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{{Postpartum thyroiditis}} | {{Postpartum thyroiditis}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{SKA}} | ||
==Overview== | ==Overview== | ||
If left untreated, [ | [[Prognosis]] for postpartum thyroiditis is generally good. If left untreated, 25 to 30% patients develop [[hypothyroidism]], 3.5 to 8.7-years after developing [[postpartum thyroiditis]] [[Postpartum thyroiditis|(PPT)]]. The symptoms of [[postpartum thyroiditis]] usually develop in the twelve months after [[delivery]], [[abortion]] or [[miscarriage]] of fetus. The symptoms of PPT depend on its clinical course such as classic triphasic, biphasic hyerthyroidism, or biphasic hypothyroidism. Common complications of PPT include [[hypothyroidism]], [[Postpartum depression (patient information)|postpartum depression]], and [[Mental retardation|fetal mental retardation]]. The mother may develop overt [[Hyperthyroidism|hyperthyroid]] symptoms in future pregnancies. Prognosis of PPT is generally good and 90% of patient recover to normal state after [[postpartum]] period. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
*The symptoms of postpartum thyroiditis | *The symptoms of [[postpartum thyroiditis]] (PPT) usually develop in the twelve months after [[delivery]], [[abortion]] or [[miscarriage]] of [[fetus]]. | ||
*The symptoms of PPT depend on its clinical course such as: | |||
*Classic triphasic: 25% | :*'''Classic triphasic''': 25% patients of [[Postpartum thyroiditis|PPT]] come to clinical attention with symptoms of [[hyperthyroidism]] starting from sixth [[postpartum]] week followed by hypothyroidism around sixth postpartum month and then euthyroidism by the of 12th postpartum month.<ref name="pmid10874538">{{cite journal| author=Stagnaro-Green A| title=Recognizing, understanding, and treating postpartum thyroiditis. | journal=Endocrinol Metab Clin North Am | year= 2000 | volume= 29 | issue= 2 | pages= 417-30, ix | pmid=10874538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10874538 }} </ref><ref name="pmid22312089">{{cite journal| author=Stagnaro-Green A| title=Approach to the patient with postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2012 | volume= 97 | issue= 2 | pages= 334-42 | pmid=22312089 | doi=10.1210/jc.2011-2576 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22312089 }} </ref> | ||
*Biphasic hyperthyroidism: 32 % patients of PPT | :*'''Biphasic [[hyperthyroidism]]''': 32 % patients of PPT develop symptoms of [[hyperthyroidism]] followed by recovery.<ref name="pmid22312089">{{cite journal| author=Stagnaro-Green A| title=Approach to the patient with postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2012 | volume= 97 | issue= 2 | pages= 334-42 | pmid=22312089 | doi=10.1210/jc.2011-2576 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22312089 }} </ref> | ||
*Biphasic hypothyroidism: 43 % patients of PPT | :*'''Biphasic [[hypothyroidism]]''': 43 % patients of [[Postpartum thyroiditis|PPT]] develop symptoms of [[hypothyroidism]] followed by recovery.<ref name="pmid22312089">{{cite journal| author=Stagnaro-Green A| title=Approach to the patient with postpartum thyroiditis. | journal=J Clin Endocrinol Metab | year= 2012 | volume= 97 | issue= 2 | pages= 334-42 | pmid=22312089 | doi=10.1210/jc.2011-2576 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22312089 }} </ref> | ||
*If left untreated, 25-30% of patients with PPT may progress to develop hypothyroidism<ref name="pmid10634366">{{cite journal| author=Premawardhana LD, Parkes AB, Ammari F, John R, Darke C, Adams H et al.| title=Postpartum thyroiditis and long-term thyroid status: prognostic influence of thyroid peroxidase antibodies and ultrasound echogenicity. | journal=J Clin Endocrinol Metab | year= 2000 | volume= 85 | issue= 1 | pages= 71-5 | pmid=10634366 | doi=10.1210/jcem.85.1.6227 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10634366 }} </ref> | *If left untreated, 25-30% of patients with [[Postpartum thyroiditis|PPT]] may progress to develop [[hypothyroidism]].<ref name="pmid10634366">{{cite journal| author=Premawardhana LD, Parkes AB, Ammari F, John R, Darke C, Adams H et al.| title=Postpartum thyroiditis and long-term thyroid status: prognostic influence of thyroid peroxidase antibodies and ultrasound echogenicity. | journal=J Clin Endocrinol Metab | year= 2000 | volume= 85 | issue= 1 | pages= 71-5 | pmid=10634366 | doi=10.1210/jcem.85.1.6227 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10634366 }} </ref> | ||
