocrinol Invest. 1997; 20(6):335-7. DOI: 10.1007/BF03350313. View

De Bellis A, Kelestimur F, Sinisi A, Ruocco G, Tirelli G, Battaglia M . Anti-hypothalamus and anti-pituitary antibodies may contribute to perpetuate the hypopituitarism in patients with Sheehan's syndrome. Eur J Endocrinol. 2008; 158(2):147-52. DOI: 10.1530/EJE-07-0647. View

10.

Alexander E, Pearce E, Brent G, Brown R, Chen H, Dosiou C . 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017; 27(3):315-389. DOI: 10.1089/thy.2016.0457. View

11.

John R, Othman S, Parkes A, Lazarus J, Hall R . Interference in thyroid-function tests in postpartum thyroiditis. Clin Chem. 1991; 37(8):1397-400. View

12.

Ide A, Amino N, Kang S, Yoshioka W, Kudo T, Nishihara E . Differentiation of postpartum Graves' thyrotoxicosis from postpartum destructive thyrotoxicosis using antithyrotropin receptor antibodies and thyroid blood flow. Thyroid. 2014; 24(6):1027-31. DOI: 10.1089/thy.2013.0585. View

13.

Gerstein H . Incidence of postpartum thyroid dysfunction in patients with type I diabetes mellitus. Ann Intern Med. 1993; 118(6):419-23. DOI: 10.7326/0003-4819-118-6-199303150-00004. View

14.

Punnose J, Agarwal M, Premchandran J . Transient diabetes insipidus and hypopituitarism after pituitary apoplexy: a rare association with pericardial effusion and painless thyroiditis. Am J Med Sci. 2000; 319(4):261-4. DOI: 10.1097/00000441-200004000-00012. View

15.

Le Donne M, Alibrandi A, Vita R, Zanghi D, Triolo O, Benvenga S . Does eating oily fish improve gestational and neonatal outcomes? Findings from a Sicilian study. Women Birth. 2016; 29(3):e50-7. DOI: 10.1016/j.wombi.2015.12.005. View

16.

Best C, Dhaliwal S, Tam S, Low T, Hughes B, Fung K . Spontaneous intrathyroidal hematoma causing airway obstruction: A case report. Medicine (Baltimore). 2016; 95(35):e3209. PMC: 5008525. DOI: 10.1097/MD.0000000000003209. View

17.

Momotani N, Noh J, Ishikawa N, Ito K . Relationship between silent thyroiditis and recurrent Graves' disease in the postpartum period. J Clin Endocrinol Metab. 1994; 79(1):285-9. DOI: 10.1210/jcem.79.1.7913091. View

18.

Taniyama M, Otsuka F, Tozaki T, Ban Y . Thyroid profiles in a patient with resistance to thyroid hormone and episodes of thyrotoxicosis, including repeated painless thyroiditis. Thyroid. 2012; 23(7):898-901. DOI: 10.1089/thy.2012.0004. View

19.

Sakinah S, Sharifah N, Yusoff K . Painful thyroiditis in postpartum period. Med J Malaysia. 1993; 48(1):83-5. View

20.

Martin-Du Pan R . [Triggering role of emotional stress and childbirth. Unexpected occurrence of Graves' disease compared to 96 cases of Hashimoto thyroiditis and 97 cases of thyroid nodules]. Ann Endocrinol (Paris). 1998; 59(2):107-12. View