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The Journal of Family Practice Dec 1980Postpartum thyroiditis is a disorder which is morphologically similar to Hashimoto's thyroiditis, but differs clinically. The disorder presents with a transient period...
Postpartum thyroiditis is a disorder which is morphologically similar to Hashimoto's thyroiditis, but differs clinically. The disorder presents with a transient period of thyrotoxicosis which may be so mild that it is clinically missed. Many of these patients subsequently develop hypothyroidism which also spontaneously resolves. Documentation that the hypothyroidism is transient would be necessary to establish the diagnosis. There is a proclivity for this disorder to develop in the postpartum period. Two patients are presented with this disorder, one with a transient hypermetabolic state and one with a transient hypothyroid state.
Topics: Adult; Diagnosis, Differential; Female; Humans; Hyperthyroidism; Postpartum Period; Pregnancy; Thyroiditis; Thyroiditis, Autoimmune
PubMed: 6893838
DOI: No ID Found -
Australian Prescriber Dec 2017
Review
PubMed: 29375183
DOI: 10.18773/austprescr.2017.075 -
American Family Physician Feb 1984Patients with this syndrome usually have no prior history of thyroid disease. Mild hyperthyroidism is noted one to three months after an uncomplicated delivery and is...
Patients with this syndrome usually have no prior history of thyroid disease. Mild hyperthyroidism is noted one to three months after an uncomplicated delivery and is followed by a brief euthyroid period. Symptomatic hypothyroidism develops three to six months postpartum. The syndrome is self-limited. The hypothyroidism is treated in the usual manner with levothyroxine. This syndrome may be confused with postpartum depression.
Topics: Adult; Diagnosis, Differential; Female; Humans; Postpartum Period; Pregnancy; Syndrome; Thyroiditis; Thyroxine
PubMed: 6702528
DOI: No ID Found -
Maryland Medical Journal (Baltimore,... May 1994
Topics: Diagnosis, Differential; Female; Humans; Puerperal Disorders; Thyroiditis
PubMed: 8052101
DOI: No ID Found -
Frontiers in Endocrinology 2020Postpartum thyroiditis (PPT) has a prevalence of 1-22%, with an ~50% rate of evolution into permanent hypothyroidism (PH). PPT risk is assessed by measuring serum...
Postpartum thyroiditis (PPT) has a prevalence of 1-22%, with an ~50% rate of evolution into permanent hypothyroidism (PH). PPT risk is assessed by measuring serum thyroid antibodies during gestation, as 1/3-1/2 of Ab+ve pregnant women will develop PPT. Family and personal history positive for autoimmune non-thyroid diseases (AINTDT), and consumption of swordfish increases while consumption of small oily fish decreases the risk of PPT. Monitoring thyroid function in a very high-risk subgroup avoids the costs of the Ab-based universal screening. We aimed at identifying such subgroup in 412 women followed from week 7-11 of gestation to month 12 postpartum. At study entry, we measured serum TPOAb, TgAb, TSH, FT4, FT3, and evaluated seafood consumption, familial history for thyroid diseases and AINTD, and personal history for AINTD. We measured TSH, FT4, FT3 at 1.5, 3, 6, and 12 months postpartum. PPT occurred in 63 women (15.3%), and PH in 34/63 (54%). Based on positivity/negativity for the three histories, women were classified into 8 categories, with PPT rates of 3.8-100%. Seafood consumption allowed further separation of subgroups having different PPT risks. We considered 11 possible strategies, termed [a] through [k]. Strategy [a] consisted in omitting gestational screening, while performing universal postpartum monitoring with TSH and one thyroid hormone; strategy [k] consisted in selective gestational screening with TPOAb and TgAb, based on history and fish consumption, and selective postpartum monitoring in TPOAb and/or TgAb+ve women. The 100% sensitivity, specificity and diagnostic accuracy of strategy [a] were counterbalanced by the highest costs (Euro 32,960 or 523 per each PPT caught). The corresponding numbers for strategy [k] were 78, 95, 93%, and Euro 8,920 or 182/PPT caught. These savings stem from gestational screening being done in 186 women, and postpartum monitoring done in 65/186 women. One gestational screning-free strategy was the cheapest (Euro 2,080 or 83/PPT caught), because based on postpartum monitoring of only 26 women, but had the lowest sensitivity (40%). Identification of pregnant women having different risks for PPT is feasible, with the costless evaluation of history and seafood consumption driving gestational screening of thyroid antibody status and postpartum monitoring of thyroid function.
