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American Family Physician Jun 2022
Topics: Adenomyosis; Borderline Personality Disorder; Comorbidity; Female; Hepacivirus; Hepatitis C; Humans; Hypotension; Postpartum Thyroiditis; Pruritus; Psychiatric Status Rating Scales
PubMed: 35704817
DOI: No ID Found -
Medicina Clinica Apr 2009
Topics: Female; Humans; Mass Screening; Postpartum Thyroiditis
PubMed: 19375120
DOI: 10.1016/j.medcli.2009.01.012 -
The Proceedings of the Nutrition Society Feb 2019Hashimoto's thyroiditis (HT) and Graves' disease (GD) are examples of autoimmune thyroid disease (AITD), the commonest autoimmune condition. Antibodies to thyroid... (Review)
Review
Hashimoto's thyroiditis (HT) and Graves' disease (GD) are examples of autoimmune thyroid disease (AITD), the commonest autoimmune condition. Antibodies to thyroid peroxidase (TPO), the enzyme that catalyses thyroid-hormone production and antibodies to the receptor for the thyroid-stimulating hormone, are characteristic of HT and GD, respectively. It is presently accepted that genetic susceptibility, environmental factors, including nutritional factors and immune disorders contribute to the development of AITD. Aiming to investigate the effect of iodine, iron and selenium in the risk, pathogenesis and treatment of thyroid disease, PubMed and the Cochrane Library were searched for relevant publications to provide a narrative review. Iodine: chronic exposure to excess iodine intake induces autoimmune thyroiditis, partly because highly-iodinated thyroglobulin (Tg) is more immunogenic. The recent introduction of universal salt iodisation can have a similar, although transient, effect. Iron: iron deficiency impairs thyroid metabolism. TPO is a haem enzyme that becomes active only after binding haem. AITD patients are frequently iron-deficient since autoimmune gastritis, which reduces iron absorption and coeliac disease which causes iron loss, are frequent co-morbidities. In two-thirds of women with persistent symptoms of hypothyroidism despite appropriate levothyroxine therapy, restoration of serum ferritin above 100 µg/l ameliorated symptoms. Selenium: selenoproteins are essential to thyroid action. In particular, the glutathione peroxidases remove excessive hydrogen peroxide produced there for the iodination of Tg to form thyroid hormones. There is evidence from observational studies and randomised controlled trials that selenium, probably as selenoproteins, can reduce TPO-antibody concentration, hypothyroidism and postpartum thyroiditis. Appropriate status of iodine, iron and selenium is crucial to thyroid health.
Topics: Autoantigens; Graves Disease; Hashimoto Disease; Humans; Hypothyroidism; Immunoglobulins, Thyroid-Stimulating; Iodide Peroxidase; Iodine; Iron; Iron-Binding Proteins; Nutritional Status; Risk Factors; Selenium; Sodium Chloride, Dietary; Thyroiditis, Autoimmune
PubMed: 30208979
DOI: 10.1017/S0029665118001192 -
Autoimmunity Reviews Jan 2010Autoimmune diseases comprise a group of about 85 heterogeneous conditions that can affect virtually any organ and tissue in the body. Many autoimmune diseases change... (Review)
Review
Autoimmune diseases comprise a group of about 85 heterogeneous conditions that can affect virtually any organ and tissue in the body. Many autoimmune diseases change significantly during pregnancy: some ameliorate, some worsen, and others are unaffected. Two autoimmune diseases present prominently in relation to pregnancy: postpartum autoimmune thyroiditis and autoimmune hypophysitis. This article will review the current state of knowledge of the immunological changes that occur during normal pregnancy, and will explore the striking temporal association with pregnancy observed in thyroiditis and hypophysitis.
Topics: Animals; Autoimmune Diseases; Female; Humans; Pituitary Diseases; Postpartum Thyroiditis; Pregnancy; Pregnancy Complications
PubMed: 19539059
DOI: 10.1016/j.autrev.2009.06.001 -
Endocrinology, Diabetes & Metabolism... Jul 2021Hypothyroidism occurring in the postpartum period can be due to pituitary or hypothalamic disease as in Sheehan's syndrome and postpartum autoimmune hypophysitis or due...
