Thyroid Autoimmuniity in Women with Postpartum Thyroid Dysfunction
Issue: 4/2014
Author: Argatska, Antoaneta V.1, Nonchev, Boyan Iv.1, Orbetzova, Мaria М.1, Pehlivanov,
Blagovest К.2
1 Clinic of Endocrinology and Metabolic Diseases,
2 Clinic of Obstetrics and Gynaecology,
“Sv. Georgy”, University Hospital, Medical University, Plovdiv
Abstract:
Autoimmune thyroid diseases (AITD) occur with increased frequency in the postpartum period. Postpartum thyroid dysfunction (PPTD) is the most common manifestation of AITD during this period but an onset or a recurrence of Graves' disease have also been described. Furthermore, changes in the thyroid function during the first year after parturition are often caused by aggravation of preexisting AITD. The role of the thyroid autoantibodies (TAAb) for the occurrence and development of postpartum thyroid dysfunction remains a matter of discussion.
Aim: To reveal the changes in thyroid autoimmunity in women with PPTD.
Patients and Methods: A total of 42 women with postpartum thyroid dysfunction (16 with hypothyroidism and 26 with thyrotoxicosis) were included in the study. Assessment of TSH, FT4, FT3, TPOAb, TGAb and TSHRAb along with thyroid ultrasound were performed at the 3rd month after parturition.
Results: Positive titers of thyroid autoantibodies were detected in 33 (75,57%) of the studied women. A significant correlation between TSH and TPOAb was found in the group with hypothyroidism. In the women with thyrotoxicosis such correlation was established between THSRAb and FT3 and FT4. TPOAb were significantly higher in the women with a 2nd degree thyroid hypoechogenicity (477,62±72,93 U/l) compared to those with close to normal echogenicity (244,79±81,75 U/l; P=0,049). We did not find considerable differences in the parenchymal echogenicity in terms of TAAb and TSHRAb titers. The assessment of thyroid volume also showedno significant differences in the women with positive and negative autoantibody titers.
Conclusion: PPTD is most often associated with high titers of thyroid autoantibodies. Both hormonal and morphological thyroid changes are more pronounced when the antibody titers are higher. Thyroid abnormalities in the period after parturition require dynamic evaluation and an individualized approach to determine the need for treatment.
Keywords: autoimmune thyroid disease, postpartum thyroiditis, postpartum thyroid dysfunction, hypothyroidism, thyrotoxicosis.