Topics: Adolescent; Adult; Autoantibodies; Biomarkers; Cohort Studies; Female; Follow-Up Studies; Humans; Hypothyroidism; Postpartum Thyroiditis; Pregnancy; Prenatal Diagnosis; Prognosis; Thyroiditis, Autoimmune; Young Adult
PubMed: 32362873
DOI: 10.3389/fendo.2020.00220 -
Gynecological Endocrinology : the... 2016Autoimmune thyroiditis (AIT) is a predisposing factor for developing postpartum thyroid dysfunction (PPTD).
INTRODUCTION
Autoimmune thyroiditis (AIT) is a predisposing factor for developing postpartum thyroid dysfunction (PPTD).
AIM
To study the characteristics of PPTD in women with AIT.
METHODS
Thirty-eight women with pre-existing AIT were included in the study. Thyroid-stimulating hormone, free triiodthyronine, free thyroxine, thyroid peroxidase antibodies, thyroglobulin antibodies were measured and ultrasound evaluation of the thyroid gland was performed in the first trimester of pregnancy and during the first year following delivery.
RESULTS
Thyroid dysfunction was recognized in 68.4% of the patients - 28.9% presented with hypothyroidism and 39.5 % with thyrotoxicosis. The immunological and morphological parameters did not differ between euthyroid women and those with thyroid dysfunction. At the end of the postpartum period restoration of euthyroid state (being on the treatment before pregnancy) was observed in 15.4% of patients with PPTD, while 84.6% required increase of the levothyroxine dose. The analysis found a significantly lower volume of the thyroid gland, shorter duration of the disease, a lower dose of levothyroxine before and during gestation in patients with impaired thyroid function at the end of the postpartum period.
CONCLUSION
The risk of PPTD in women with AIT predating pregnancy is higher among women with preserved thyroid functional capacity motivating a thorough assessment of thyroid hormone levels and close follow-up of those women during the postpartum period.
Topics: Adult; Autoantibodies; Female; Humans; Hypothyroidism; Postpartum Period; Pregnancy; Pregnancy Trimester, First; Thyroglobulin; Thyroid Function Tests; Thyroid Gland; Thyroiditis, Autoimmune; Thyrotoxicosis; Thyrotropin; Thyroxine; Triiodothyronine
PubMed: 26669901
DOI: 10.3109/09513590.2015.1124261 -
Presse Medicale (Paris, France : 1983) Dec 2012This overview of the thyroid autoimmunity in human presents the various facets of a very common pathology. Focus is rather on fundamental than clinical aspects, although... (Review)
Review
This overview of the thyroid autoimmunity in human presents the various facets of a very common pathology. Focus is rather on fundamental than clinical aspects, although some specific clinical situations are discussed. Epidemiology, pathophysiology and pathology of AITD are detailed. One of the peculiarities of AITD is that they express two opposed phenotypes, hypothyroid thyroiditis and hyperthyroid Graves' disease. The latter is characterised by the presence of a unique type of autoantibodies, the anti-TSH receptor antibodies. Those are capable to activate the TSH receptor leading to the gland hypertrophy and hyperfunction. On the contrary, the autoimmune thyroiditis processus progressively and slowly tends to the necrosis/apoptosis of thyroid cells and their functional impairment. Other forms of autoimmune thyroiditis, postpartum thyroiditis and silent thyroiditis are also described. This review, which is not exhaustive, aims at providing a wide scope on the AITD, a basis from which the interested reader or the specialist will be able to find routes towards deeper knowledge.
Topics: Autoantibodies; Autoimmunity; Disease Susceptibility; Humans; Models, Biological; Risk Factors; Thyroid Gland; Thyroiditis, Autoimmune
PubMed: 23164679
DOI: 10.1016/j.lpm.2012.10.002 -
Endocrine May 2024To provide an overview of consequences of undertreatment with levothyroxine (LT4) in the common non-communicable disease, hypothyroidism. (Review)
Review
PURPOSE
To provide an overview of consequences of undertreatment with levothyroxine (LT4) in the common non-communicable disease, hypothyroidism.
METHODS
Narrative review of the literature.
RESULTS
Hypothyroidism is globally very prevalent at all age groups and represents a non-communicable disease in which the risks and consequences are preventable. In children and adolescents, the most devastating consequences of undertreatment are poor growth and development. Lack of early treatment in congenital hypothyroidism can lead to permanent damage of brain function. In young to middle-aged adults, consequences are often overlooked, and treatment delayed by many years. The resulting consequences are also at this age group compromised brain and physical functioning but less severe and partly reversible with treatment. The undertreated condition often results in a higher risk of several secondary devastating diseases such as increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, poor quality of life. In young women of fertile age the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, preeclampsia, compromised fetal growth and neurocognitive development. There is a further risk of 30-50% of developing postpartum thyroiditis. In the elderly population care must be given to avoid confusing a slightly high serum TSH as result of physiological age adaptation with a requirement for LT4 treatment in a truly hypothyroid patient.