*Patients who are anti-TPO antibodies | *Patients who are positive for anti-TPO [[antibodies]], HLA-DRW9 and/or HLA-DRB51, and developed [[Hypothyroidism|hypothyroid]] phase of [[Postpartum thyroiditis|PPT]], are at increased risk of developing permanent [[hypothyroidism]].<ref name="pmid3162458">{{cite journal| author=Tachi J, Amino N, Tamaki H, Aozasa M, Iwatani Y, Miyai K| title=Long term follow-up and HLA association in patients with postpartum hypothyroidism. | journal=J Clin Endocrinol Metab | year= 1988 | volume= 66 | issue= 3 | pages= 480-4 | pmid=3162458 | doi=10.1210/jcem-66-3-480 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3162458 }} </ref><ref name="StuckeyKent2010">{{cite journal|last1=Stuckey|first1=B G A|last2=Kent|first2=G N|last3=Ward|first3=L C|last4=Brown|first4=S J|last5=Walsh|first5=J P|title=ORIGINAL ARTICLE: Postpartum thyroid dysfunction and the long-term risk of hypothyroidism: results from a 12-year follow-up study of women with and without postpartum thyroid dysfunction|journal=Clinical Endocrinology|volume=73|issue=3|year=2010|pages=389–395|issn=03000664|doi=10.1111/j.1365-2265.2010.03797.x}}</ref> | ||
===Complications=== | ===Complications=== | ||
*Common complications of [ | *Common complications of postpartum thyroiditis include: | ||
**[ | **[[Hypothyroidism]]<ref name="pmid108745383">{{cite journal| author=Stagnaro-Green A| title=Recognizing, understanding, and treating postpartum thyroiditis. | journal=Endocrinol Metab Clin North Am | year= 2000 | volume= 29 | issue= 2 | pages= 417-30, ix | pmid=10874538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10874538 }}</ref> | ||
**[ | **[[Postnatal depression|Postpartum depression]]<ref name="pmid108745382">{{cite journal| author=Stagnaro-Green A| title=Recognizing, understanding, and treating postpartum thyroiditis. | journal=Endocrinol Metab Clin North Am | year= 2000 | volume= 29 | issue= 2 | pages= 417-30, ix | pmid=10874538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10874538 }}</ref> | ||
**[ | **Recurrence<ref name="pmid7062963">{{cite journal| author=Amino N, Mori H, Iwatani Y, Tanizawa O, Kawashima M, Tsuge I et al.| title=High prevalence of transient post-partum thyrotoxicosis and hypothyroidism. | journal=N Engl J Med | year= 1982 | volume= 306 | issue= 14 | pages= 849-52 | pmid=7062963 | doi=10.1056/NEJM198204083061405 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7062963 }} </ref> | ||
**Fetal [[mental retardation]]<ref name="pmid3394739">{{cite journal| author=Hayslip CC, Fein HG, O'Donnell VM, Friedman DS, Klein TA, Smallridge RC| title=The value of serum antimicrosomal antibody testing in screening for symptomatic postpartum thyroid dysfunction. | journal=Am J Obstet Gynecol | year= 1988 | volume= 159 | issue= 1 | pages= 203-9 | pmid=3394739 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3394739 }} </ref> | |||
**Future pregnancies may present with features of overt [[Hyperthyroidism|hyperthyroidism]]<ref name="pmid7062963">{{cite journal| author=Amino N, Mori H, Iwatani Y, Tanizawa O, Kawashima M, Tsuge I et al.| title=High prevalence of transient post-partum thyrotoxicosis and hypothyroidism. | journal=N Engl J Med | year= 1982 | volume= 306 | issue= 14 | pages= 849-52 | pmid=7062963 | doi=10.1056/NEJM198204083061405 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7062963 }} </ref> | |||
===Prognosis=== | ===Prognosis=== | ||
*Prognosis is generally | * [[Prognosis]] is generally good and 90% of patient with PPT recover to normal state after postpartum period.<ref name="pmid27981252">{{cite journal| author=Alemu A, Terefe B, Abebe M, Biadgo B| title=Thyroid hormone dysfunction during pregnancy: A review. | journal=Int J Reprod Biomed (Yazd) | year= 2016 | volume= 14 | issue= 11 | pages= 677-686 | pmid=27981252 | doi= | pmc=5153572 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27981252 }}</ref> | ||
* If left untreated, 25 to 30% patients develop [[hypothyroidism]], 3.5 to 8.7-years after developing [[postpartum thyroiditis]] [[Postpartum thyroiditis|(PPT)]].<ref name="pmid10634366" /> | |||
* | |||
==References== | ==References== | ||
Latest revision as of 16:49, 10 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]
Overview
Prognosis for postpartum thyroiditis is generally good. If left untreated, 25 to 30% patients develop hypothyroidism, 3.5 to 8.7-years after developing postpartum thyroiditis (PPT). The symptoms of postpartum thyroiditis usually develop in the twelve months after delivery, abortion or miscarriage of fetus. The symptoms of PPT depend on its clinical course such as classic triphasic, biphasic hyerthyroidism, or biphasic hypothyroidism. Common complications of PPT include hypothyroidism, postpartum depression, and fetal mental retardation. The mother may develop overt hyperthyroid symptoms in future pregnancies. Prognosis of PPT is generally good and 90% of patient recover to normal state after postpartum period.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of postpartum thyroiditis (PPT) usually develop in the twelve months after delivery, abortion or miscarriage of fetus.
