This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Premawardhana, L. D. K. E. Articles by Lazarus, J. H. Search for Related Content PubMed PubMed Citation Articles by Premawardhana, L. D. K. E. Articles by Lazarus, J. H.

Postpartum Thyroiditis and Long-Term Thyroid Status: Prognostic Influence of Thyroid Peroxidase Antibodies and Ultrasound Echogenicity

Departments of Medicine, Medical Biochemistry (R.J.), Blood Transfusion Services (C.D.), and Radiology (H.A.), University of Wales College of Medicine, Cardiff, United Kingdom CF83 2WW

Address all correspondence and requests for reprints to: Dr. L. D. K. E. Premawardhana, Department of Medicine, Caerphilly Miner’s Hospital, St. Martin’s Road, Caerphilly, Mid Glamorgan, United Kingdom CF83 2WW.

Postpartum thyroid dysfunction (PPTD) occurs in 5% of women, with hypothyroidism developing in 23% of these after 3–5 yr. We have determined the prognostic significance of thyroid peroxidase antibody (TPOAb), thyroid ultrasound morphology (U/S), human leukocyte antigen haplotype, and postpartum thyroid status on the development of thyroid dysfunction 77–81 months after PPTD. Ninety-eight TPOAb-positive [48 who had developed PPTD (group 1) and 50 without PPTD (group 2)] and 70 TPOAb-negative (group 3) women (derived from 145 TPOAb-positive and 229 TPOAb-negative cohorts at the index pregnancy), with comparable ages, parity, pregnancies after index pregnancy, and follow-up duration, were studied. Thyroid dysfunction occurred in 46% of group 1 vs. 4% of group 2 (P < 0.001) and 24.5% of groups 1 and 2 vs. 1.4% of group 3 (P < 0.001). Factors predictive of thyroid dysfunction included a hypothyroid form of PPTD, TSH more than 20 mU/L, and higher TPOAb levels (213.8 kIU/L in group 1 vs. 131.8 kIU/L in group 2; P < 0.002) during the postpartum period. Although TPOAb was higher in group 1 than in group 2 at follow-up (166 vs. 97.7 kIU/L; P < 0.03), there was no significant fall in TPOAb levels within either group during the period of follow-up. The prevalence of ultrasound hypoechogenicity was higher in group 1 than in group 2 at follow-up (76% vs. 52%; P < 0.006), but U/S improved in 62.5% of group 1 during the period of follow-up. Human leukocyte antigen DR10 was lower in those who developed late thyroid dysfunction. These data, representing the longest follow-up of PPTD women, clearly show that the hypothyroid form of PPTD, high TPOAb levels, and a hypoechogenic U/S pattern lead to a high risk (relative risk, 32) of long term thyroid dysfunction. This compares with a relative risk of 12.9 for TPOAb- and PPTD-positive women, who remained euthyroid at the end of the first postpartum year, and 2.8 for TPOAb-positive but PPTD-negative women, all compared to TPOAb-negative women. Therefore, long term surveillance of TPOAb- and PPTD-positive women (group 1) is indicated.

This article has been cited by other articles:

				C. Dosiou, G. D Sanders, S. S Araki, and L. M Crapo Screening pregnant women for autoimmune thyroid disease: a cost-effectiveness analysis. Eur. J. Endocrinol., June 1, 2008; 158(6): 841 - 851. [Abstract] [Full Text] [PDF]

				Subsection Reports J. Clin. Endocrinol. Metab., August 1, 2007; 92(8_suppl): s8 - s47. [Full Text] [PDF]

				M. Abalovich, N. Amino, L. A. Barbour, R. H. Cobin, L. J. De Groot, D. Glinoer, S. J. Mandel, and A. Stagnaro-Green Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., August 1, 2007; 92(8_suppl): s1 - s47. [Abstract] [Full Text] [PDF]

				R. Negro, G. Greco, T. Mangieri, A. Pezzarossa, D. Dazzi, and H. Hassan The Influence of Selenium Supplementation on Postpartum Thyroid Status in Pregnant Women with Thyroid Peroxidase Autoantibodies J. Clin. Endocrinol. Metab., April 1, 2007; 92(4): 1263 - 1268. [Abstract] [Full Text] [PDF]

				B. M. Casey and K. J. Leveno Thyroid disease in pregnancy. Obstet. Gynecol., November 1, 2006; 108(5): 1283 - 1292. [Abstract] [Full Text] [PDF]

				L D K E Premawardhana and J H Lazarus Management of thyroid disorders. Postgrad. Med. J., September 1, 2006; 82(971): 552 - 558. [Abstract] [Full Text] [PDF]

				F Azizi The occurrence of permanent thyroid failure in patients with subclinical postpartum thyroiditis Eur. J. Endocrinol., September 1, 2005; 153(3): 367 - 371. [Abstract] [Full Text] [PDF]

				J H Lazarus and L D K E Premawardhana BEST PRACTICE NO 184 Screening for thyroid disease in pregnancy J. Clin. Pathol., May 1, 2005; 58(5): 449 - 452. [Abstract] [Full Text] [PDF]

				E. N. Pearce, A. P. Farwell, and L. E. Braverman Thyroiditis N. Engl. J. Med., June 26, 2003; 348(26): 2646 - 2655. [Full Text] [PDF]

				O.E. Okosieme, A.B. Parkes, B. McCullough, D. Doukidis, B.P. Morgan, C.J. Richards, and J.H. Lazarus Complement activation in postpartum thyroiditis QJM, March 1, 2002; 95(3): 173 - 179. [Abstract] [Full Text] [PDF]

				A. F. Muller, H. A. Drexhage, and A. Berghout Postpartum Thyroiditis and Autoimmune Thyroiditis in Women of Childbearing Age: Recent Insights and Consequences for Antenatal and Postnatal Care Endocr. Rev., October 1, 2001; 22(5): 605 - 630. [Abstract] [Full Text] [PDF]