CONCLUSION
Undertreatment of the preventable non-communicable disease hypothyroidism requires more focus both from caretakers in the healthcare system, but also from the global political systems in order to prevent the personally devastating and socioeconomically challenging consequences.
Topics: Humans; Hypothyroidism; Thyroxine; Female; Pregnancy; Undertreatment
PubMed: 37556077
DOI: 10.1007/s12020-023-03460-1 -
Psychoneuroendocrinology Aug 1998The term postpartum psychosis refers to a group of severe and heterogeneous disorders with psychotic symptoms that occur most frequently in the context of a mood...
The term postpartum psychosis refers to a group of severe and heterogeneous disorders with psychotic symptoms that occur most frequently in the context of a mood disorder during the postpartum period. We report a case of 'postpartum psychosis' possibly associated with postpartum thyroiditis in a 29 year-old woman. The appearance of psychotic symptoms was chronologically related to the onset of postpartum thyroiditis and resolution of psychosis synchronized with the achievement of biochemical euthyroidism. The patient had typical symptoms of 'classic postpartum psychosis' (a historical term not included in DSM-IV, but used frequently by many physicians to describe diagnostic and therapeutic challenges posed by puerperal psychoses). Three months postpartum, the patient began to believe that she was pregnant with the Christ child, although she was not pregnant. Her delusions resolved around the 'pregnancy' and harm to her 'unborn' child. She also believed that her child (Jesus) was going to be killed. Other key symptoms included hallucinations, mixed mood symptoms, agitation and transient disorientation. Her DSM-IV diagnosis on admission was major depression with psychotic features and her discharge diagnosis (most likely diagnosis) was psychotic disorder due to thyrotoxicosis caused by postpartum thyroiditis. The differential diagnosis of co-occurring psychosis and postpartum thyroiditis can be examined relative to four possibilities: (1) psychosis due to thyrotoxicosis caused by postpartum thyroiditis; (2) a coincidence (no association between psychosis and postpartum thyroiditis); (3) precipitation of psychotic symptoms and disorientation related to a postpartum thyroiditis in a woman with a pre-existing mood disorder; or (4) both psychosis and thyroiditis caused by a pre-existing defect in autoimmunity. The authors stress the importance of early diagnosis and prompt treatment of postpartum psychosis. They discuss the indications for thyroid screening in postpartum psychoses. Further research is needed to clarify the nosology and mechanisms of severe postpartum disorders and to elucidate treatment-relevant and etiologically-distinct subsets of postpartum psychosis.
Topics: Adult; Antithyroid Agents; Female; Humans; Postpartum Period; Pregnancy; Psychiatric Status Rating Scales; Psychotic Disorders; Thyroid Hormones; Thyroiditis
PubMed: 9802134
DOI: 10.1016/s0306-4530(98)00034-1 -
Rays 1999Thyroiditis belongs to a heterogeneous group of inflammatory thyroid diseases. Hashimoto's thyroiditis, has an autoimmune pathogenesis: patients can be euthyroid or... (Review)
Review
Thyroiditis belongs to a heterogeneous group of inflammatory thyroid diseases. Hashimoto's thyroiditis, has an autoimmune pathogenesis: patients can be euthyroid or develop hypothyroidism, but may also experience transient thyrotoxicosis. Silent and postpartum thyroiditis also recognize an autoimmune origin; their clinical course being characterized by transient thyrotoxicosis occurring either sporadically or post-partum. Subacute thyroiditis is a painful, inflammatory disease of viral origin. Acute thyroiditis is a rare, serious, bacterial inflammatory disease. Riedel's thyroiditis is a rare chronic inflammatory disorder of unknown etiology, characterized by dense thyroid fibrosis. A diffuse thyroid hypoechogenicity is the hallmark of Hashimoto's thyroiditis, due to extensive lymphocytic infiltration of the gland. In postpartum and silent thyroiditis a diffuse or multifocal hypoechogenicity is found, while subacute thyroiditis is characterized by multiple ill-defined and migrating hypoechogenic areas. Both in acute and Riedel's thyroiditis there is marked hypoechogenicity.
Topics: Adolescent; Adult; Child; Diagnostic Imaging; Female; Humans; Male; Pregnancy; Pregnancy Complications; Thyroiditis
PubMed: 10509132
DOI: No ID Found