SUMMARY
Hypothyroidism occurring in the postpartum period can be due to pituitary or hypothalamic disease as in Sheehan's syndrome and postpartum autoimmune hypophysitis or due to a primary thyroid disease as in postpartum thyroiditis. It is important that the correct diagnosis is ascertained because hypothalamic or pituitary disorders are often associated with other pituitary hormone deficiencies, especially life-threatening adrenal insufficiency or adrenal crisis. A combination of various symptoms and biochemical markers, especially serum thyroid-stimulating hormone levels dictate the initial diagnostic pathway. We present a case of a woman who presented with a 2-month history of tiredness and neck discomfort following delivery. A thyroid function test demonstrated results, which we initially interpreted as central hypothyroidism. Follow-up results indicated that this was in fact the transition period between the thyrotoxic phase and hypothyroid phases of postpartum thyroiditis. This case highlights the potential for diagnostic confusion between central hypothyroidism and postpartum thyroiditis.
LEARNING POINTS
Postpartum thyroiditis affects one in twenty mothers within 12 months of delivery. The majority of patients have transient thyrotoxicosis only, some have transient hypothyroidism only, and the rest has a triphasic pattern (thyrotoxic, hypothyroid then a euthyroid phase). During the transition from the thyrotoxic phase to hypothyroid phase, when serum TSH is still suppressed, the biochemical results can resemble that of central hypothyroidism. If central hypothyroidism is suspected, then urgent diagnostic investigations should be carried out along with the assessment of adrenal function. There is a potential for diagnostic confusion between postpartum central hypothyroidism and postpartum thyroiditis; however, the obstetric history, clinical symptoms, and signs (headaches, breastfeeding, goitre, etc.) and serum adrenocorticotropic levels should help with the differential diagnosis.
PubMed: 34280894
DOI: 10.1530/EDM-21-0069 -
Postgraduate Medicine Oct 1989Subacute thyroiditis is a common disease that often goes undetected. Indeed, both painful and painless thyroiditis are easily overlooked or misdiagnosed and perhaps... (Review)
Review
Subacute thyroiditis is a common disease that often goes undetected. Indeed, both painful and painless thyroiditis are easily overlooked or misdiagnosed and perhaps mistreated unless careful attention is paid to the patient's history and physical examination. Treating the hyperthyroidism of subacute thyroiditis as if it were Graves' disease, for example, would be inappropriate, since therapy for the two entities is completely different. A form of painless thyroiditis, for reasons that remain unclear, can occur in the postpartum period and may be related to postpartum psychosis or depression.
Topics: Female; Humans; Pain; Pregnancy; Puerperal Disorders; Thyroiditis
PubMed: 2678067
DOI: 10.1080/00325481.1989.11704451 -
Endocrine May 2021The world is dealing with the Covid-19 pandemic due to the coronavirus SARS-CoV-2. Amongst the extra-pulmonary manifestations presented by Covid-19 patients, thyroiditis... (Review)
Review
The world is dealing with the Covid-19 pandemic due to the coronavirus SARS-CoV-2. Amongst the extra-pulmonary manifestations presented by Covid-19 patients, thyroiditis form part of the spectrum of visceral involvement linked to SARS-CoV-2. In this review, we will describe the various documented clinical forms of thyroiditis (inflammatory thyroiditis, subacute or de Quervain's thyroiditis, chronic lymphocytic thyroiditis or Hashimoto's disease, painless (silent) postpartum thyroiditis) to facilitate their diagnosis in more or less symptomatic Covid-19 patients and to provide guidance for patient treatment.
Topics: COVID-19; Female; Humans; Pandemics; SARS-CoV-2; Thyroiditis; Thyroiditis, Subacute
PubMed: 33774779
DOI: 10.1007/s12020-021-02689-y -
Journal of Endocrinological... Aug 2022To review the pathophysiology, diagnosis and management of postpartum thyroid dysfunction, and related management of thyroid disorders during lactation. (Review)
Review
PURPOSE
To review the pathophysiology, diagnosis and management of postpartum thyroid dysfunction, and related management of thyroid disorders during lactation.
