Postpartum thyroiditis natural history, complications and prognosis: Difference between revisions
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===Natural History=== | ===Natural History=== | ||
*The symptoms of postpartum thyroiditis, PPT usually develop in the | *The symptoms of [[postpartum thyroiditis]], PPT usually develop in the twelve months after devilry , [[abortion]] or [[miscarriage]] of [[fetus]] and start with symptoms depending on clinical course that it follows. | ||
*There are three clinical courses: | *There are three clinical courses: | ||
*Classic triphasic: 25% of patients of PPT come to clinical attention with symptoms of hyperthyroidism starting from sixth postpartum week<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> followed by hypothyroidism around sixth postpartum month and then euthyroidisum by the of 12 months of postpartum .<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> | *Classic triphasic: 25% of patients of PPT come to clinical attention with symptoms of [[hyperthyroidism]] starting from sixth [[postpartum]] week<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> followed by hypothyroidism around sixth postpartum month and then euthyroidisum by the of 12 months of postpartum .<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 develops symptoms of hyperthyroidism followed 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 [[hyperthyroidism]]: 32 % patients of PPT develops symptoms of [[hyperthyroidism]] followed 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 develops symptoms of hypothyroidism followed 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 develops symptoms of [[hypothyroidism]] followed 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 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 positive,HLA-DRW9 and/or HLA-DRB51 <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> , and developed hypothyroid phase of PPT, are at increased risk of developing permanent hypothyroidism.<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> | *Patients who are anti-TPO antibodies positive,HLA-DRW9 and/or HLA-DRB51 <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> , and developed hypothyroid phase of PPT, are at increased risk of developing permanent [[hypothyroidism]].<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=== |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Prognosis is generally good, 25-30% in 3.5 to 8.7-year patients with postpartum thyroiditis PPT develop hypothyroidism.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of postpartum thyroiditis, PPT usually develop in the twelve months after devilry , abortion or miscarriage of fetus and start with symptoms depending on clinical course that it follows.
- There are three clinical courses:
- Classic triphasic: 25% of patients of PPT come to clinical attention with symptoms of hyperthyroidism starting from sixth postpartum week[1] followed by hypothyroidism around sixth postpartum month and then euthyroidisum by the of 12 months of postpartum .[2]
- Biphasic hyperthyroidism: 32 % patients of PPT develops symptoms of hyperthyroidism followed recovery.[2]
- Biphasic hypothyroidism: 43 % patients of PPT develops symptoms of hypothyroidism followed recovery .[2]
- If left untreated, 25-30% of patients with PPT may progress to develop hypothyroidism[3]
- Patients who are anti-TPO antibodies positive,HLA-DRW9 and/or HLA-DRB51 [4] , and developed hypothyroid phase of PPT, are at increased risk of developing permanent hypothyroidism.[5]
Complications
- Common complications of include:
Prognosis
- Prognosis is generally good and 90% of patient recover to normal state after 12 months of postpartum.[10]
- 25-30% in 3.5 to 8.7-year patients with postpartum thyroiditis develop hypothyroidism.
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.
- ↑ 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.