- The symptoms of PPT depend on its clinical course such as:
- Classic triphasic: 25% patients of PPT come to clinical attention with symptoms of hyperthyroidism starting from sixth postpartum week followed by hypothyroidism around sixth postpartum month and then euthyroidism by the of 12th postpartum month.[1][2]
- Biphasic hyperthyroidism: 32 % patients of PPT develop symptoms of hyperthyroidism followed by recovery.[2]
- Biphasic hypothyroidism: 43 % patients of PPT develop symptoms of hypothyroidism followed by recovery.[2]
- If left untreated, 25-30% of patients with PPT may progress to develop hypothyroidism.[3]
- Patients who are positive for anti-TPO antibodies, HLA-DRW9 and/or HLA-DRB51, and developed hypothyroid phase of PPT, are at increased risk of developing permanent hypothyroidism.[4][5]
Complications
- Common complications of postpartum thyroiditis include:
- Hypothyroidism[6]
- Postpartum depression[7]
- Recurrence[8]
- Fetal mental retardation[9]
- Future pregnancies may present with features of overt hyperthyroidism[8]
Prognosis
- Prognosis is generally good and 90% of patient with PPT recover to normal state after postpartum period.[10]
- If left untreated, 25 to 30% patients develop hypothyroidism, 3.5 to 8.7-years after developing postpartum thyroiditis (PPT).[3]
References
- ↑ Stagnaro-Green A (2000). "Recognizing, understanding, and treating postpartum thyroiditis". Endocrinol Metab Clin North Am. 29 (2): 417–30, ix. PMID 10874538.
- ↑ 2.0 2.1 2.2 Stagnaro-Green A (2012). "Approach to the patient with postpartum thyroiditis". J Clin Endocrinol Metab. 97 (2): 334–42. doi:10.1210/jc.2011-2576. PMID 22312089.
- ↑ 3.0 3.1 Premawardhana LD, Parkes AB, Ammari F, John R, Darke C, Adams H; et al. (2000). "Postpartum thyroiditis and long-term thyroid status: prognostic influence of thyroid peroxidase antibodies and ultrasound echogenicity". J Clin Endocrinol Metab. 85 (1): 71–5. doi:10.1210/jcem.85.1.6227. PMID 10634366.
- ↑ Tachi J, Amino N, Tamaki H, Aozasa M, Iwatani Y, Miyai K (1988). "Long term follow-up and HLA association in patients with postpartum hypothyroidism". J Clin Endocrinol Metab. 66 (3): 480–4. doi:10.1210/jcem-66-3-480. PMID 3162458.
- ↑ Stuckey, B G A; Kent, G N; Ward, L C; Brown, S J; Walsh, J P (2010). "ORIGINAL ARTICLE: Postpartum thyroid dysfunction and the long-term risk of hypothyroidism: results from a 12-year follow-up study of women with and without postpartum thyroid dysfunction". Clinical Endocrinology. 73 (3): 389–395. doi:10.1111/j.1365-2265.2010.03797.x. ISSN 0300-0664.
- ↑ Stagnaro-Green A (2000). "Recognizing, understanding, and treating postpartum thyroiditis". Endocrinol Metab Clin North Am. 29 (2): 417–30, ix. PMID 10874538.
- ↑ Stagnaro-Green A (2000). "Recognizing, understanding, and treating postpartum thyroiditis". Endocrinol Metab Clin North Am. 29 (2): 417–30, ix. PMID 10874538.
- ↑ 8.0 8.1 Amino N, Mori H, Iwatani Y, Tanizawa O, Kawashima M, Tsuge I; et al. (1982). "High prevalence of transient post-partum thyrotoxicosis and hypothyroidism". N Engl J Med. 306 (14): 849–52. doi:10.1056/NEJM198204083061405. PMID 7062963.
- ↑ Hayslip CC, Fein HG, O'Donnell VM, Friedman DS, Klein TA, Smallridge RC (1988). "The value of serum antimicrosomal antibody testing in screening for symptomatic postpartum thyroid dysfunction". Am J Obstet Gynecol. 159 (1): 203–9. PMID 3394739.
- ↑ Alemu A, Terefe B, Abebe M, Biadgo B (2016). "Thyroid hormone dysfunction during pregnancy: A review". Int J Reprod Biomed (Yazd). 14 (11): 677–686. PMC 5153572. PMID 27981252.