METHODS
We reviewed the literature on postpartum thyroid dysfunction and management of thyroid disorders during lactation.
RESULTS
The postpartum period is characterized by a rebound from the immunotolerance induced by pregnancy. Routine thyroid function screening is not recommended for asymptomatic women in the postpartum period. Testing thyroid function should be considered at 6-12-week postpartum for high-risk populations, including women with a previous episode of postpartum thyroiditis, Graves' disease, or those with Hashimoto's thyroiditis on thyroid hormone replacement, known thyroid peroxidase antibody positivity, type 1 diabetes mellitus, other nonthyroidal autoimmune disease, or chronic hepatitis C. A serum TSH should also be checked in the setting of postpartum depression or difficulty lactating. If patients have thyrotoxicosis, new-onset or recurrent Graves' disease must be differentiated from postpartum thyroiditis, because the management differs. Periodic thyroid function testing is recommended following recovery from postpartum thyroiditis due to high lifetime risk of developing permanent hypothyroidism. Levothyroxine, and the lowest effective dose of antithyroid drugs, (propylthiouracil, methimazole, and carbimazole) can be safely used in lactating women. The use of radiopharmaceutical scanning is avoided during lactation and radioactive iodine treatment is contraindicated.
CONCLUSIONS
Diagnosing postpartum thyroid dysfunction is challenging, because symptoms may be subtle. A team approach involving primary care providers, endocrinologists, and obstetricians is essential for transitioning thyroid care from the gestational to the postpartum setting.
Topics: Female; Graves Disease; Humans; Iodine Radioisotopes; Lactation; Postpartum Period; Postpartum Thyroiditis; Pregnancy; Puerperal Disorders; Thyroid Diseases; Thyroid Neoplasms
PubMed: 35181848
DOI: 10.1007/s40618-022-01762-1 -
The Journal of Clinical Endocrinology... Jul 2020Postpartum thyroiditis (PPT) is defined as the occurrence of de novo autoimmune thyroid disease accompanied by thyroid dysfunction in the first year postpartum. However,...
CONTEXT
Postpartum thyroiditis (PPT) is defined as the occurrence of de novo autoimmune thyroid disease accompanied by thyroid dysfunction in the first year postpartum. However, hormonal changes resembling the typical pattern of PPT have been reported to occur even in women with pregestational Hashimoto's thyroiditis (HT) on levothyroxine (LT4).
OBJECTIVE
To evaluate the risk of PPT in women with HT antedating pregnancy.
DESIGN/SETTING
Retrospective chart review of pregnant women with HT antedating pregnancy seen in a university hospital (2008-2017), who were followed from preconception up to 1 year after delivery.
PATIENTS
167 women preconceptionally diagnosed with HT and classified as hypothyroid HT (hypo-HT; n = 98) or euthyroid HT (eu-HT; n = 69), according to their thyroid status at the time of diagnosis.
OUTCOME MEASURES
PPT occurrence and associated clinical characteristics/risk factors.
RESULTS
PPT occurred in 65/167 women, with a rate statistically greater in the eu-HT than in the hypo-HT group (68.1% vs 18.4%; odds ratio [OR] 9.49, 95% confidence interval [CI] 4.62-19.49). Most of the women experiencing PPT in both groups were euthyroid at the time of first-trimester evaluation (39/47 eu-HT [83%] and 16/18 hypo-HT [88.9%]). Multivariate regression analysis showed eu-HT group and first-trimester euthyroidism to be positively associated with PPT occurrence (ORs 10.71 and 3.89, respectively).
CONCLUSION
PPT may occur in hypo-HT women on LT4 therapy, although significantly less frequently than in eu-HT women. The 4-fold higher risk of PPT in HT women maintaining euthyroidism at first -trimester of gestation suggests that the risk of PPT could be related to the amount of unaffected thyroid tissue.
Topics: Adult; Female; Hashimoto Disease; Humans; Hypothyroidism; Incidence; Postpartum Period; Postpartum Thyroiditis; Pregnancy; Retrospective Studies; Risk; Thyroxine; Young Adult
PubMed: 32301483
DOI: 10.1210/clinem/dgaa197